Understanding What Age Group Should Get a Bone Density Test

According to the Bone Health and Osteoporosis Foundation, about one in two women and up to one in four men aged 50 and older will break a bone due to osteoporosis. Knowing what age group should get a bone density test is a critical step in proactively managing your bone health and preventing these potentially life-altering fractures.

Quick Summary

Generally, screening is recommended for all women aged 65 and older and men aged 70 and older, but earlier testing is crucial for individuals with specific risk factors such as a prior fracture, low body weight, or certain medical conditions and medications.

Key Points

• Age Recommendations: Women should receive a bone density test starting at age 65, and men at age 70, unless risk factors indicate earlier screening.

• Early Screening for Risk Factors: Anyone with a fragility fracture after age 50, a family history of osteoporosis, low body weight, or certain medical conditions should be screened earlier.

• DEXA Scan is the Standard: Dual-energy X-ray absorptiometry (DEXA) is the most common and accurate method for measuring bone mineral density and assessing fracture risk.

• Medicare Coverage: Medicare Part B covers bone mass measurements every 24 months for those at high risk for osteoporosis.

• No Symptoms: Osteoporosis is often called a silent disease, meaning you may not know you have it until a fracture occurs. Screening is therefore crucial for early detection and prevention.

• Personalized Assessment: Guidelines vary among organizations, so the best approach is to have a personalized risk assessment with your primary care provider.

General Bone Density Screening Guidelines

For many years, the standard recommendation for bone density testing has been based primarily on age and gender. The logic is that after reaching peak bone mass in your 20s and 30s, bone density naturally begins to decline, and the risk of developing osteoporosis increases significantly with age. Leading health organizations provide clear age benchmarks for routine screening.

For Women

1. Women aged 65 and older: All women in this age group are recommended for a bone mineral density (BMD) test, most commonly a DEXA scan.
2. Postmenopausal women under 65: Screening is recommended for this group if they have one or more specific risk factors for osteoporosis.

For Men

1. Men aged 70 and older: Many organizations recommend routine bone density screening for men in this age bracket.
2. Men under 70 with risk factors: As with women, earlier screening is advised for men between ages 50 and 69 who have increased risk factors for low bone mass.

Factors Warranting Earlier or More Frequent Screening

Beyond general age guidelines, your doctor may recommend a bone density test at a younger age or more frequently based on a careful assessment of your personal risk factors. Osteoporosis is often called a 'silent disease' because there are no outward symptoms until a fracture occurs, making proactive screening vital for those at higher risk.

Lifestyle Risk Factors

• Tobacco Use: Smoking has been shown to contribute to weak bones.
• Excessive Alcohol Consumption: Regular consumption of more than two drinks per day increases osteoporosis risk.
• Sedentary Lifestyle: A lack of weight-bearing exercise can lead to accelerated bone loss.
• Low Body Weight: People with a small body frame have less bone mass to draw from as they age.

Medical Risk Factors

• History of Fractures: Any fragility fracture (a fracture from a minor fall) after age 50 is a strong indicator for a bone density test.
• Family History: A parent or sibling with osteoporosis, especially a parent who fractured a hip, increases your risk significantly.
• Medications: Long-term use of corticosteroids (e.g., prednisone), certain anti-seizure medications, and some cancer treatments can interfere with bone rebuilding.
• Medical Conditions: A number of conditions increase risk, including: celiac disease, inflammatory bowel disease, kidney or liver disease, rheumatoid arthritis, thyroid conditions, and certain cancers.
• Hormone Levels: The rapid fall in estrogen at menopause is a primary risk factor for women, while low testosterone levels can affect men.

The DEXA Scan: The Gold Standard for Testing

The most common and effective bone density test is a dual-energy X-ray absorptiometry (DEXA) scan. This simple, non-invasive procedure is crucial for assessing your bone health.

What a DEXA Scan Reveals

• T-Score: This score compares your bone density to that of a healthy young adult of the same gender. A score of -2.5 or lower indicates osteoporosis, while a score between -1.0 and -2.5 indicates low bone mass, or osteopenia.
• Z-Score: This score compares your bone density to that of someone of your same age, size, and gender. It is particularly useful for premenopausal women and younger men to help diagnose secondary causes of osteoporosis.

What to Expect During a DEXA Scan

1. You will lie on a padded table fully clothed.
2. A mechanical arm will pass over your body, typically focusing on your hips and spine.
3. The procedure is quick, painless, and involves a very low dose of radiation.
4. The results are sent to your doctor, who will then discuss the findings and a potential treatment plan if necessary.

Comparison of Screening Guidelines

Population	General Screening Age	Early Screening Triggers
All Women	65+	Postmenopause + Risk Factors (low body weight, smoking, family history)
All Men	70+	Age 50-69 + Risk Factors (low body weight, smoking, family history, low testosterone)
Adults 50+	N/A	History of fragility fracture
Adults on Medications	N/A	Taking long-term steroids or certain other medications
Adults with Medical Conditions	N/A	Having conditions like rheumatoid arthritis or kidney disease

Conclusion

Regular bone density screening is a powerful tool in preventing debilitating fractures associated with osteoporosis. While standardized guidelines provide a starting point for men and women over 50, it is essential to consider individual risk factors. By understanding these factors and consulting with your healthcare provider, you can determine the most appropriate time to get a bone density test for your personal health situation.

For more detailed information on preventing and treating osteoporosis, consult the resources from the Bone Health and Osteoporosis Foundation.

Frequently Asked Questions

What is a bone density test?

A bone density test, also known as a DEXA scan, is a quick, non-invasive imaging test that measures how strong and dense your bones are. It helps diagnose osteoporosis and determine your risk of future fractures.

What age should women get a bone density test?

Women should generally get a bone density test starting at age 65. However, postmenopausal women under 65 with risk factors like low body weight, a previous fracture, or a family history of osteoporosis should be screened earlier.

What age should men get a bone density test?

Routine screening for men is typically recommended beginning at age 70. Men aged 50 to 69 with risk factors for low bone mass, such as a prior fracture or long-term steroid use, may need to be screened earlier.

What are the common risk factors for osteoporosis?

Risk factors include age, family history, a small body frame, tobacco use, excessive alcohol intake, and certain medical conditions like rheumatoid arthritis or celiac disease. Some medications, particularly long-term corticosteroids, also increase risk.

How often do I need a bone density test?

The frequency depends on your initial results and risk level. Some high-risk individuals or those on treatment may be tested every 1-2 years, while those with normal or moderately low bone mass may only need testing every 3-5 years or longer.

What does a T-score from a DEXA scan mean?

A T-score compares your bone density to that of a healthy young adult. A score above -1.0 is considered normal, between -1.0 and -2.5 indicates osteopenia (low bone mass), and a score of -2.5 or lower indicates osteoporosis.

Does insurance cover bone density tests?

Yes, most insurance plans, including Medicare, cover bone density tests for individuals who meet specific criteria based on age and risk factors. Medicare Part B typically covers the test every 24 months for those at risk.

Who is at highest risk for osteoporosis?

Postmenopausal women who are white or of Asian descent are at the highest risk, primarily due to hormonal changes, smaller bone mass, and other genetic factors. However, osteoporosis can affect anyone.