Bone density scans can help detect osteoporosis and estimate fracture risk, but most women do not need routine screening in early adulthood.

For women at average risk, screening generally begins at age 65. Earlier testing may be appropriate for people with certain medical conditions, medications, or other risk factors that increase the chance of bone loss.

Understanding when bone density starts to decline and who benefits from earlier testing can help you avoid unnecessary scans while still protecting your long-term bone health.

When Do Women Start Losing Bone Density?

Most women reach peak bone mass by their late twenties.

After that, bone density often remains relatively stable for years unless other risk factors are present.

Bone Loss Often Accelerates Around Menopause

For many women, more noticeable bone loss begins during late perimenopause and around menopause as estrogen levels decline.

The fastest period of bone loss often occurs during the first few years after the final menstrual period.

After that, bone loss usually continues at a slower rate.

What Can Cause Earlier Bone Loss?

Some people begin losing bone density earlier than expected.

Possible risk factors include:

  • Family history of osteoporosis
  • Low body weight
  • Poor nutrition
  • Vitamin D deficiency
  • Low calcium intake
  • Eating disorders
  • Celiac disease or other malabsorption conditions
  • Irregular or absent menstrual periods
  • Long-term steroid use
  • Certain hormone-suppressing medications
  • Smoking
  • Heavy alcohol use

Some chronic medical conditions can also affect calcium, vitamin D, kidney function, or hormone levels and increase the risk of weaker bones.

What Is A DEXA Scan?

A DEXA scan, short for dual-energy X-ray absorptiometry, is a painless imaging test used to measure bone mineral density.

It uses a very low dose of X-rays and usually examines areas where osteoporosis-related fractures commonly occur.

Common Areas Tested

These include:

  • Hip
  • Lower spine
  • Forearm in certain situations

The scan is typically quick and does not require injections or special preparation.

What Do DEXA Scan Results Mean?

DEXA scan results commonly include a T-score and Z-score.

T-Score

The T-score compares your bone density with the average bone density of a healthy young adult.

It is commonly used when evaluating postmenopausal women and adults over age 50.

Lower scores may suggest osteopenia or osteoporosis.

Z-Score

The Z-score compares your bone density with that of people of a similar age and sex.

It is more commonly used when evaluating younger adults.

A significantly low Z-score may encourage a healthcare provider to investigate possible underlying causes of bone loss.

When Should Routine Screening Begin?

For women at average risk, routine osteoporosis screening generally begins at age 65.

Women younger than 65 may be screened if their fracture risk is high enough to justify earlier testing.

Earlier Screening May Be Considered If You Have

  • A history of low-impact fractures
  • Long-term corticosteroid use
  • Very low body weight
  • Early menopause
  • Certain eating disorders
  • Conditions that reduce nutrient absorption
  • Strong family history of osteoporosis
  • Medications that reduce estrogen levels
  • Other medical conditions associated with bone loss

A healthcare provider may use a fracture-risk assessment tool to determine whether testing is appropriate.

Do Most Women Need A DEXA Scan Before Menopause?

Usually not.

Younger women typically have a very low fracture risk, even if their bone density is slightly lower than average.

As a result, routine screening before menopause may provide little useful information unless there are clear signs of skeletal fragility.

When Testing May Make Sense

A healthcare provider may recommend testing if someone has:

  • Experienced an unexplained fracture from a minor fall
  • Used prednisone or similar medications for a long time
  • Experienced prolonged absence of menstrual periods
  • Had an eating disorder
  • Been diagnosed with celiac disease
  • Used medications that suppress estrogen
  • Developed another condition strongly associated with bone loss

In these situations, testing may help guide treatment or additional evaluation.

Could Screening Around Menopause Be Helpful?

Some experts believe screening during late perimenopause or shortly after menopause could identify bone loss earlier.

In theory, earlier detection might allow people to strengthen prevention strategies before significant bone loss occurs.

However, there is still limited evidence showing that routine DEXA screening at this stage improves long-term outcomes for average-risk women.

Because of that, early screening is generally individualized rather than recommended for everyone.

Are There Downsides To Getting Scanned Too Early?

DEXA scans are generally safe, but unnecessary testing can still have drawbacks.

Possible Downsides Include

  • Out-of-pocket costs
  • Anxiety about results
  • Unnecessary repeat testing
  • Additional medical appointments
  • Potential overtreatment

A mildly low score in a younger person does not always translate into meaningful fracture risk.

Knowing that number may create worry without changing medical management.

