What Age Should You Get a Bone Density Test? A Guide to DEXA Screening

What does a bone density test measure?

A bone density test — most commonly a DEXA scan (Dual-energy X-ray Absorptiometry) — measures the mineral content in your bones, typically at the hip and spine. Results are reported as a T-score comparing your bone density to a healthy young adult at peak bone mass 2Ref 2National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Bone Mineral Density Tests: What the Numbers Mean.T-score thresholds: -1 or higher is healthy; -1 to -2.5 is osteopenia; -2.5 or lower indicates possible osteoporosis; fracture risk increases 1.5 to 2 times per 1-point drop in T-score.

• T-score at or above -1.0: Normal bone density
• T-score between -1.0 and -2.5: Low bone density (osteopenia) — not yet osteoporosis, but a stage where action can slow further loss. The risk of fracture increases by 1.5 to 2 times with each 1-point drop in T-score 2Ref 2National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Bone Mineral Density Tests: What the Numbers Mean.T-score thresholds: -1 or higher is healthy; -1 to -2.5 is osteopenia; -2.5 or lower indicates possible osteoporosis; fracture risk increases 1.5 to 2 times per 1-point drop in T-score.
• T-score at or below -2.5: Osteoporosis — significantly increased fracture risk 2Ref 2National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Bone Mineral Density Tests: What the Numbers Mean.T-score thresholds: -1 or higher is healthy; -1 to -2.5 is osteopenia; -2.5 or lower indicates possible osteoporosis; fracture risk increases 1.5 to 2 times per 1-point drop in T-score

The scan is quick (typically 10–20 minutes), requires no injection or special preparation, and delivers a very small radiation dose — far less than a standard chest X-ray.

Who should be screened, and when?

Women age 65 and older: The USPSTF recommends routine bone density testing starting at 65, regardless of other risk factors, with a Grade B recommendation 1Ref 1US Preventive Services Task Force (2018).Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement.Grade B recommendation for routine bone density screening starting at age 65 for women; earlier screening for postmenopausal women under 65 with risk factors; FRAX as a recommended risk assessment tool; insufficient evidence for routine screening of men.

Women under 65 with risk factors: Earlier testing may be appropriate if you have any of the following: - Early menopause (before age 45) - A history of fracture from minor trauma - Long-term use of corticosteroids or other bone-affecting medications 4Ref 4Humphrey MB, Russell L, Danila MI, et al. (2023).2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Baseline bone density testing recommended for patients starting long-term glucocorticoid therapy; risk stratification by FRAX and T-score; glucocorticoid use as a leading medication-related cause of bone loss - Low body weight - A parent who had a hip fracture - Conditions linked to bone loss: rheumatoid arthritis, inflammatory bowel disease, celiac disease, eating disorders, or thyroid/parathyroid disorders 3Ref 3National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Osteoporosis: Risk Factors, Symptoms, and Diagnosis.Risk factors for osteoporosis including sex, age, body size, family history, smoking, heavy alcohol use, thyroid conditions, and low testosterone in men; note that men are less likely to be evaluated after a fracture

Men: Population-wide screening for men does not carry a universal recommendation comparable to women — the USPSTF found insufficient evidence to assess the balance of benefits and harms in men 1Ref 1US Preventive Services Task Force (2018).Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement.Grade B recommendation for routine bone density screening starting at age 65 for women; earlier screening for postmenopausal women under 65 with risk factors; FRAX as a recommended risk assessment tool; insufficient evidence for routine screening of men. However, men with significant risk factors — low-trauma fractures, low testosterone, long-term steroid use, or heavy alcohol use — are often candidates, and many clinicians consider screening around age 70 3Ref 3National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Osteoporosis: Risk Factors, Symptoms, and Diagnosis.Risk factors for osteoporosis including sex, age, body size, family history, smoking, heavy alcohol use, thyroid conditions, and low testosterone in men; note that men are less likely to be evaluated after a fracture.

Anyone on long-term corticosteroids: Chronic use of prednisone and similar drugs is one of the strongest known drivers of medication-related bone loss. The American College of Rheumatology recommends baseline bone density testing for patients starting long-term glucocorticoid therapy 4Ref 4Humphrey MB, Russell L, Danila MI, et al. (2023).2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Baseline bone density testing recommended for patients starting long-term glucocorticoid therapy; risk stratification by FRAX and T-score; glucocorticoid use as a leading medication-related cause of bone loss.

