The Bone Density Test That Finds the Problem Before the Break

Here is a fact worth a second look. Osteoporosis usually causes no symptoms. MedlinePlus, from the National Institutes of Health, calls it a “silent” disease: you may not know you have it until you break a bone, most often in the hip, spine, or wrist.

It’s also common. National data cited by the U.S. Preventive Services Task Force show that osteoporosis affects more than 1 in 4 women 65 and older, and about 6 in 100 men in the same age group.

The good news: a painless test can find thinning bones early, and Medicare covers it for people who qualify.

Why Finding It Early Matters

A broken bone can change daily life. The task force notes that only 40% to 60% of people who break a hip get back to their earlier level of mobility and ability to handle everyday activities.

Finding weak bones before a break gives you time to act. The task force found convincing evidence that treating women 65 and older who have osteoporosis offers a moderate benefit in preventing fractures.

What the Test Is Like

The most common and accurate bone density test is a DEXA scan (also written DXA). According to MedlinePlus:

• It uses low-dose X-rays. You get more radiation from a chest X-ray than from a DEXA scan.
• It’s painless. You lie on a soft table while the scanner passes over your lower spine and hip. In most cases, you don’t need to undress.
• There’s a little prep. Don’t take calcium supplements for 24 hours before the test, and expect to remove metal items like jewelry and buckles.

What Your Results Mean

Your results usually come back as a T-score, which compares your bone density with that of a healthy young woman. MedlinePlus explains the ranges:

• -1.0 or higher: normal range
• -1.1 to -2.4: possible bone loss, also called osteopenia
• -2.5 or lower: likely osteoporosis

Your T-score is only part of the picture. MedlinePlus notes that treatment decisions depend on your total fracture risk, which can be calculated with a tool called FRAX (Fracture Risk Assessment Tool). According to the task force, FRAX estimates your 10-year chance of a hip fracture or other major osteoporotic fracture, with or without your bone density result.

Who Should Get Tested

In January 2025, the task force recommended osteoporosis screening for:

• All women 65 and older
• Women past menopause who are younger than 65 and at higher risk of a fracture

For men, the task force says the evidence isn’t strong enough to recommend for or against routine screening, and it leaves the decision to clinicians’ judgment. MedlinePlus notes that men of any age may need testing if they have risk factors, such as:

• Breaking a bone after age 50
• Significant loss of height
• A strong family history of osteoporosis
• Past treatment for prostate cancer
• Conditions such as rheumatoid arthritis, diabetes, or thyroid problems
• Long-term use of medicines such as corticosteroids
• Low body weight, or long-term tobacco or heavy alcohol use

What Medicare Covers

Medicare Part B covers a bone density test once every 24 months, or more often if medically necessary, if you meet at least one of these conditions:

• You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis.
• Your X-rays show possible osteoporosis, osteopenia, or spine fractures.
• You’re taking prednisone or steroid-type drugs, or are planning to start.
• You’ve been diagnosed with primary hyperparathyroidism.
• You’re being monitored to see if your osteoporosis medicine is working.

You pay nothing if you meet one of these conditions, the test falls within Medicare’s time limit, and your provider accepts Medicare assignment. Several risk factors that may prompt testing, like a family history of osteoporosis, aren’t on Medicare’s list. Medicare.gov warns that tests it doesn’t cover, or that are done more often than it covers, could cost you extra, so ask what Medicare will pay before the test.

Keeping Your Bones Strong

To help prevent osteoporosis, MedlinePlus says the best thing to do is eat a healthy diet rich in calcium and vitamin D. Regular physical activity, limiting alcohol, and not smoking can also help.

If you have osteoporosis, MedlinePlus lists steps your provider may recommend:

• A balanced diet with enough calcium, vitamin D, and protein
• Weight-bearing exercise like walking, plus strength training and balance exercises
• Fall prevention, since preventing falls helps reduce the risk of breaking a bone
• Quitting smoking and limiting alcohol
• Medicines that slow bone loss or help rebuild bone

MedlinePlus also advises people with osteoporosis to avoid movements that twist the spine, like swinging a golf club, or that bend forward from the waist, such as sit-ups and toe touches. And the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases advises anyone with low bone density, osteoporosis, or other physical limitations to talk with a health care provider before starting an exercise program.

Questions Worth Asking at Your Next Visit

• Do I need a bone density test, and does Medicare cover one for me?
• Do any of my medicines affect my bones?
• What can I do to lower my risk of falling?

The Bottom Line