Will Insurance Cover An Early DEXA Scan?

Insurance coverage varies.

In many cases, routine screening before age 65 may not be covered unless there is a documented medical reason.

A healthcare provider may need to explain why the test is medically necessary.

Without coverage, the scan may cost from roughly tens of dollars to several hundred dollars depending on the location and facility.

How To Keep Your Bones Strong Before 65

For most younger adults, prevention is more important than early routine scanning.

Bone health depends heavily on nutrition, physical activity, hormones, and lifestyle habits.

Get Enough Calcium

Calcium is an essential mineral for maintaining bone structure.

Many adults can meet their needs through food.

Calcium-Rich Foods Include

  • Milk
  • Yogurt
  • Cheese
  • Fortified plant milks
  • Tofu made with calcium
  • Sardines
  • Canned salmon with bones
  • Leafy green vegetables

Women ages 19 to 50 generally need around 1,000 milligrams of calcium per day, while women over 50 often need about 1,200 milligrams.

Food sources are usually preferred, although supplements may help fill nutritional gaps when necessary.

Get Enough Vitamin D

Vitamin D helps the body absorb calcium.

Low vitamin D levels can contribute to poor bone mineralization over time.

Sources Of Vitamin D Include

  • Sunlight exposure
  • Fatty fish
  • Egg yolks
  • Fortified dairy products
  • Fortified plant milks

Some people may need supplements, particularly if blood testing confirms deficiency.

Eat Enough Protein

Protein supports both muscle and bone health.

Maintaining muscle is especially important because stronger muscles improve balance and reduce fall risk.

Good protein sources include:

  • Fish
  • Poultry
  • Eggs
  • Dairy
  • Beans
  • Lentils
  • Tofu
  • Tempeh
  • Nuts and seeds

Strength Train Regularly

Resistance training is one of the most effective forms of exercise for supporting bone health.

Exercises that load the bones encourage them to adapt and maintain strength.

Examples Include

  • Squats
  • Lunges
  • Deadlifts
  • Resistance band exercises
  • Dumbbell exercises
  • Weight machines

Aim to train major muscle groups regularly while gradually increasing resistance as your strength improves.

Include Weight-Bearing Cardio

Weight-bearing activities require your bones to support your body weight against gravity.

Examples include:

  • Walking
  • Hiking
  • Jogging
  • Dancing
  • Stair climbing

These activities can complement resistance training.

Swimming and cycling provide excellent cardiovascular benefits but place less direct loading stress on the bones.

Practice Balance Training

Strong bones are important, but preventing falls is equally important.

Balance exercises may reduce the chance of falling and experiencing a fracture later in life.

Examples include:

  • Standing on one leg
  • Tai Chi
  • Yoga
  • Heel-to-toe walking
  • Controlled step exercises

Avoid Smoking

Smoking is associated with lower bone density and a higher fracture risk.

Quitting can support bone health along with many other aspects of long-term health.

Limit Excessive Alcohol

Heavy alcohol consumption may interfere with bone formation and increase fall risk.

Keeping alcohol intake moderate can help protect skeletal health.

Review Your Medications

Some medications can accelerate bone loss.

Long-term corticosteroid use is one of the most common examples.

Other medications can also affect hormones, calcium metabolism, or bone turnover.

If you take medications associated with bone loss, ask your healthcare provider whether earlier bone density testing or preventive treatment is appropriate.

Who Should Talk To A Doctor About Early Screening?

Consider discussing a DEXA scan before age 65 if you have multiple osteoporosis risk factors.

Talk To Your Healthcare Provider If You Have

  • A previous fragility fracture
  • Very low body weight
  • Early menopause
  • Long-term steroid use
  • Strong family history of hip fractures
  • Celiac disease
  • An eating disorder
  • Hormonal conditions affecting estrogen
  • Chronic kidney, liver, or gastrointestinal disease
  • Significant height loss
  • Unexplained back pain associated with possible spinal compression

Your provider can evaluate your overall fracture risk rather than relying on age alone.

Final Thoughts

Most healthy women do not need routine bone density scans before age 65.

Earlier testing can be useful for people with higher fracture risk, certain medical conditions, long-term medication use, low body weight, or a history of fractures.

For everyone else, the best strategy is usually to focus on lifelong bone protection through strength training, weight-bearing activity, adequate calcium and vitamin D, good nutrition, balance training, and avoiding smoking.

Bone health is built over decades, so healthy habits started early can make a meaningful difference later in life.