Most women should start routine bone density screening at age 65, and most men at age 70. But several common risk factors can move that timeline earlier, sometimes by a decade or more. Knowing where you fall helps you get tested at the right time, not too early and not too late.
Standard Screening Ages for Women
The U.S. Preventive Services Task Force recommends routine bone density screening for all women aged 65 and older, regardless of risk factors. For women between 60 and 64 who have an increased risk of fractures, screening should begin at 60. Below age 60, there’s no blanket recommendation for postmenopausal women unless specific risk factors are present.
The single strongest predictor of low bone density in women is low body weight. Weighing under about 154 pounds (70 kg) meaningfully raises your odds of bone loss. A simple screening tool called the ORAI combines your age, weight, and whether you use hormone replacement therapy to flag risk, and it catches 94% of women who actually have low bone density.
For younger postmenopausal women who don’t meet the age threshold, the National Osteoporosis Foundation recommends testing if you’ve already had a fracture or if you carry one or more risk factors for osteoporosis. That means screening isn’t just about age. It’s about your individual profile.
When Men Should Be Tested
Men lose bone more slowly than women, so routine screening starts later. The Endocrine Society recommends bone density testing for all men aged 70 and older. Men between 50 and 69 should be tested if they have risk factors like low body weight, a fracture during adulthood, or a history of smoking. Because osteoporosis in men is underdiagnosed, many who would benefit from early screening never receive it.
Risk Factors That Move Screening Earlier
Several factors can justify a bone density scan well before the standard age thresholds. These apply to both men and women:
- Low body weight or BMI. Weighing under 60 kg (about 132 pounds) is one of the highest-scoring risk factors in fracture prediction tools. Even a BMI around 25 in a 65-year-old woman carries a measurable 10-year fracture risk.
- Parental history of hip fracture. A parent who broke a hip significantly raises your own fracture probability, independent of your bone density.
- Smoking. Current and past smoking accelerates bone loss. The interaction between smoking and age compounds risk over time.
- Excess alcohol consumption. Regular heavy drinking weakens bone remodeling and increases fall risk.
- Early menopause. Women who went through menopause before age 45 lose the protective effect of estrogen earlier, which means more years of accelerated bone loss by the time they reach their 60s.
- Prior fracture as an adult. A broken bone after age 50 from a low-impact event (like falling from standing height) is itself a strong indicator of weakened bone.
If you have multiple risk factors, your doctor can estimate your 10-year fracture probability using a tool called FRAX. A 10-year risk of major osteoporotic fracture at or above 20%, or a hip fracture risk at or above 3%, is the threshold where treatment is typically recommended.
Medications That Trigger Immediate Screening
Certain medications cause bone loss rapidly enough that screening should happen as soon as treatment begins, not years later.
Oral corticosteroids (like prednisone) are the most common culprit. If you’re taking 5 mg or more per day and expect to continue for three months or longer, guidelines recommend a bone density assessment right away. Bone loss from steroids is fastest in the first few months of use, which is why waiting for a routine screening age doesn’t make sense in this situation.
Cancer treatments also warrant earlier and more frequent monitoring. Women with breast cancer starting aromatase inhibitors should have a baseline bone density scan before or at the start of treatment, with repeat scans every one to two years. These drugs lower estrogen levels dramatically, which accelerates bone thinning. Men on androgen deprivation therapy for prostate cancer face a similar pattern of rapid bone loss and need comparable monitoring.
Chronic Conditions That Warrant Earlier Testing
Rheumatoid arthritis is a notable driver of bone loss, both from the disease itself and from the corticosteroids often used to manage it. Because rheumatoid arthritis frequently affects people in their 30s to 50s, bone density testing may be appropriate decades before the standard screening age. For patients in this younger age group, the International Society for Clinical Densitometry recommends a scan of the lumbar spine specifically.
Other conditions that impair nutrient absorption, like celiac disease, Crohn’s disease, and inflammatory bowel disease, also weaken bones over time. If your body can’t properly absorb calcium and vitamin D from food, your bones don’t get the raw materials they need to stay dense. Anyone with a known malabsorption condition should discuss early screening with their provider rather than waiting for age-based guidelines to kick in.
What Your Results Mean
Bone density is measured with a DXA scan, a quick, painless X-ray of your hip and spine that takes about 10 to 15 minutes. The result is reported as a T-score, which compares your bone density to that of a healthy 30-year-old.
- T-score of -1.0 or higher: Normal, healthy bone density.
- T-score between -1.0 and -2.5: Osteopenia, meaning bone density is lower than normal but not yet in the osteoporosis range.
- T-score of -2.5 or lower: Osteoporosis.
Your T-score also determines how often you need to be rescreened. If your first scan shows normal density or only mild thinning (T-score above -1.5), you likely won’t need another scan for about 15 years. Moderate osteopenia (T-score between -1.5 and -2.0) calls for rescreening in about 5 years. Advanced osteopenia (T-score between -2.0 and -2.5) should be rechecked within a year. For women over 80, these intervals should be shortened by roughly one-third.
Using FRAX Before a Scan
You don’t necessarily need a DXA scan to get an initial sense of your fracture risk. The FRAX tool, available free online, estimates your 10-year probability of a major fracture using inputs like age, sex, weight, smoking status, alcohol use, and whether you’ve had a prior fracture or a parent with a hip fracture. It can be run with or without a bone density measurement.
In some screening approaches, a FRAX score at or above 15% triggers a DXA scan to get a precise measurement. If the DXA then confirms osteoporosis, treatment begins. This two-step process avoids unnecessary scans in lower-risk individuals while catching those who genuinely need intervention. A large trial using this strategy found it effectively identified women who benefited from treatment, making it a practical option for people unsure whether they’ve reached the point where a scan makes sense.