How osteoporosis testing works
The standard test for osteoporosis is a bone density scan, also called a DXA scan or DEXA scan. It uses low-dose X-rays to measure how much mineral is in your bones compared to a healthy young adult. The scan takes about 10 to 30 minutes, is painless, and you stay fully clothed. You lie still on a table while a scanner passes over your spine, hip, and sometimes your forearm.
The results come back as a T-score, which tells you whether your bones are normal, show early bone loss (called osteopenia), or have osteoporosis. A T-score of -1.0 or higher is normal. A score between -1.0 and -2.5 means osteopenia. A score of -2.5 or lower means osteoporosis. Your doctor will explain what your specific score means for your risk of fracture.
You do not need to do anything special to prepare. Wear loose, comfortable clothing without metal buttons or zippers. Tell your doctor if you have had a barium X-ray or injected contrast dye in the past two weeks, as these can interfere with results.
Key Takeaways
- A DXA scan is the standard test and takes 10 to 30 minutes with no pain or special preparation.
- Your doctor will order the scan if you are over 50, have risk factors like family history or low body weight, or have had a fracture.
- Results come back as a T-score that shows whether your bones are normal, have early loss, or have osteoporosis.
- Medicare covers one baseline scan at age 65 and repeat scans every two years if you meet certain criteria.
- A positive test result means you and your doctor can start treatment to slow bone loss and reduce fracture risk.
Who should be tested and when
The U.S. Preventive Services Task Force recommends bone density screening for all women age 65 and older, and for postmenopausal women under 65 who have risk factors. Men age 70 and older should also be screened. Your doctor may recommend testing earlier if you have had a fracture from a minor fall, take certain medications like corticosteroids, have rheumatoid arthritis, or have a family history of osteoporosis.
If you are a woman who has gone through menopause, talk to your doctor about whether you should be tested. Bone loss speeds up after menopause because estrogen levels drop. Men lose bone more slowly, but the risk increases with age, especially after 70.
You do not need to wait for symptoms. Osteoporosis has no warning signs — many people do not know they have it until they break a bone. That is why screening is important, especially as you get older.
What happens during the scan
You will lie on your back on a padded table. The technician will position your legs on a support to keep them still. A scanner arm will pass slowly over your lower spine and hip area. You may hear a faint buzzing sound. The technician will ask you to hold very still for a few seconds at a time, but you can breathe normally.
The scan measures bone density at two or three sites: the lumbar spine (lower back), the hip, and sometimes the forearm. The hip and spine are the most common fracture sites, so these areas give the most useful information. The whole process is quick and you will feel nothing.
After the scan, you can go back to your normal activities right away. There are no side effects from the radiation — the dose is very low, much less than a standard chest X-ray.
Understanding your test results
Your results will show a T-score for each bone site tested. The T-score compares your bone density to that of a healthy 30-year-old. A higher score means stronger bones. Here is what the numbers mean:
| T-Score Range | What It Means |
|---|---|
| -1.0 or higher | Normal bone density |
| -1.0 to -2.5 | Osteopenia (early bone loss) |
| -2.5 or lower | Osteoporosis |
Your doctor will also calculate your 10-year fracture risk using your T-score and other factors like age, weight, and whether you smoke. This helps decide whether you need treatment. Two people with the same T-score may have different fracture risks depending on their overall health.
Ask your doctor to explain your specific numbers and what they mean for you. If you have osteopenia, your doctor may recommend lifestyle changes like exercise and calcium intake rather than medication. If you have osteoporosis, medication is usually recommended along with lifestyle changes.
Insurance coverage and costs
Medicare covers one baseline DXA scan for women age 65 and older and for postmenopausal women ages 50 to 64 who meet certain criteria. It also covers repeat scans every two years if you have been diagnosed with osteoporosis or osteopenia, or every five years for screening without a prior diagnosis. You pay nothing if your doctor orders the scan as a covered benefit.
Private insurance coverage varies by plan. Some plans cover screening at age 50 or 60, while others follow Medicare guidelines. Call your insurance company or check your plan documents to find out what is covered. If you do not have insurance, ask the imaging center about their cash prices — DXA scans typically cost between $100 and $300 without insurance.
The scan must be ordered by your doctor. You cannot schedule one on your own. Your doctor will send the order to an imaging center, hospital, or clinic that has the equipment.
What to do after your results come back
Schedule a follow-up appointment with your doctor to discuss your results. Bring a list of any medications you take, including over-the-counter ones, and any fractures you have had. Tell your doctor about your diet, exercise habits, and whether you smoke or drink alcohol regularly. All of these affect your bone health and treatment decisions.
If your results show osteoporosis, your doctor may prescribe medication to slow bone loss. The most common first-line medications are bisphosphonates, which you take by mouth or by injection. Your doctor will also recommend calcium and vitamin D, weight-bearing exercise, and fall prevention strategies.
If your results show osteopenia, your doctor may recommend lifestyle changes first. These include getting enough calcium (1,000 to 1,200 mg per day for most adults), vitamin D (600 to 800 IU per day, or more if your level is low), and doing weight-bearing or muscle-strengthening exercise most days of the week. Your doctor will tell you when to have your next scan — usually in one to five years depending on your risk factors.
When to ask your doctor about testing
Talk to your doctor about bone density testing if you are a woman over 50 or a man over 70. Also ask if you have had a fracture from a minor fall, take corticosteroid medications, have rheumatoid arthritis, have a family history of osteoporosis, weigh less than 127 pounds, or have gone through early menopause (before age 45).
If you have already been diagnosed with osteoporosis or osteopenia, ask your doctor how often you should be rescanned. Most people are rescanned every one to two years to see whether treatment is working. Your doctor may also order blood tests to check your calcium and vitamin D levels, especially if you are starting treatment.
Do not wait for a fracture to get tested. Screening is the only way to know your bone density before a break happens.
Frequently Asked Questions
Does a bone density scan hurt?
No. The scan is completely painless. You lie still on a padded table while a scanner passes over your bones. You will not feel anything during the test. The radiation dose is very low — much less than a standard chest X-ray.
Can I eat or drink before my scan?
Yes. There are no fasting requirements for a DXA scan. You can eat and drink normally before your appointment. Wear loose, comfortable clothing without metal zippers or buttons, as these can interfere with the images.
How long does it take to get results?
The scan itself takes 10 to 30 minutes. Your doctor usually receives the results within a few days. Your doctor's office will contact you to schedule a follow-up appointment to discuss what the results mean and what to do next.
What if I have had joint replacements or metal implants?
Tell the technician before your scan if you have metal implants, pacemakers, or joint replacements. These may affect the images. The technician can adjust the scan to work around them, or your doctor may order a different type of bone density test if needed.
Do I need to repeat the scan if my first result was normal?
If your first scan shows normal bone density and you have no risk factors, your doctor will tell you when to have your next scan — usually in five to ten years. If you have risk factors or early bone loss, you may need to repeat it sooner. Your doctor will decide based on your individual situation.