What risk factors matter most?

Bone loss is slow and silent. Understanding your risk helps you and your clinician decide when to screen 1Ref 1US Preventive Services Task Force (2018).Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement.Grade B recommendation for routine bone density screening starting at age 65 for women; earlier screening for postmenopausal women under 65 with risk factors; FRAX as a recommended risk assessment tool; insufficient evidence for routine screening of men3Ref 3National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Osteoporosis: Risk Factors, Symptoms, and Diagnosis.Risk factors for osteoporosis including sex, age, body size, family history, smoking, heavy alcohol use, thyroid conditions, and low testosterone in men; note that men are less likely to be evaluated after a fracture:

• Female sex — women lose bone faster, especially after menopause as estrogen drops
• Smaller body frame — less bone mass in reserve means the same rate of loss has more impact
• Family history — a parent with a hip fracture roughly doubles your own risk
• Low calcium or vitamin D intake — both are essential for bone formation and maintenance 5Ref 5National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Calcium and Vitamin D: Important for Bone Health.Adequate calcium and vitamin D essential for bone health; weight-bearing exercise such as walking helps build and maintain bone; insufficient intake raises osteoporosis and fracture risk
• Physical inactivity — weight-bearing exercise maintains bone density; sedentary habits accelerate loss 5Ref 5National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Calcium and Vitamin D: Important for Bone Health.Adequate calcium and vitamin D essential for bone health; weight-bearing exercise such as walking helps build and maintain bone; insufficient intake raises osteoporosis and fracture risk
• Smoking — directly impairs bone cell activity 3Ref 3National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Osteoporosis: Risk Factors, Symptoms, and Diagnosis.Risk factors for osteoporosis including sex, age, body size, family history, smoking, heavy alcohol use, thyroid conditions, and low testosterone in men; note that men are less likely to be evaluated after a fracture
• Heavy alcohol use — interferes with calcium absorption and bone maintenance 3Ref 3National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Osteoporosis: Risk Factors, Symptoms, and Diagnosis.Risk factors for osteoporosis including sex, age, body size, family history, smoking, heavy alcohol use, thyroid conditions, and low testosterone in men; note that men are less likely to be evaluated after a fracture
• Long-term steroid use — the most common medication-related cause 4Ref 4Humphrey MB, Russell L, Danila MI, et al. (2023).2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Baseline bone density testing recommended for patients starting long-term glucocorticoid therapy; risk stratification by FRAX and T-score; glucocorticoid use as a leading medication-related cause of bone loss
• Low estrogen or testosterone — whether from menopause, surgical removal of the ovaries, or hypogonadism in men
• Certain medical conditions — hyperthyroidism, hyperparathyroidism, chronic kidney disease, malabsorption syndromes

What do the results mean, and what happens next?

Normal results: Your clinician will typically recommend repeat testing in several years, depending on your risk level. In the meantime, adequate calcium and vitamin D 5Ref 5National Institute of Arthritis and Musculoskeletal and Skin Diseases (2023).Calcium and Vitamin D: Important for Bone Health.Adequate calcium and vitamin D essential for bone health; weight-bearing exercise such as walking helps build and maintain bone; insufficient intake raises osteoporosis and fracture risk, regular weight-bearing exercise, not smoking, and limiting alcohol all help preserve bone.

Osteopenia (low bone density): This is a stage to take seriously but not panic over. Lifestyle changes can meaningfully slow bone loss. Your clinician may use the FRAX fracture risk assessment tool to estimate your 10-year fracture probability and decide whether medication is warranted in addition to lifestyle measures 1Ref 1US Preventive Services Task Force (2018).Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement.Grade B recommendation for routine bone density screening starting at age 65 for women; earlier screening for postmenopausal women under 65 with risk factors; FRAX as a recommended risk assessment tool; insufficient evidence for routine screening of men.

Osteoporosis: Several effective drug classes exist. Your clinician will likely recommend medication alongside calcium, vitamin D, fall prevention strategies, and possibly a referral to a rheumatologist or endocrinologist. Treatment substantially reduces fracture risk — a DEXA result is a guide to action, not a fixed outcome.

DEXA scans for eligible women aged 65 and older are typically covered under Medicare and most ACA-compliant plans. Coverage for younger women and men varies by plan and clinical indication.