Yes, men get DEXA scans, though screening guidelines for men are less straightforward than for women. While women are routinely screened at age 65, the U.S. Preventive Services Task Force has not issued a firm recommendation for or against routine osteoporosis screening in men, citing insufficient evidence. Several major medical organizations, however, recommend that men start routine screening at age 70, and many men with specific risk factors should be screened much earlier.
When Men Should Get a DEXA Scan
The simplest threshold: if you’re a man over 70, most guidelines recommend a baseline DEXA scan regardless of symptoms. Osteoporosis produces no warning signs until a bone breaks, so screening is the only way to catch it early.
For men younger than 70, a DEXA scan is warranted when specific risk factors are present. These include a history of a fracture from minimal trauma (a fragility fracture), long-term use of corticosteroids (even low doses of prednisone), low testosterone, a parent who fractured a hip, current smoking, excessive alcohol use, low body weight, a recent history of falls, and chronic conditions like diabetes, rheumatoid arthritis, or COPD. Men under 50 who have had a fragility fracture or show signs of low bone density on an X-ray should also be evaluated.
Why Osteoporosis in Men Is Underdiagnosed
Osteoporosis is often framed as a women’s health issue, which leads many men and their doctors to overlook it. But the consequences for men are actually worse. One-year mortality after a hip fracture is 37.1% in men compared to 26.4% in women. Men who fracture a hip are significantly less likely to survive the following year, partly because they tend to be diagnosed later, when bone loss is more advanced, and partly because they’re less likely to receive treatment afterward.
Because the USPSTF hasn’t made a definitive screening recommendation for men, there’s no universal prompt built into routine care the way there is for women at 65. The task force encourages men and their clinicians to make a shared decision about whether screening makes sense given individual risk factors.
Health Conditions and Medications That Increase Risk
A surprisingly long list of medical conditions can cause bone loss in men. Endocrine problems like low testosterone (hypogonadism), hyperparathyroidism, and diabetes all weaken bones. Gastrointestinal conditions, including celiac disease, inflammatory bowel disease, and chronic liver disease, impair the absorption of calcium and other nutrients essential for bone health. Men who’ve had bariatric surgery face the same issue.
Certain medications are also culprits. Glucocorticoids are the most well-known, and bone loss can begin at doses as low as 2.5 mg of prednisone per day, including inhaled corticosteroids used for asthma. Antiepileptic drugs, some antidepressants (SSRIs), proton pump inhibitors used for acid reflux, and certain diabetes medications have all been linked to increased bone loss. Men receiving androgen deprivation therapy for prostate cancer face a particularly high risk and should have a baseline DEXA scan.
HIV infection and its treatments also increase the risk, and baseline bone density testing is recommended for these patients.
How the Results Are Interpreted for Men
DEXA scan results are reported as a T-score, which compares your bone density to a young, healthy reference point. A T-score of negative 1.0 or above is normal. Between negative 1.0 and negative 2.5 indicates osteopenia (lower-than-normal bone density). A T-score at or below negative 2.5 means osteoporosis.
One detail that surprises many people: men’s T-scores are calculated using a female reference database, not a male one. The International Society for Clinical Densitometry endorsed this approach in 2013, reasoning that fracture risk at a given bone density level is similar between the sexes. This means a man and a woman with the same T-score face roughly comparable fracture risk, even though men generally start with denser bones. Using a male reference database would shift some men’s scores and potentially change their diagnosis. For example, a 55-year-old man might have a T-score of negative 2.2 on the female reference (osteopenia) but negative 2.5 on a male reference (osteoporosis).
The FRAX Tool and Treatment Decisions
A T-score alone doesn’t always determine whether treatment is needed. Doctors often use a calculator called FRAX, which estimates your 10-year probability of a major fracture or a hip fracture. It factors in age, sex, BMI, and seven yes-or-no risk factors: prior fragility fracture, parental hip fracture, current smoking, glucocorticoid use, excess alcohol intake, rheumatoid arthritis, and other causes of secondary osteoporosis. Bone density from a DEXA scan can be entered into FRAX but isn’t required.
Current international guidelines recommend that all men who’ve already had a fragility fracture should be considered for medication. For other men, treatment thresholds are age-dependent and based on FRAX results. First-line treatments are typically oral medications that slow bone breakdown, with injectable options available as second-line therapy. Men at very high fracture risk may be started on a bone-building medication first, followed by a medication that preserves the gains.
Does Insurance Cover DEXA Scans for Men?
Medicare Part B covers bone density testing once every 24 months if you meet at least one qualifying condition: X-rays suggesting osteoporosis or vertebral fractures, current or planned steroid therapy, a diagnosis of primary hyperparathyroidism, or monitoring of existing osteoporosis treatment. More frequent scans are covered when medically necessary. Private insurers generally follow similar criteria, though coverage varies by plan. If you have a documented risk factor, your scan is more likely to be covered without issue.
Body Composition Scans Are Different
Some men encounter DEXA scans in a completely different context: body composition testing. Fitness-focused DEXA scans measure body fat percentage, lean muscle mass, fat mass, and visceral fat (the deep abdominal fat surrounding organs). These scans use the same machine but serve a different purpose and are almost never covered by insurance. They’re popular among athletes and people tracking fitness progress, and they typically cost $75 to $200 out of pocket. The bone density scan your doctor orders is specifically evaluating fracture risk, not body composition.
How to Prepare for a DEXA Scan
The scan itself is quick and painless, usually lasting 10 to 20 minutes. You lie on a padded table while a low-dose X-ray arm passes over your body, typically scanning the hip and lower spine. Radiation exposure is minimal, far less than a standard chest X-ray.
A few preparation steps matter. Stop taking calcium supplements at least 24 hours before the test, since calcium tablets in your digestive tract can skew readings. Wear loose clothing without metal zippers, belts, or buttons, and leave jewelry at home. If you’ve recently had a barium study, a CT scan with contrast dye, or a nuclear medicine test, let your doctor know beforehand. Contrast materials can linger in your body and interfere with accurate bone density measurement, so your scan may need to be rescheduled.