Menopause & Midlife
Osteoporosis Screening After Menopause: When to Get a Bone Density Test
The US Preventive Services Task Force (USPSTF) recommends osteoporosis screening for all women 65 and older, and for postmenopausal women under 65 who are at increased risk of fracture. Screening is done with a DXA scan, a quick, painless bone density test. Finding bone loss early means treatment can start before a bone breaks.
Here's the thing most people don't realize: osteoporosis has no symptoms. You can't feel your bones thinning. The first sign is often a broken wrist from a fall that "shouldn't have" broken anything, or a spine fracture that shows up as lost height.
Why menopause causes bone loss
Estrogen helps balance breaking down old bone and building new bone. When estrogen drops at menopause, breakdown outpaces building. Bone loss is fastest in the first several years after the final period.
Over time, bones can become thin and fragile, most often at the hip, spine and wrist. Spine fractures can cause height loss and a stooped posture, sometimes without any obvious injury.
Who should get a bone density test?
According to the USPSTF's 2025 recommendation:
- Women 65 and older: get screened.
- Postmenopausal women under 65: get screened if a formal risk assessment shows increased fracture risk.
Your clinician may use a tool like FRAX, which estimates your 10-year fracture risk from factors like age, weight and history.
Risk factors: a quick self-check
Count how many apply to you:
- Early menopause (before 45), including surgical menopause
- Low body weight
- A parent who broke a hip
- Smoking
- Three or more alcoholic drinks a day
- Long-term steroid medicines (like prednisone)
- Rheumatoid arthritis
- Conditions that affect absorption, such as celiac disease or bariatric surgery
- Certain breast cancer medicines (aromatase inhibitors)
- A past fracture from a minor fall
If you checked even one and you're past menopause, bring it up at your next visit. If you went through early or premature menopause, ask whether you need screening sooner.
What a DXA scan is like
A DXA (dual-energy X-ray absorptiometry) scan measures bone density, usually at the hip and lower spine. It's one of the easiest tests you'll ever have.
- You lie on a padded table while a scanner arm passes slowly over you.
- It takes several minutes, and you'll be asked to stay still.
- You keep your clothes on but remove metal like belts and zippers. Wear leggings or sweatpants and skip the underwire bra to make it simpler.
- The radiation dose is very low.
Some imaging centers ask you to skip calcium supplements for about a day beforehand, since they can affect results; follow their instructions. Ask too whether you can get future scans on the same machine; comparisons are most accurate that way.
Reading your T-score
Your result comes back as a T-score, which compares your bone density with a healthy young adult's.
| T-score | What it means |
|---|---|
| -1.0 or higher | Normal bone density |
| Between -1.0 and -2.5 | Low bone mass (osteopenia) |
| -2.5 or lower | Osteoporosis |
Your clinician also weighs your overall fracture risk, not just the number. Someone with low bone mass and several risk factors may be advised to start treatment. Anyone who's had a hip or spine fracture from a minor fall may be diagnosed with osteoporosis regardless of T-score.
"I have osteopenia. Do I need medicine?"
Not automatically. Low bone mass is common after menopause. Your clinician will look at your overall fracture risk, often with FRAX.
With low to moderate risk, the focus is usually on:
- Strength and balance training
- Enough calcium and vitamin D
- Not smoking and limiting alcohol
- Fall-proofing your home
- A repeat scan at the interval your clinician recommends
If your fracture risk is high even though your T-score isn't in the osteoporosis range, medicine may still make sense. The goal is preventing fractures, not improving a number.
How to protect your bones after menopause
Calcium and vitamin D
Food first, supplements to fill gaps. The NIH Office of Dietary Supplements lists recommended daily amounts by age: for women over 50 the calcium recommendation is higher than for younger adults, and vitamin D needs rise after 70. Ask your clinician whether you need a supplement and how much, since too much supplemental calcium can cause problems like kidney stones.
Good calcium sources include dairy, fortified plant milks, canned fish with bones (sardines, canned salmon), tofu made with calcium, and leafy greens.
Exercise
- Weight-bearing exercise like walking, stair climbing and dancing. City walking and taking the stairs at subway stations count.
- Strength training at least two days a week
- Balance work, such as tai chi, to prevent falls
Daily habits
- Don't smoke
- Limit alcohol
- Fall-proof your home: good lighting, no loose rugs, grab bars in the bathroom, and a night light on the way to the bathroom
Osteoporosis treatment options
If you're diagnosed with osteoporosis or high fracture risk, your clinician may recommend medicine. Options include:
- Bisphosphonates (pills or a yearly IV infusion)
- Denosumab (injection every six months; it must not be stopped without a plan, because bone loss can rebound)
- Bone-building medicines such as teriparatide, abaloparatide or romosozumab, often for people at very high risk
- Raloxifene, a SERM that protects the spine
- Hormone therapy, which The Menopause Society notes prevents bone loss and reduces fractures. It can be a good fit for people under 60 or within 10 years of menopause who also have hot flashes. See menopause hormone therapy benefits and risks.
The choice depends on your fracture risk, other health conditions and preferences.
Questions to ask about your results
- What's my T-score at the hip and spine?
- What's my estimated 10-year fracture risk?
- Do I need medicine, or should I focus on lifestyle for now?
- When should I repeat the test?
- Could another condition or medicine be contributing to my bone loss?
When to see a doctor
Talk to your clinician about bone health if:
- You're 65 or older and haven't had a bone density test
- You're postmenopausal with any of the risk factors above
- You went through menopause before 45
- You've lost height, have new back pain, or broke a bone from a minor fall
- You take steroids or aromatase inhibitors long term
Find care in New York
Many gynecologists, OB/GYNs and nurse practitioners order DXA scans and manage bone health after menopause. If you're on Medicare, bone density testing is generally covered for eligible women; ask the imaging center to confirm before you go. Search the directory, or browse gynecologists in Suffolk County and providers who take Medicare.
Frequently asked questions
At what age should women get a bone density test?
The USPSTF recommends osteoporosis screening for all women 65 and older. Postmenopausal women younger than 65 should be screened if a risk assessment shows increased fracture risk.
What is a normal T-score?
A T-score of -1.0 or higher is normal. Between -1.0 and -2.5 is low bone mass (often called osteopenia), and -2.5 or lower means osteoporosis.
Is a DXA scan painful or risky?
No. A DXA scan is quick and painless, and it uses a very small amount of radiation, much less than a standard chest X-ray.
How often should I repeat a bone density test?
There's no single interval for everyone. Your clinician will base the timing on your last result, your risk factors and whether you're on treatment.
Can osteoporosis be reversed?
Medicines can increase bone density and lower fracture risk, and some build new bone. Exercise, calcium, vitamin D and fall prevention also help.
Sources
- USPSTF — Osteoporosis to Prevent Fractures: Screening (2025)
- ACOG — Management of Postmenopausal Osteoporosis (Clinical Practice Guideline No. 2)
- The Menopause Society — Management of Osteoporosis in Postmenopausal Women (Position Statement)
- NIH Office of Dietary Supplements — Calcium and Vitamin D Fact Sheets
- Bone Health & Osteoporosis Foundation
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.