Most women should get their first bone density test at age 65, even if they feel healthy and have never broken a bone. Women younger than 65 who have gone through menopause should be tested earlier if they have risk factors for osteoporosis, such as early menopause, low body weight, a parent who broke a hip, or long-term steroid use. Premenopausal women generally only need testing when a specific medical reason exists.
As a clinician working in hematology and bone-related medicine, I get this question constantly, often from daughters worried about a mother’s hip fracture. The age cut-off is only the starting point. Below I explain who needs testing earlier, what the scan involves, how to read your results, and how often to repeat it.
What Is a Bone Density Test?
A bone density test measures how much mineral, mainly calcium, is packed into a section of bone. The standard method is a DEXA scan (dual-energy X-ray absorptiometry), which uses two low-dose X-ray beams, usually aimed at the hip and lower spine. These are the sites where osteoporotic fractures cause the most harm and where measurements best predict fracture risk.
The test is used to:
- Diagnose osteoporosis before a fracture happens
- Identify osteopenia, bone density lower than normal but not yet osteoporosis
- Estimate your future fracture risk
- Track whether bone density is stable or responding to treatment
Osteoporosis rarely causes symptoms until a bone breaks, which is why screening matters. Once a hip or spine fracture has occurred, the chance of another one is much higher.
Recommended Screening Ages for Women
Major guidelines broadly agree on the following approach.
| Group | When to test |
|---|---|
| Women 65 and older | Routine screening for all, regardless of risk factors |
| Postmenopausal women under 65 | Screen if risk factors raise fracture risk, often judged with a tool such as FRAX |
| Women going through menopause | Consider testing if there are strong risk factors like low body weight, prior fracture, or high-risk medication |
| Premenopausal women | Only for specific reasons, such as a fracture from minor trauma or a disease or drug known to cause bone loss |
| Any age, after a fragility fracture | Test promptly |
The age-65 threshold exists because bone loss speeds up in the years after menopause as estrogen falls, and fracture risk climbs steeply with age. By 65, enough women have low bone density that testing everyone is worthwhile.
Risk Factors That Mean Testing Earlier
You may need a bone density test before 65 if any of these apply:
- Early menopause: before age 45, including surgical removal of the ovaries
- Family history: a parent who had a hip fracture
- Low body weight: a small, thin frame or significant weight loss
- Previous fracture from a fall from standing height or less
- Medications: long-term glucocorticoids such as prednisone, aromatase inhibitors for breast cancer, some anti-seizure drugs, and excess thyroid hormone
- Medical conditions: rheumatoid arthritis, celiac disease or other malabsorption, overactive thyroid or parathyroid, type 1 diabetes, chronic kidney or liver disease, and eating disorders
- Blood disorders: multiple myeloma and some other marrow conditions can weaken bone, which is one reason hematologists pay attention to bone health
- Lifestyle: smoking, drinking three or more alcoholic drinks a day, and very low physical activity
- Height loss of about 4 cm (1.5 inches) or more, which can signal silent spinal fractures
How to Prepare and What Happens During the Scan
Preparation is simple:
- Stop calcium supplements for 24 hours before the test.
- Tell the clinic if you recently had a barium study or a scan using contrast dye, since these can interfere with results.
- Wear comfortable clothes without metal zippers, buttons, or belts.
- Let staff know if there is any chance you are pregnant.
You lie on a padded table while a scanning arm passes slowly over your hip and lower spine. You need to stay still, but nothing touches you and there is no needle or injection. The scan itself takes just a few minutes, and the whole appointment is usually 10–30 minutes. You can drive and return to normal activity immediately.
The radiation dose is very low, well below that of a standard chest X-ray.
Understanding Your T-Score
Results are reported as a T-score, which compares your bone density with that of a healthy young adult at peak bone mass. The World Health Organization categories are:
| T-score | Category | What it usually means |
|---|---|---|
| -1.0 or higher | Normal | Bone density in the healthy range |
| Between -1.0 and -2.5 | Osteopenia (low bone mass) | Lower than ideal; treatment depends on overall fracture risk |
| -2.5 or lower | Osteoporosis | Treatment usually recommended |
Premenopausal women receive a Z-score instead, which compares you with people of your own age and sex. A low Z-score suggests something other than aging may be causing bone loss and deserves investigation.
Your doctor may combine your result with other risk factors in a tool such as FRAX to estimate your 10-year chance of a major fracture. That estimate, not the T-score alone, often decides whether medication is needed.
How Often Should You Repeat the Test?
There is no single interval that suits everyone:
- With normal or only mildly low results, repeat scans are usually spaced several years apart.
- With osteopenia closer to the osteoporosis range, testing is typically sooner.
- If you start osteoporosis medication, a follow-up scan is often done about 1–2 years later to check the response.
Ideally, have repeat scans on the same machine, since results can vary slightly between devices. Our osteoporosis guide explains the treatment options if your result is low.
Key Takeaways
- All women should have a bone density test by age 65.
- Postmenopausal women under 65 with risk factors should be tested earlier.
- A DEXA scan is quick, painless, and uses very little radiation.
- A T-score of -2.5 or lower indicates osteoporosis; between -1.0 and -2.5 indicates osteopenia.
- Repeat testing depends on your result and whether you are on treatment.
Frequently Asked Questions
Should I get a bone density test at 50?
Only if you are postmenopausal and have risk factors such as early menopause, low body weight, steroid use, or a parent with a hip fracture. Otherwise, routine screening starts at 65. Ask your doctor to assess your risk.
Does insurance cover a bone density test?
Coverage varies by country and plan. Screening for women 65 and older, and for younger women with documented risk factors, is commonly covered. Check with your insurer about repeat testing intervals.
Can I get a bone density test before menopause?
Yes, but only when there is a clear reason, such as a fracture from minor trauma, a condition that causes bone loss, or a medication known to thin bones. Routine screening is not recommended for healthy premenopausal women.
Is a heel ultrasound the same as a DEXA scan?
No. Heel ultrasound devices found at health fairs can suggest who needs further testing, but they cannot diagnose osteoporosis or monitor treatment. A DEXA scan of the hip and spine remains the standard.
