Published: March 22, 2026 · Last updated: April 28, 2026
- Osteoporosis is called a "silent" disease — bone density falls without any symptoms, and many people first learn they have it after a fracture (NIAMS).
- The U.S. Preventive Services Task Force gives a B recommendation for osteoporosis screening in women 65+ and in younger postmenopausal women at increased risk — meaning the evidence supports it strongly enough that insurance must cover it (USPSTF).
- The standard test is a central DEXA scan; the Bone Health and Osteoporosis Foundation recommends every woman 65+ and every man 70+ get one as a baseline (BHOF).
Most people learn about their bone density the worst possible way: they fall, they break a hip, and the X-ray reveals years of progressive thinning that nobody had been tracking. By the time bones break under ordinary loads, the loss has been substantial and ongoing for a long time.
It does not have to work that way. A central DEXA scan — dual-energy X-ray absorptiometry, the standard test for bone density — takes about 15 minutes, uses a small fraction of the radiation of a chest X-ray, and produces a number that tells you exactly where your bones stand. The screening recommendations are clear, the test is widely available, and most insurance covers it. Here is what to know.
Why bones thin invisibly
Bone is living tissue. It constantly remodels — old bone gets broken down and removed by cells called osteoclasts, and new bone gets laid down by cells called osteoblasts. In youth, the rebuild keeps pace with or outpaces the breakdown. After roughly age 30, the balance starts to tilt the other way. After menopause in women (or after about 70 in men), the tilt accelerates.
There are no symptoms during this process — none. The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes osteoporosis as a silent disease for exactly this reason. You do not feel bones thinning. The first symptom is usually a fracture from an event that should not have caused one (a minor fall, a sneeze, lifting groceries).
Risk factors are well-established: female sex, age over 65, postmenopausal status, family history of fracture, low body weight, smoking, excessive alcohol, sedentary lifestyle, certain medications (long-term glucocorticoids in particular), and several medical conditions. The more risk factors, the earlier the screening conversation should happen.
What the screening guidelines actually recommend
The U.S. Preventive Services Task Force gives a B recommendation for osteoporosis screening with bone-density testing in women aged 65 and older to prevent fractures. The same B recommendation applies to postmenopausal women under 65 who are at increased risk based on a formal clinical risk assessment tool (FRAX is the most commonly used).
For men, the USPSTF currently states that the evidence is insufficient to issue a population-level recommendation, while encouraging men concerned about their bone health to talk to their physicians. The Bone Health and Osteoporosis Foundation goes further, recommending all women 65+ and all men 70+ get a baseline DEXA scan, with earlier scans for those with risk factors.
The frequency of repeat scans is risk-tiered: every 2 years for high-risk patients, every 3–5 years for moderate-risk, and every 10–15 years for low-risk.
What a DEXA scan actually tells you
A central DEXA scan measures bone mineral density at the hip and lumbar spine — the two sites where weak bones are most likely to break. The test is non-invasive: you lie on a table, a low-dose X-ray scanner passes over you, and the result is a number called a T-score.
The T-score compares your bone density to that of a healthy young adult. T-score above –1.0 is normal. T-score between –1.0 and –2.5 is osteopenia (low bone mass, increased fracture risk but not yet osteoporosis). T-score at or below –2.5 is osteoporosis. A second number, the Z-score, compares your density to people your own age and helps identify cases where loss is faster than expected.
The Bone Health and Osteoporosis Foundation's framing of the test is that it is used to diagnose osteoporosis BEFORE you break a bone, estimate your fracture risk, and monitor whether treatments are working. Without the scan, none of that information is available — it is invisible until something breaks.
What you can do once you know your number
If your DEXA shows normal density, the goal is to keep what you have. The interventions are well-established: weight-bearing exercise (walking, jogging, resistance training), 1,000–1,200 mg of calcium daily (food first, supplement only if intake falls short), 800–2,000 IU of vitamin D daily, no smoking, and limited alcohol.
If your DEXA shows osteopenia, the same lifestyle measures apply with greater urgency, and your clinician may discuss whether your risk profile warrants medication. If your DEXA shows osteoporosis, medication is usually appropriate (bisphosphonates are first-line for most patients), alongside the same lifestyle interventions and fall-prevention measures.
The most important takeaway: the scan is the entry point. Without it, you do not know which category you are in, which means you cannot match the response to the situation. With it, the path is clear.
To your health,
Ageless CoachTM
Age Strong. Live Long.
Trusted Sources Behind This Article
This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Reading this article does not create a provider-patient relationship. Always consult your physician or qualified healthcare provider before making changes to your diet, exercise, or health routine. Ageless Coach is not liable for any actions taken based on this information.
Frequently Asked Questions
Want one verified-science article like this every week?
Get Better Health, Weekly