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A bone density test usually means a central dual-energy X-ray absorptiometry scan (DXA, often written DEXA). It estimates bone mineral density (BMD), most often at the hip and lower spine, to help assess osteoporosis and fracture risk. The scan is quick, noninvasive and uses a very small—but not zero—amount of ionizing radiation.
Whether you should have one depends on age, menopause status, fracture history, medical conditions and medicines. In its January 14, 2025 recommendation, the U.S. Preventive Services Task Force (USPSTF) recommends screening women 65 and older and postmenopausal women younger than 65 who are at increased risk. It found evidence insufficient to judge the balance of benefits and harms for routine screening of men, which is not the same as advising men against an individualized evaluation.
What does a bone density test measure?
Central DXA uses two X-ray energy levels to estimate how much mineral, mainly calcium and phosphorus, is contained in a measured area of bone. The result is an areal bone mineral density value, usually reported for the lumbar spine, total hip and femoral neck. These are the standard sites used to assess skeletal strength and calculate internationally recognized scores.
Density at a particular site helps predict fracture risk at that site. A hip measurement is useful for hip-fracture risk, for example, but density is only one part of the picture. Age, previous fractures, family history, smoking, alcohol use, fall risk, body size, medical conditions and medications can all change a person’s overall risk. A DXA report therefore supports a clinical assessment; it is not a complete personal diagnosis by itself.
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DXA is the most commonly used bone measurement test for osteoporosis screening and diagnosis. It is different from a regular X-ray: a standard X-ray can show an established fracture or advanced bone loss, but it is not sensitive enough to measure BMD for routine screening.
When should I ask for a bone density test?
Women 65 and older
The 2025 USPSTF recommendation is clearest for women age 65 years or older: screening is recommended with DXA BMD, with or without a formal fracture-risk assessment. The recommendation is U.S.-specific and applies to adults without a known diagnosis of osteoporosis or a previous fragility fracture.
Postmenopausal women younger than 65
For a postmenopausal woman under 65, the USPSTF recommends a two-step approach rather than an automatic age cutoff. A clinician first reviews risk factors and then uses a validated clinical risk-assessment tool to identify women whose risk is high enough to justify DXA. Risk factors can include low body weight, a parent with a hip fracture, cigarette smoking, excess alcohol use and other factors included in the chosen tool.
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The USPSTF says evidence is insufficient to determine whether routine screening of men produces more benefit than harm. An “I statement” means the available evidence is inadequate for a population-wide recommendation; it does not mean a bone density test is ineffective or inappropriate for every man. Men with fractures, conditions that weaken bone, or medicines associated with bone loss should discuss individualized testing and treatment with a clinician.
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People who fall outside the routine screening statement
The USPSTF screening rule should not be applied mechanically to people who already have osteoporosis, have had a fragility fracture, have secondary osteoporosis, or use bone-loss-associated medicines chronically. Its recommendation also excludes secondary osteoporosis caused by conditions such as cancer, metabolic bone disease or hyperthyroidism, and chronic use of medicines such as glucocorticoids. These situations call for clinical management based on the underlying cause and fracture risk, not simply waiting until a screening age.
Screening policies differ among countries and professional organizations. If you live outside the United States, use your local guidance and your clinician’s assessment rather than assuming the USPSTF ages apply unchanged.
Why screening matters
Osteoporosis can progress without pain or obvious symptoms until a fracture occurs. In USPSTF-reported U.S. data for 2025, age-adjusted osteoporosis prevalence was 27.1% among women and 5.7% among men age 65 or older. Among community-dwelling U.S. residents age 50 or older, the age-adjusted prevalence was 12.6%. These figures describe populations, not an individual’s probability.
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What happens during a DXA scan?
A central DXA appointment is generally simple and noninvasive. You remain fully clothed unless clothing has metal that interferes with the scan, and the technologist positions you on a padded table. The scanner passes over the lower spine and hips while you hold still. The measurement itself commonly takes only minutes, although the entire appointment can be longer because of registration and positioning.
- Before arrival: Ask the imaging facility for its current instructions. Preparation is usually minimal. The facility may ask you not to take calcium supplements for at least 24 hours beforehand.
- Tell the staff about relevant exposures: Report possible pregnancy, a recent barium examination, an injection of contrast material for CT, or a radioisotope scan. Recent contrast or tracer material can interfere with results, and the facility may recommend waiting.
- Positioning: You lie on your back while the technologist positions your legs or feet to obtain standardized hip and spine views. Staying still improves accuracy.
- Scanning: The arm of the DXA machine moves over the body without touching or enclosing you. There is no injection, incision or sedation.
- Afterward: You can normally return to routine activities immediately. A clinician interprets the report alongside your medical history and, when appropriate, a fracture-risk calculator.
DXA uses a very small dose of ionizing radiation. Calling it “radiation-free” is inaccurate. The dose is low, but tell the facility if pregnancy is possible so staff can decide whether to proceed.
What does my T-score mean?
For postmenopausal women and men age 50 or older, the T-score compares your BMD with the average BMD of a healthy young-adult reference population. The lower the T-score, the higher the risk of bone fracture, but the number must be interpreted with your age, fracture history and other clinical factors.
