Learn About Bone Density Testing by Age and Risk

Understanding Bone Density and Why It Matters

Bone density refers to the amount of mineral content in your bones, typically measured in grams per square centimeter. Your bones are living tissue that constantly break down and rebuild throughout your life. When you're younger, new bone is added faster than old bone is removed, which increases bone mass. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more bone mass than you gain.

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Bone density testing, also called a DXA scan or DEXA scan (dual-energy x-ray absorptiometry), measures how tightly packed the minerals are in your bones. This test takes pictures of your skeleton and compares your bone density to that of a healthy young adult. The test produces a score that indicates whether your bones are strong, weak, or somewhere in between.

Understanding your bone density matters because weak bones can break easily from minor falls or injuries. This condition, called osteoporosis, affects about 10 million Americans—about 1 in 3 women over age 70 and 1 in 5 men over age 70. Another condition called osteopenia means your bones are weaker than normal but not yet at the level of osteoporosis. Both conditions can develop without any symptoms or pain, which is why testing can provide valuable information about your bone health.

Several factors influence bone density throughout your life. Women lose bone density more rapidly after menopause due to lower estrogen levels. Men typically maintain better bone density longer but can develop osteoporosis as they age. Other factors include family history, body weight, physical activity level, calcium and vitamin D intake, and certain medications like corticosteroids. Racial and ethnic background also plays a role—white and Asian women have higher osteoporosis rates than Black and Hispanic women, though this doesn't mean other groups are risk-free.

Practical takeaway: Bone density isn't something you can feel or assess on your own. Testing is the only way to know your actual bone density and understand your fracture risk. Knowing this information allows you and your healthcare provider to discuss whether preventive steps or treatment might be appropriate for you.

Bone Density Testing Guidelines by Age and Gender

Medical organizations provide recommendations about when bone density testing should be considered for different age groups. The National Osteoporosis Foundation and the U.S. Preventive Services Task Force offer guidance based on research about when testing is most valuable. These guidelines focus on identifying people at higher risk before serious problems develop.

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Women: Testing is recommended for all women age 65 and older, regardless of risk factors. For women between ages 50 and 64, testing may be considered if they have risk factors such as low body weight, family history of osteoporosis, smoking, excessive alcohol use, or use of certain medications. Women who have experienced early menopause (before age 45) or those taking long-term corticosteroid medications may benefit from testing at younger ages. Additionally, women who have had fractures from minor falls or injuries should be tested to assess their bone health.

Men: Testing is recommended for all men age 70 and older. For men between ages 50 and 69, testing may be considered if they have risk factors including family history of osteoporosis, smoking, excessive alcohol consumption, low body weight, or use of medications that affect bone health. Men with conditions affecting bone health—such as rheumatoid arthritis, chronic kidney or liver disease, or prostate cancer—may need testing at younger ages. Men who have sustained fractures from minor trauma should also be tested.

Younger adults: People under age 50 are not routinely screened for osteoporosis unless they have specific risk factors. However, testing may be considered for younger women who have stopped menstruating for extended periods (whether from overexercise, eating disorders, or other causes), young people with a strong family history of osteoporosis, those with conditions affecting bone health such as cystic fibrosis or celiac disease, those taking long-term corticosteroids, or those who have experienced fractures from minor falls. Young men with risk factors similar to those listed above may also be tested.

These are general guidelines, and individual circumstances vary. A healthcare provider can assess your specific situation, personal and family history, and other risk factors to determine whether testing would be valuable for you. The decision about testing should be made through conversation with your doctor rather than based solely on age.

Practical takeaway: Age is just one factor in determining whether bone density testing might be useful. Even if you're younger than the standard screening age, discuss with your healthcare provider whether you have risk factors that warrant testing. Conversely, being older doesn't automatically mean you need testing if you have no risk factors—though the recommendation still tends to favor screening at older ages.

Risk Factors That May Indicate Testing Is Appropriate

Beyond age, numerous risk factors can influence bone density and fracture risk. Understanding these factors helps explain why some people benefit from testing earlier than standard age-based guidelines. Risk factors can be divided into categories: those related to bone biology, lifestyle factors, medical conditions, and medications.

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Biological risk factors include being female, being over age 50, having a family history of osteoporosis or fractures, having a small body frame or low body weight (BMI under 21), and early menopause in women (before age 45). Race and ethnicity matter too—white and Asian women and men have higher rates of osteoporosis than other groups, though all ethnic groups can develop weak bones. Hormonal factors such as low testosterone in men or prolonged absence of menstrual periods in women also affect bone density.

Lifestyle risk factors include sedentary behavior or insufficient exercise, low intake of calcium or vitamin D, excessive caffeine consumption, and smoking. Alcohol use—particularly heavy or long-term drinking—impacts bone health. These lifestyle factors are significant because they're often modifiable. Regular weight-bearing exercise like walking, running, or dancing helps maintain bone density. Adequate calcium intake (1,000 to 1,200 mg daily for most adults) and vitamin D (600 to 800 IU daily for most adults, though some people need more) support bone health.

Medical conditions that affect bone density include gastrointestinal disorders that interfere with nutrient absorption (such as celiac disease, Crohn's disease, or inflammatory bowel disease), kidney or liver disease, rheumatoid arthritis, Type 1 diabetes, thyroid disorders, cancer, and conditions causing prolonged immobility. Women who have gone through early menopause due to cancer treatment or surgical removal of ovaries face increased bone loss. Men with low testosterone levels from any cause have lower bone density.

Medications associated with bone loss include corticosteroids (like prednisone, used for conditions such as asthma or autoimmune diseases), certain anti-seizure medications, some cancer treatments, long-term use of proton pump inhibitors (acid reflux medications), and hormonal medications. If you take any of these medications long-term, mention this to your healthcare provider when discussing bone health.

Practical takeaway: You may have multiple risk factors, or just one or two significant ones. Creating a list of your personal risk factors and family history to discuss with your healthcare provider can help guide the conversation about whether bone density testing would be informative for you.

What to Expect During a Bone Density Test

A bone density test is a quick, painless procedure that takes about 10 to 30 minutes depending on which bones are being scanned. Understanding what happens during the test can reduce any anxiety you might have about the process. The most common type of bone density test is the DXA scan, which uses low-dose x-rays to measure bone mineral density.

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Before your test: You'll typically be asked to wear comfortable clothing without metal buttons or zippers, since metal can interfere with imaging. Depending on the type of scan, you may be asked to remove jewelry, glasses, or hearing aids. You won't need any special preparation like fasting, though some facilities may request you avoid calcium supplements for 24 hours before the test to avoid interference. Tell your healthcare provider if you're pregnant or think you might be, since the test isn't performed on pregnant women. Mention any recent barium x-rays or contrast dye procedures, as these can affect scan