Bone density can silently decrease for years before a fracture occurs, a serious event that affects up to half of women over 50, which is double the rate seen in men. While standard bone density testing often begins at age 65 for women, experts suggest several reasons to consider screening earlier.

Peak bone mass is typically achieved around age 35, according to Kim J. Templeton, MD, professor of orthopedic surgery and sports medicine at the University of Kansas Medical Center. After this peak, bone loss can start as early as the 40s unless proactive bone-maintaining habits are adopted. Susan Bukata, MD, professor and chair of Orthopaedics at UC San Diego, notes that menopause significantly accelerates this loss due to declining estrogen levels, with women potentially losing 1% to 2% of their mass annually during that transition decade.

The general guideline for screening at 65 is based on when enough of the population has developed osteoporosis to justify the cost and time of widespread testing, Dr. Templeton explains. However, both physicians agree that numerous health and lifestyle factors can elevate an individual's risk for an osteoporosis-related fracture well before that benchmark age.

When to Discuss an Earlier Bone Density Scan

If any of the following risk factors apply, Dr. Bukata advises consulting your physician about whether a DEXA scan is appropriate, regardless of your current age. If you have insurance, coverage for the scan is likely, as Dr. Templeton notes, “It’s cheaper to pay for a DEXA than to pay for somebody after they break their hip.”

The Seven Indicators for Pre-65 Screening

  • 1. Fracture from Minimal Trauma: Experiencing a broken bone from an everyday injury suggests inadequate bone density, as adult bones should withstand minor impacts, according to Dr. Templeton. Multiple fractures from low-trauma events are a significant warning sign.
  • 2. Family History of Early Osteoporosis: Genetics play a role in bone building and loss. If a parent or sibling developed osteoporosis in their 40s or 50s, it suggests suboptimal genetics for bone health, Dr. Bukata states.
  • 3. Early Menopause: Entering menopause before age 45 means a longer period without the bone-protective effects of estrogen. This can occur spontaneously or due to medical interventions like ovary removal or ovary-suppressing medication.
  • 4. Long-Term Corticosteroid Use: Individuals managing chronic conditions such as severe allergies, asthma, lupus, or inflammatory bowel disease (IBD) who use oral corticosteroids like prednisone long-term may experience hindered bone tissue formation, Dr. Templeton notes. Inflammation from these conditions can also weaken bones.
  • 5. Liver or Kidney Disease: These conditions can disrupt the balance of essential vitamins and minerals. Impaired kidneys struggle to filter phosphorus, which depletes calcium, while liver disease can reduce the production of insulin-like growth factor needed for bone formation, Dr. Templeton points out.
  • 6. History of RED-S or Eating Disorders: Relative Energy Deficiency in Sport (RED-S), common in female athletes who under-consume calories relative to training expenditure, or diagnosed eating disorders can lead to very low body weight, severely impacting bone health, says Dr. Templeton.
  • 7. Recent Significant Weight Loss: Rapid or major weight reduction negatively affects bone health. Dr. Templeton suggests that research indicates a loss of about 1% to 2% of bone mass for every 10% of body weight lost, often due to reduced load-bearing stimulus on the bones.

Next Steps After Identifying Low Bone Density

If a DEXA scan reveals lower-than-expected bone density for your age, it is crucial to discuss the underlying cause with your physician. Potential causes include genetics, existing health conditions, significant weight loss, or lifestyle factors like heavy alcohol use or poor calcium and vitamin D intake.

If the cause is unclear, further testing for other underlying health issues may be necessary, as bone loss can sometimes precede other symptoms, Dr. Templeton mentions. Regardless of the cause, focusing on bone-building habits is essential for those at high risk.

Strategies for Bone Health Maintenance

Dr. Bukata recommends several key habits: avoiding smoking and excessive alcohol, increasing intake of protein, calcium, and vitamin D, incorporating weight-bearing and strength-building exercises, and practicing balance training to prevent falls. For those approaching menopause, discussing hormone therapy to restore estrogen levels is also recommended. If risk factors are numerous or DEXA results are poor, medication may be suggested to slow bone loss. Awareness through screening is the critical first step, allowing for earlier intervention to prevent future fractures, Dr. Bukata concludes.