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|---|---|---|
| −1.0 or higher | Normal or healthy bone mass | BMD is within the usual young-adult reference range. |
| Between −1.0 and −2.5 | Low bone mass (often called osteopenia) | BMD is below the young-adult reference but not in the densitometric osteoporosis range. |
| −2.5 or lower | May indicate osteoporosis | The result meets the usual BMD threshold used in diagnostic evaluation. |
The thresholds are not a stand-alone treatment decision. The Bone Health and Osteoporosis Foundation notes that a person can still be diagnosed with osteoporosis when the T-score is above −2.5—for example, after a qualifying fragility fracture or when overall fracture risk is high on a tool such as FRAX. Conversely, a low score does not tell you when a fracture will occur or guarantee that a fracture will happen.
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When are Z-scores used?
Premenopausal women, men younger than 50 and children are generally assessed with Z-scores rather than adult T-score categories. A Z-score compares BMD with people of similar age and related demographic reference groups. A Z-score of −2.0 or less is commonly described as “below the expected range for age.”
Do not label a child or a younger adult as osteoporotic solely by applying the postmenopausal T-score cutoffs. Growth, puberty, pregnancy, hormonal status and the underlying reason for testing affect interpretation. The clinician may investigate nutrition, endocrine disease, malabsorption, medication effects or another secondary cause.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How do other bone tests compare with central DXA?
Several technologies can estimate bone status, but they are not interchangeable. The key distinctions are the measurement site, whether the result is a screening signal or a diagnostic BMD measurement, the imaging method and whether standard T-score classification can be applied.
| Approach | Typical site | Modality and radiation | How the result is used |
|---|---|---|---|
| Central DXA | Hip, femoral neck and lumbar spine | Two-energy X-ray; very low ionizing-radiation dose | Standard screening and diagnostic BMD measurement; supports conventional T-score assessment. |
| Peripheral ultrasound | Often heel; some devices assess the forearm or another peripheral site | Sound waves; no ionizing radiation | Can screen for low bone mass. A result suggesting loss still requires central DXA when a diagnostic measurement is needed. |
| Quantitative CT (QCT) | Usually a central skeletal region, depending on the protocol | CT imaging; radiation exposure is generally higher than DXA | Can assess low bone mass in selected settings, but is less commonly used than DXA and is not a direct substitute in every clinical pathway. |
A home scale, fitness device or supplement cannot measure BMD. A consumer ultrasound result should not be treated as proof that you do—or do not—have osteoporosis without appropriate clinical follow-up.
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How should I act on a DXA report?
Check which site and score are being reported
Reports often list separate values for the lumbar spine, total hip and femoral neck. The lowest valid site may influence diagnostic classification, but artifacts such as arthritis, spinal hardware or a previous fracture can make a site less reliable. Ask which measurements the clinician considers usable.
Put the number into a fracture-risk assessment
Age and previous fractures can raise risk even when BMD is not in the osteoporosis range. A clinician may combine the DXA result with history and a validated fracture-risk tool. Do not use a calculator result as a prescription; medication choice also depends on kidney function, other illnesses, pregnancy potential, dental and jaw history where relevant, and personal preferences.
Look for causes of bone loss
Unexpectedly low BMD may prompt review of thyroid or parathyroid disease, malabsorption, kidney or liver disease, low sex hormones, nutritional deficiencies, cancer-related conditions and medicines such as long-term glucocorticoids. Treating an underlying cause can be as important as the density number.
How often should I repeat the test?
There is no single evidence-based interval that fits everyone. The USPSTF says evidence about appropriate repeat-screening intervals is limited. Timing should depend on the initial result, age, fracture history, rate of expected bone loss, new medications or medical conditions, and whether a new measurement would change management.
Repeating too soon can produce a change smaller than the scanner’s measurement error and create confusion. Repeating after a clinically meaningful interval, ideally on the same machine or a facility using compatible quality standards, makes comparisons more useful. A new fracture or start of a bone-loss-associated medicine may justify earlier clinical review even if a routine rescan was not yet planned.
Quick Recap
Common mistakes and how to avoid them
- Assuming an age rule applies to everyone: The USPSTF guidance is for a defined U.S. population and does not replace evaluation of secondary osteoporosis or prior fragility fracture.
- Calling DXA radiation-free: It uses a very small dose of ionizing radiation, so disclose possible pregnancy and recent contrast or tracer studies.
- Treating osteopenia as a diagnosis of osteoporosis: Low bone mass is a range. Overall fracture risk, not the label alone, guides management.
- Using a T-score for a child or young adult: Ask for age-appropriate Z-score interpretation.
- Accepting peripheral ultrasound as a definitive diagnosis: A suspicious peripheral result needs central DXA when diagnosis or treatment decisions require standard BMD measurement.
- Comparing scans without checking the machine or site: Different scanners, regions of the skeleton and reporting methods can make apparent changes misleading.
Questions to discuss at the appointment
- Which risk factors make testing appropriate in my case?
- Which sites will be scanned, and are there reasons one site may be unreliable?
- Should I have a fracture-risk calculation in addition to BMD?
- Could a medicine or medical condition be causing bone loss?
- What result would change treatment, fall-prevention planning or follow-up?
- When would repeating the measurement provide useful information?
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