Bone health is a critical aspect of aging, and studies show that bone density in women tends to decline more rapidly with age than in men. Women face a significantly higher risk of osteoporosis, with nearly one in five women over age 50 having the disease, compared to just one in twenty men. This stark difference in risk is why regular bone health screening is emphasized for women as they age, to detect bone loss early and prevent fractures.
Understanding Bone Density and Osteoporosis
Osteoporosis is often called a “silent” disease because bone loss occurs without obvious symptoms until a fracture happens. It is defined by a loss of bone mass and density that weakens the bones, making them fragile and prone to breaking. To assess bone strength and detect osteoporosis before a fracture, doctors use a specialized X-ray scan called a bone mineral density test. This bone densitometry test, most commonly a DEXA scan, measures how much calcium and other minerals are present in your bones.
Why Women Are at Greater Risk for Bone Loss
Women experience osteoporosis at much higher rates than men due to a combination of biological factors. In general, women have smaller, thinner bones than men, and they also tend to live longer, which means they undergo more years of age-related bone loss. As a result, about 80% of the 10 million Americans with osteoporosis are women. Men, on the other hand, typically start out with larger bones and do not face an equivalent abrupt hormonal change in midlife, so age-related bone loss in men tends to occur later and progress more gradually. These differences in bone structure and aging are a key reason women need earlier and more frequent bone density screenings.
Menopause and Bone Loss
The link between menopause and bone loss is one of the biggest reasons women's bone density drops faster with age. When women reach menopause, the body’s estrogen levels plummet – and as a result, they can lose a significant amount of bone mass in a short period. Women may shed up to about 10% of their bone mass within the first five years after menopause due to this sharp decline in estrogen. This rapid post-menopausal bone loss makes women much more susceptible to osteoporosis than men.
Men do experience a gradual drop in testosterone with age, but it tends to cause slower, steadier bone thinning without the sudden downturn that women face. The estrogen deficiency after menopause essentially removes a protective effect on women’s bones, so their bone density can decrease quickly unless steps are taken to counteract it.
Common Osteoporosis Risk Factors
Of course, sex and age are not the only factors in bone health. There are numerous osteoporosis risk factors. Some you can change, others you cannot. Being aware of these factors can help in managing your bone health:
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Advanced age: The risk of osteoporosis increases as you get older, for both women and men.
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Family history: Having a parent or sibling with osteoporosis or a history of hip fractures raises your risk.
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Body type: People with a small, thin build have less bone mass to draw from as they age, making them more vulnerable to osteoporosis. Women under about 127 pounds or with a very low BMI are at higher risk.
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Certain medical conditions: Disorders like rheumatoid arthritis, thyroid disorders, celiac or inflammatory bowel disease, diabetes, or hormone imbalances can contribute to bone loss.
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Long-term medication use: Chronic use of corticosteroids (steroids like prednisone), some anti-seizure drugs, certain cancer treatments, or high-dose thyroid medication can lead to thinning bones.
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Lifestyle factors: Smoking tobacco and heavy alcohol use are both linked to lower bone density. A sedentary lifestyle also weakens bones over time.
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Poor nutrition: A diet low in calcium and vitamin D will impair bone building. Eating disorders or severe calorie restriction can also cause bone loss.
Among modifiable factors, nutrition plays a huge role. Calcium and bone density are closely connected. A lifelong low intake of calcium contributes to lower bone density, leading to earlier bone loss and higher fracture risk. Likewise, inadequate vitamin D can worsen the problem. The good news is that improving your diet and lifestyle can mitigate many of these risks and help maintain stronger bones.
Bone Density Screening Recommendations
Because of their higher risk, medical guidelines make clear that regular bone density screening is more crucial for women. Most experts advise bone scans for women starting at age 65, even if they have no symptoms. Women younger than 65 are also urged to get tested earlier if they have significant risk factors. For example, a history of fractures or other osteoporosis risks. In contrast, routine screening for men isn’t typically recommended until age 70, unless a man has risk factors that put him at a bone health risk equivalent to an older woman. This means women generally begin bone density testing about 5 years earlier than men do, and physicians remain more vigilant about monitoring women’s bone health throughout later life.
