For women at average risk, the standard recommendation is to get your first DEXA scan at age 65. For men, it’s age 70. But if you have certain risk factors, screening can start much earlier, sometimes as young as 40. The right time depends on your sex, menopause status, medications, and personal risk profile.
Standard Screening Ages
The U.S. Preventive Services Task Force recommends routine bone density screening for all women 65 and older, regardless of risk factors. For men, major medical organizations recommend starting at 70. These ages reflect the point where bone loss has progressed enough in the general population that catching osteoporosis early can prevent fractures.
Women lose bone faster than men because of the sharp drop in estrogen during menopause. Some women lose an average of 25% of their bone mass between menopause and age 60, according to data from Weill Cornell Medicine. That rapid decline is why screening guidelines are more aggressive for women and kick in five years earlier.
Why Some People Should Start Before 65
Postmenopausal women younger than 65 should get screened if they have one or more risk factors for osteoporosis and their estimated fracture risk crosses a certain threshold. Specifically, if an online fracture risk calculator (called FRAX) puts your 10-year risk of a major osteoporotic fracture above 8.4%, screening is recommended even in your 50s or early 60s.
The risk factors that can trigger earlier screening include:
- Body size: weighing under 127 pounds or having a BMI below 20
- Family history: a parent who had a hip or spine fracture
- Smoking or heavy alcohol use (three or more drinks per day)
- Early menopause, whether from natural causes or surgery
- Certain medical conditions: rheumatoid arthritis, chronic kidney disease, type 1 or type 2 diabetes, hyperparathyroidism, anorexia nervosa, HIV, Turner syndrome, or primary ovarian insufficiency
- Prior fracture after age 50, particularly from a low-impact fall
- Ethnicity: Asian or Northern European descent carries higher risk
- Vitamin D deficiency or chronically low calcium intake
UCSF’s radiology department notes that some of these factors can justify screening as early as age 40 for certain candidates, particularly young female athletes with disrupted menstrual cycles or people with a history of eating disorders.
Medications That Warrant Earlier Scanning
Several common drug classes weaken bones over time, and guidelines recommend getting a baseline DEXA scan before or shortly after starting them. The most well-known are corticosteroids like prednisone. Taking them daily for three months or more significantly raises fracture risk, and most guidelines call for a bone density measurement before you even begin the course.
Other medications that should prompt a DEXA conversation with your doctor:
- Aromatase inhibitors, used in breast cancer treatment. Guidelines recommend a DEXA for all women starting these drugs.
- Hormone-blocking therapies for prostate cancer (androgen deprivation therapy or GnRH agonists)
- Anti-seizure medications, especially with long-term use
- Certain diabetes medications in the thiazolidinedione class
- Proton pump inhibitors for acid reflux, SSRIs for depression, the injectable birth control shot, blood thinners like heparin, antiretrovirals for HIV, and some chemotherapy drugs
If you’re on any of these medications and haven’t discussed bone health with your provider, it’s worth bringing up. Age becomes less relevant when a drug is actively pulling minerals from your skeleton.
What Your Results Mean
A DEXA scan measures bone mineral density and reports it as a T-score, which compares your bones to those of a healthy 30-year-old. The scale works like this:
- T-score of -1 or higher: healthy bone density
- T-score between -1 and -2.5: osteopenia (mild to moderate bone loss, not yet osteoporosis)
- T-score of -2.5 or lower: osteoporosis
Your T-score doesn’t just tell you where you stand today. It also determines how soon you’ll need a follow-up scan, which matters because unnecessary repeat scans are common.
How Often to Repeat the Scan
One of the most practical findings in bone health research is that not everyone needs a DEXA every two years. A large study tracking postmenopausal women found that the time it takes to progress from healthy bone density to osteoporosis varies enormously based on your starting point.
For women with normal bone density or only mild osteopenia (T-score above -1.50), it took an average of nearly 17 years to develop osteoporosis. That means a 15-year gap between scans is reasonable for this group. For moderate osteopenia (T-score between -1.50 and -1.99), rescreening every 5 years makes sense. For advanced osteopenia (T-score between -2.0 and -2.49), annual scans are appropriate because the transition to osteoporosis can happen in just over a year.
Women over 80 lose bone faster, so reducing these intervals by about a third is reasonable. A woman in her 80s with moderate osteopenia, for example, might benefit from rescreening every 3 to 4 years instead of 5.
Men and Bone Density Screening
Men are often left out of the osteoporosis conversation, but one in four men over 50 will break a bone due to osteoporosis in their lifetime. The standard starting age of 70 applies to men at average risk. Men younger than 70 should get a DEXA if they have low body weight, a prior fracture, long-term corticosteroid use, or are on androgen deprivation therapy for prostate cancer. Heavy drinking, smoking, and chronic kidney disease also move up the timeline.