How osteoporosis testing works

A bone density test, also called a DXA scan or DEXA scan, is the standard way to check for osteoporosis. The test uses low-dose X-rays to measure how much mineral is packed into your bones. It takes about 10 to 30 minutes, you stay fully clothed, and there is no pain or injection. The machine scans your hip, spine, and sometimes your forearm — the places where fractures are most common.

The test produces a score called a T-score, which compares your bone density to that of a healthy 30-year-old. A T-score of −1.0 or higher means normal bone density. A score between −1.0 and −2.5 means low bone density, sometimes called osteopenia. A score of −2.5 or lower means osteoporosis. Your doctor will explain your specific score and what it means for your risk of breaking a bone.

You do not need to do anything special to prepare. Wear loose, comfortable clothing without metal buttons or zippers. Remove jewelry, watches, and anything else metal. If you have had a barium X-ray or injected contrast dye in the past week, tell your doctor — it can interfere with the scan.

Key Takeaways

  • A bone density test (DXA scan) is a quick, painless X-ray that measures how much mineral is in your bones and takes 10 to 30 minutes.
  • Your doctor will order the test based on your age, sex, medical history, and risk factors — not because you have symptoms, since osteoporosis has no early warning signs.
  • The test produces a T-score that tells you whether your bone density is normal, low, or in the osteoporosis range.
  • Medicare covers bone density testing for women 65 and older and for men 70 and older, and for younger people with certain risk factors.
  • Results usually come back within a few days, and your doctor will discuss next steps, which may include medication, diet changes, or exercise.

Who should get tested and when

The decision to test depends on your age and risk factors. The U.S. Preventive Services Task Force recommends bone density testing for all women 65 and older and all men 70 and older, regardless of risk factors. Younger people should be tested if they have risk factors such as a family history of osteoporosis, a previous fracture from a minor fall, long-term use of corticosteroid medications, rheumatoid arthritis, or low body weight.

Women who have gone through menopause but are younger than 65 should talk to their doctor about whether testing makes sense for them. Menopause causes a sharp drop in estrogen, which speeds bone loss. Men between 50 and 70 should also discuss testing with their doctor if they have risk factors. Your doctor can review your personal and family history and recommend whether testing is right for you now or whether waiting and retesting later makes more sense.

If you have already been tested and your results were normal, your doctor will tell you when to come back for another scan. For people with normal bone density, testing every 10 years is common. For those with low bone density, testing may happen every 1 to 2 years to track changes.

Where to get tested

Your primary care doctor can order a bone density test. You can also ask for a referral to a bone health specialist or endocrinologist if your doctor thinks one would be helpful. The test itself is usually done at a hospital radiology department, an outpatient imaging center, or sometimes at a large medical clinic. Call ahead to ask whether you need to make an appointment (most places do) and whether there are any restrictions on what you can eat or drink beforehand (usually there are none).

If you do not have a primary care doctor, you can contact your local health department or a community health center to find one. Some urgent care clinics and walk-in centers can also refer you for bone density testing, though they may not order it themselves. If cost is a concern, ask about sliding-scale fees or community programs before you go.

What Medicare and insurance cover

Medicare Part B covers bone density testing once every 24 months for women 65 and older. For men 70 and older, Medicare covers it once every 24 months if they have risk factors. Medicare also covers testing for younger people (men 50–69 and women 50–64) if they have certain conditions, such as a previous fracture, long-term corticosteroid use, or a diagnosis of osteoporosis. You pay 20 percent of the Medicare-approved amount after you have met your Part B deductible.

Private insurance coverage varies by plan. Some plans cover bone density testing for anyone over a certain age; others cover it only if you have risk factors or symptoms. Call your insurance company or check your plan documents to find out what your coverage is. If you are uninsured, ask the imaging center about their cash price — bone density tests often cost between $100 and $300 out of pocket, though prices vary by location and facility.

Understanding your results

Your results will include your T-score and sometimes a Z-score. The T-score is what matters most — it tells you how your bone density compares to a healthy young adult. The Z-score compares you to people your own age and sex and can help your doctor spot whether bone loss is happening faster than normal for your age group.

A normal T-score (−1.0 or higher) means your bones are strong and your fracture risk is low. A low T-score between −1.0 and −2.5 means your bones are weaker than normal but you do not yet have osteoporosis. A T-score of −2.5 or lower means you have osteoporosis. Your doctor may also calculate your 10-year fracture risk using a tool called FRAX, which combines your T-score with other factors like age, weight, and previous fractures to estimate your personal risk.

Ask your doctor to explain your score in plain language and what it means for your daily life. Some people with a low score never break a bone; others with a normal score do. Your score is one piece of information your doctor uses to decide whether you need treatment, and what kind.

What happens after your test

Your doctor will review your results with you within a few days to a week. If your bone density is normal, your doctor will likely recommend that you continue weight-bearing exercise, get enough calcium and vitamin D, and avoid smoking and heavy alcohol use. You will be scheduled for another test in 10 years or so, unless you develop new risk factors.

If you have low bone density or osteoporosis, your doctor may recommend medication, usually a class of drugs called bisphosphonates. These slow bone loss and can reduce fracture risk. Your doctor may also refer you to a dietitian to review your calcium and vitamin D intake, or to a physical therapist to work on balance and strength to reduce fall risk. Some people benefit from a bone health class or support group.

If you have osteoporosis, your doctor will want to know about any falls you have had, any new pain, or any change in your height or posture. These can be signs of a fracture. Report them right away rather than waiting for your next appointment.

Common reasons for delayed or repeated testing

Sometimes a bone density test has to be repeated. This can happen if you moved during the scan, if metal in your body (like a hip replacement or pacemaker) interfered with the image, or if the machine was not working properly. The facility will call you to reschedule — this is normal and does not mean anything is wrong with your bones.

If your first test was done at a different facility than your follow-up test, results may not be directly comparable because different machines can produce slightly different scores. Your doctor will account for this when reviewing your results over time. If you are switching doctors or moving, ask for a copy of your bone density report to bring to your new provider — it helps them track your bone health accurately.

Some people delay testing because they are worried about radiation exposure. The radiation dose from a bone density test is very small — much less than a chest X-ray — and the benefit of knowing your bone status usually outweighs the tiny risk.

Frequently Asked Questions

Do I need to fast before a bone density test?

No. You can eat and drink normally before your test. You do not need to fast or avoid any foods. Just wear loose clothing without metal and remove any jewelry or metal objects before the scan.

Can I get a bone density test if I have a metal implant?

It depends on the type and location of the implant. Hip replacements, knee replacements, and some spinal hardware can interfere with the scan in that area, but the test can usually still be done on other bones. Tell the facility about any implants when you schedule, and they will let you know whether the test can go ahead and which bones they can scan.

How often should I be retested?

If your bone density is normal, retesting every 10 years is standard. If you have low bone density, your doctor may recommend testing every 1 to 2 years to track whether your bones are getting weaker or staying stable. If you start medication for osteoporosis, your doctor will decide when to retest based on how you are responding to treatment.

What if my results show osteoporosis but I have never broken a bone?

Many people with osteoporosis never break a bone, especially if they avoid falls and take steps to protect their bones. Your doctor will discuss your personal fracture risk and whether medication makes sense for you. Not everyone with osteoporosis needs medication — some people do well with exercise, calcium, vitamin D, and fall prevention alone.

Can osteoporosis be reversed?

Osteoporosis cannot be completely reversed, but bone loss can be slowed or stopped with medication, exercise, and proper nutrition. Some people see small improvements in bone density with treatment. The goal is to prevent fractures and keep your bones as strong as possible as you age.