Once a baseline bone density test is done, how often should it be repeated? That depends on the results and the individual’s risk profile. Patients who are found to have osteoporosis or multiple risk factors may be advised to have a DEXA scan every two years or so. If a woman has mild bone loss, her doctor might recommend re-testing in 2–5 years to see if it’s worsening. Those with normal bone density and low risk might only need to repeat the test every 5–10 years. The frequency is tailored to the person. The higher the risk of fracture, the more frequently doctors will monitor bone density. Proactive surveillance in women can catch rapid bone loss and allow for timely treatment or lifestyle changes.
DEXA Scan Costs and Insurance
One practical consideration is the DEXA scan cost and accessibility of testing. Fortunately, bone density testing is not prohibitively expensive, and it is often covered by health insurance for those in recommended screening groups. For patients paying out-of-pocket, the average price of a DEXA bone density test in the U.S. is around $150–$250. Medicare and most private insurance plans typically cover the test for older adults at risk for osteoporosis, which means eligible women can often get screened with little or no copay. If you have insurance, it’s wise to check your plan, but in many cases, a bone density scan will be fully covered for women 65 and over as part of preventive care. Even without insurance, some clinics offer DEXA scans at reasonable self-pay rates or through community health programs, recognizing the importance of bone health screening.
How Is a Bone Density Test Done
The bone density test procedure is usually performed with a machine called a DEXA scanner. You simply lie flat on a padded table while the machine’s scanning arm passes over your body. During the bone density scan, the detector focuses on areas like your hip and lower spine, sites that are most prone to osteoporotic fracture, and it measures how much of the low-dose X-rays are absorbed by your bones.
There are no injections, no contrast dyes, and you remain fully clothed. The entire scan is completed in a matter of minutes, typically about 15 to 20 minutes from start to finish. The radiation exposure is extremely low, so the test is very safe. A DEXA bone density test is an easy, outpatient procedure that gives valuable information about the strength of your bones.
In addition to measuring bone, DEXA technology can also assess body composition. The same scan can differentiate between bone, lean muscle, and fat tissue, essentially providing a body composition scan alongside the bone density measurement. Some facilities, like BOD, which is a dedicated DEXA scan clinic, offer combined bone density and DEXA body composition analyses in one session for a more comprehensive look at your health. In a single painless test, you can learn both how strong your bones are and get insights into your body fat percentage and lean muscle mass. While body composition results aren’t directly related to osteoporosis, they are a useful add-on for overall health assessment. They can motivate positive changes in diet or exercise that also benefit your bones.
Understanding Your DEXA Results (The DEXA Scale)
After the scan, you will receive results in the form of a T-score and sometimes a Z-score. The T-score compares your bone density to that of a healthy young adult, and it’s the number doctors use to determine if you have osteoporosis or low bone mass. Your T-score shows where you fall on the DEXA scale of bone density. Interpreting it is fairly straightforward: a T-score of -1.0 or higher is considered normal bone density, a T-score between -1.0 and -2.5 indicates low bone mass (osteopenia), and a T-score of -2.5 or lower is diagnostic of osteoporosis. For example, a T-score of 0 or -0.5 is normal; a T-score of -1.8 indicates osteopenia, and a T-score of -2.6 indicates osteoporosis. Doctors pay close attention to these numbers because they correlate with fracture risk. The lower your T-score, the weaker your bones are relative to a young adult’s bones. Your report may also include a Z-score, which compares your bone density to what’s typical for someone of your age, sex, and ethnic background. This is mainly used to see if your bone density is unexpectedly low for your peer group.
Signs of Bone Weakness to Watch For
One challenging aspect of osteoporosis is that there are often no obvious signs of bone weakness until a bone actually breaks. You won’t feel your bones getting thinner, and there’s usually no pain as your bones lose density. That’s why osteoporosis is a silent disease. Many people don’t know they have it until they suffer a fracture from a minor fall or strain that generally wouldn’t crack a healthy bone. However, there are a few subtle warning signs that can suggest your bones are becoming fragile. Loss of height over time can indicate weakening spinal bones. Developing a stooped or hunched posture, sometimes called a “dowager’s hump,” is often due to minor compression fractures in the vertebrae of the spine. By the time you experience clear symptoms like fractures, the disease may already be advanced. It’s far better to detect bone weakness early via a scan than to discover it after breaking a bone.
