Most women should get their first bone density test at age 65. If you’ve gone through menopause early or have certain risk factors, screening may start as young as your 40s or 50s. These recommendations come from the U.S. Preventive Services Task Force, which gives bone density screening a “B” grade for both groups, meaning there’s strong evidence it helps prevent fractures.
The Standard Screening Age
For women with no major risk factors and who went through menopause around the typical age (late 40s to early 50s), the recommended starting point for screening is 65. At this age, bone loss has progressed enough that a scan can reliably identify women who would benefit from treatment. The recommendation applies to women who haven’t already been diagnosed with osteoporosis and haven’t had a fragility fracture (a break caused by a fall from standing height or less).
When You Should Be Tested Earlier
Postmenopausal women younger than 65 who have even one risk factor for osteoporosis should talk to their provider about screening sooner. For some women, that means testing as early as 40. The most significant risk factors include:
- Early menopause. Whether it happened naturally or through surgery (such as having your ovaries removed), losing estrogen’s bone-protective effects ahead of schedule accelerates bone loss. Women who become postmenopausal in their 40s may need screening by age 50.
- Low body weight or a history of eating disorders. A low BMI is one of the strongest predictors of low bone density.
- Family history of osteoporosis. A parent who had osteoporosis, especially a mother who broke a hip, raises your risk substantially.
- Long-term steroid use. Taking corticosteroids like prednisone daily for three months or more weakens bone. Guidelines recommend a bone density scan before starting long-term steroids whenever possible.
- Certain medications. Aromatase inhibitors used for breast cancer treatment lower estrogen levels beyond what menopause alone causes, accelerating bone loss. Screening is recommended for all women starting these drugs. Other medications linked to bone loss include certain antidepressants, anti-seizure drugs, long-term acid reflux medications, and some blood thinners.
- Smoking or heavy alcohol use. Three or more drinks per day over a long period increases fracture risk.
- Specific health conditions. Rheumatoid arthritis, chronic kidney disease, and a history of hormone treatment for breast or prostate cancer all raise osteoporosis risk.
- Ethnicity. Women of Asian or Northern European descent have a higher baseline risk.
- Breaking a bone after age 50. Any fracture from a minor fall or impact warrants screening regardless of age.
How Your Doctor Decides If You Need Early Screening
For women under 65, doctors often use a tool called FRAX to estimate your 10-year probability of breaking a bone. It factors in your age, weight, smoking status, alcohol use, fracture history, family history, and other variables. In the U.S., a 10-year risk of 20% or higher for a major fracture (or 3% or higher for a hip fracture specifically) is the threshold that triggers a recommendation for a scan or treatment. Your doctor can run this calculation in a few minutes using information from your medical history alone.
What the Test Involves
A bone density test, called a DEXA scan, is painless and noninvasive. You lie on a padded table while a low-dose X-ray arm passes over your body, typically scanning your hips and spine. The whole process takes about 30 minutes. There’s no injection, no fasting, and no need to undress beyond removing anything with metal. The one preparation step: skip calcium supplements and certain vitamins for 24 hours before the test.
Understanding Your Results
Your results come back as a T-score, which compares your bone density to that of a healthy 30-year-old woman at peak bone mass. A T-score of negative 1 or higher is normal. Between negative 1 and negative 2.5 is classified as osteopenia, meaning your bones are thinner than normal but not yet in the osteoporosis range. A T-score of negative 2.5 or lower indicates osteoporosis.
Osteopenia isn’t a diagnosis that automatically requires medication. It’s a signal to pay attention to calcium and vitamin D intake, weight-bearing exercise, and other modifiable risk factors. Whether treatment is needed depends on your overall fracture risk, not just the number alone.
How Often to Repeat the Test
Your first T-score determines how soon you’ll need another scan. Because the technology can’t reliably detect small changes, repeat scans are spaced at least two years apart. Beyond that minimum, the interval depends on your results:
- T-score higher than negative 1.5 with no new risk factors: You may not need another scan for 10 years.
- T-score between negative 1.5 and negative 1.9: A repeat scan in about 5 years is reasonable.
- T-score between negative 2.0 and negative 2.4: Rescreening in 2 years helps catch progression before it crosses into osteoporosis.
- T-score of negative 2.5 or lower (osteoporosis): If you start treatment, a follow-up scan in about 5 years can assess whether the medication is working. Without treatment, scans every 2 years help monitor the situation.
If your health changes significantly between scans, such as starting a medication known to affect bone or developing a new condition, your provider may recommend rescreening sooner regardless of your last T-score.
Insurance and Medicare Coverage
Medicare Part B covers bone density tests once every 24 months for women whose doctor determines they are estrogen-deficient and at risk for osteoporosis. More frequent testing may be covered when medically necessary. Most private insurance plans follow similar criteria, covering screening at 65 for average-risk women and earlier for those with documented risk factors. If you’re unsure about coverage, your provider’s office can typically verify eligibility before scheduling the scan.