Most women should get their first DEXA scan at age 65, and most men at age 70. But dozens of risk factors can move that timeline earlier, sometimes by decades. Knowing where you fall helps you catch bone loss before a fracture forces the conversation.
Standard Screening Ages
The U.S. Preventive Services Task Force recommends routine bone density screening for all women 65 and older. For men, the Endocrine Society recommends screening starting at 70. These are the defaults for people with no major risk factors.
Postmenopausal women younger than 65 qualify for earlier screening if a clinical risk assessment suggests elevated fracture risk. Men between 50 and 69 with risk factors like low body weight, a prior adult fracture, or smoking also qualify for earlier testing. If none of those apply, the standard age thresholds are your starting point.
Risk Factors That Move the Timeline Earlier
A tool called FRAX is widely used to estimate your 10-year fracture probability. It considers seven key risk factors: a prior fragility fracture, a parent who fractured a hip, current smoking, long-term steroid use, excess alcohol intake, rheumatoid arthritis, and other causes of secondary osteoporosis. Your age, sex, and BMI also factor in. If your overall risk score is elevated, your doctor can justify a scan well before the standard screening age.
Several major medical organizations also flag these specific triggers for earlier screening in younger postmenopausal women:
- Personal history of fractures
- Parental history of fracture
- Low body weight (under 127 pounds or a BMI below 21)
- Current smoking
- Excessive alcohol consumption
- Certain medications (covered below)
Medications That Trigger a Scan
Some drugs damage bone fast enough that a baseline DEXA scan is recommended before or shortly after starting treatment. Glucocorticoids (steroids like prednisone) are the biggest culprit. Doses as low as 2.5 mg daily are linked to increased spine fracture risk, and 10 mg daily for more than 90 days leads to a 17-fold increase in vertebral fractures. Guidelines call for a bone density measurement or fracture risk analysis before starting any glucocorticoid course expected to last months.
Aromatase inhibitors, commonly prescribed after breast cancer, also warrant a DEXA scan at the start of therapy. If the scan shows healthy bone, repeat testing every two years monitors for loss. Antiepileptic drugs, hormone-suppressing therapies used in prostate and endometrial cancer, certain diabetes medications, and immune-suppressing drugs used around organ transplant all carry similar screening recommendations. Even SSRIs, when combined with other bone risk factors, may justify a scan.
Medical Conditions That Warrant Screening
Dozens of diseases accelerate bone loss independently of age. Rheumatoid arthritis stands out: roughly one-third of people with RA have osteoporosis, and their fracture rate is nearly double that of the general population. Primary hyperparathyroidism, which typically appears after age 50, directly disrupts calcium balance in bone. Celiac disease causes malabsorption that starves the skeleton of the minerals it needs. Other endocrine disorders, chronic kidney disease, and inflammatory bowel conditions also qualify.
The general rule is that premenopausal women with osteoporosis and men under 50 who present with unexplained fractures or low bone density should be investigated for an underlying medical cause. In those cases, a DEXA scan is part of a broader workup, not a standalone screening test.
Why Menopause Timing Matters So Much
Bone loss isn’t gradual and steady. It accelerates sharply around the final menstrual period. During the late perimenopause transition, women lose 1.8 to 2.3% of their spinal bone density per year and 1.0 to 1.4% at the hip. In the two years immediately after the final period, spinal bone loss can spike to 3.3% annually before settling back to about 1.1% per year in later postmenopausal years.
This surge is why waiting until age 65 may be too late for women with additional risk factors. If you went through menopause early (before 45) or have premature ovarian insufficiency, the clock on bone loss started sooner, and screening should too. A baseline scan around the time of menopause gives you and your doctor a reference point to track changes during the period of fastest loss.
How Often to Repeat a DEXA Scan
Your first scan result determines how soon you need the next one. A large study tracking postmenopausal women found that the interval between a normal baseline and the development of osteoporosis averaged nearly 17 years. For women with mild osteopenia, the timeline was similar, around 17 years. But for moderate osteopenia, the average dropped to under 5 years. For advanced osteopenia, it was just over 1 year.
Based on these findings, practical rescreening intervals look like this:
- Normal or mild osteopenia (T-score above -1.50): Rescreen in about 15 years
- Moderate osteopenia (T-score -1.50 to -1.99): Rescreen in about 5 years
- Advanced osteopenia (T-score -2.00 to -2.49): Rescreen in about 1 year
Women over 80 may need these intervals shortened by roughly one-third. And if you’re on a medication being monitored for bone effects, your doctor may order scans every one to two years regardless of your T-score.
What Your T-Score Means
A DEXA scan compares your bone density to that of a healthy 30-year-old, the age when bones are typically at their strongest. The result is expressed as a T-score. A score of -1 or higher means healthy bone density. Between -1 and -2.5 is osteopenia, a milder form of bone loss that doesn’t always require medication but does require monitoring. A score of -2.5 or lower indicates osteoporosis.
These categories aren’t just labels. They determine your treatment path, your rescreening schedule, and whether certain medications (like steroids or aromatase inhibitors) need to be paired with bone-protective therapy from the start.
What Medicare and Insurance Cover
Medicare Part B covers a bone density measurement once every 24 months for people who meet at least one qualifying condition: estrogen deficiency with osteoporosis risk, X-ray findings suggesting bone loss or vertebral fractures, current or planned prednisone or steroid therapy, a diagnosis of primary hyperparathyroidism, or monitoring to check whether osteoporosis treatment is working. More frequent scans can be covered if deemed medically necessary.
Most private insurers follow similar criteria, tying coverage to age thresholds or documented risk factors. If you’re under 65 and want a scan without a clear medical indication, expect to pay out of pocket, typically $100 to $300 depending on your location and facility.