Maintaining Bone Health as You Age
The good news is that there are plenty of steps you can take to protect your bones and reduce the chance that you’ll ever face an osteoporotic fracture. Prioritizing bone health for aging well is crucial to maintaining independence and quality of life. Here are some key strategies for keeping your bones strong:
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Get enough calcium and vitamin D: Calcium is the primary mineral in bones, so a diet rich in calcium is essential for bone density. Adults over 50 generally need 1,200 mg of calcium per day. Dairy products, leafy green vegetables, and fortified foods are good sources. Vitamin D is equally important because it helps your body absorb calcium. Aim for 800–1000 IU of vitamin D daily.
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Engage in weight-bearing exercise: Bones get stronger when you regularly exercise against gravity. Weight-bearing activities like walking, hiking, jogging, dancing, tennis, or climbing stairs help stimulate bone maintenance. Strength training is also excellent for building up the supporting muscles and bones around your hips, spine, and wrists. Aim for at least 30 minutes of weight-bearing exercise most days of the week. Staying active not only preserves bone mass but also improves balance and coordination, which can prevent falls.
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Avoid smoking and limit alcohol: Smoking has a direct negative effect on bone cells and also can lead to earlier menopause, both of which accelerate bone loss. If you smoke, seek help to quit. Your bones will thank you. Excessive alcohol intake is also harmful to bone health and balance. It’s best to drink only in moderation or not at all. Heavy drinking is a known risk factor for osteoporosis and fractures.
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Prevent falls in your environment: Since fractures often result from falls, take steps to fall-proof your life, especially as you get older. Make sure your home is well-lit and free of tripping hazards. Install grab bars in bathrooms and handrails on stairways. If you have balance issues, exercises like tai chi or yoga can improve your stability. Having your vision checked and using any needed corrective lenses can also reduce fall risk.
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Maintain a healthy body weight and diet: Being underweight (BMI < 19) is associated with lower bone density and higher fracture risk, so ensure you’re eating enough nutrient-dense calories to support your bones. Include protein in your diet, as protein is a building block for bone tissue. At the same time, avoid diets that are excessively low in nutrients or that cause rapid weight loss, as these can harm bone health. A balanced diet with plenty of fruits and vegetables provides the vitamins and minerals bones need.
By following these measures, you can greatly improve your bone density or slow down bone loss. Bone is living tissue, constantly remodeling in response to the stresses placed on it and the nutrients available. Even in later life, adopting healthier habits can have a positive effect on your bone strength.
Women need to check their bone density more often than men because they are at a much higher risk for rapid bone loss and osteoporosis. Biological differences mean that women’s bones tend to weaken sooner and faster. As a result, proactive screening and prevention are critical. Regular bone density tests allow women to detect osteoporosis early, and interventions such as diet, exercise, and medications can then be used to protect bone health. Men are certainly not immune to osteoporosis, but their risk generally comes later in life and progresses more slowly, so they don’t require the same level of early routine screening unless risk factors dictate otherwise. The bottom line is that every woman, especially as she approaches menopause and beyond, should be mindful of her bone health. Getting timely bone density scans and taking steps to strengthen your bones will go a long way toward ensuring you remain fracture-free and active throughout your golden years.
Sources
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Centers for Disease Control and Prevention (CDC) – Facts About Bone Density (DEXA Scan) cdc.gov.
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U.S. Office on Women’s Health – Osteoporosis: Women’s Health Fact Sheet womenshealth.gov.
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University Health, San Antonio – Why Osteoporosis Is More Common in Women than Men universityhealth.com.
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Bone Health & Osteoporosis Foundation – Evaluation of Bone Density Testing (Diagnosis Information) bonehealthandosteoporosis.org.
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Mayo Clinic – Osteoporosis: Symptoms and Causes mayoclinic.org
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American Medical Association – What Doctors Wish Patients Knew About Osteoporosis ama-assn.org.