A bone density test usually means a central dual-energy X-ray absorptiometry scan, abbreviated DXA or DEXA. It estimates bone mineral density (BMD), most often at the hip and lower spine, to help assess osteoporosis and fracture risk. The result is one part of a medical evaluation—not a complete diagnosis by itself.
In the United States, the current U.S. Preventive Services Task Force (USPSTF) recommendation, issued January 14, 2025, supports screening women age 65 and older and postmenopausal women younger than 65 who are at increased risk. Men should discuss personal risk with a clinician because evidence is insufficient for a routine screening recommendation.
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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 packed into a measured area of bone. The report expresses this as bone mineral density. It commonly includes the lumbar spine, femoral neck and total hip, although the exact sites depend on the facility and clinical question.
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Density at a particular site helps predict fracture risk at that site. A hip measurement is useful for understanding hip-fracture risk, while a spine measurement can reveal low density in the vertebrae. Density is not the only determinant of a broken bone: age, previous fractures, medications, falls, health conditions and other clinical factors also matter.
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DXA is the most commonly used test for osteoporosis screening and diagnosis. It is noninvasive and uses a very small dose of ionizing radiation. “Low dose” does not mean radiation-free, so tell the facility if pregnancy is possible.
When should I ask for a bone density test?
Women age 65 or older
The 2025 USPSTF recommendation advises screening women 65 years or older with DXA BMD, with or without a formal fracture-risk assessment. This is a U.S.-specific preventive recommendation; other countries and professional organizations may use different policies.
Postmenopausal women younger than 65
For a postmenopausal woman under 65, the USPSTF recommends a two-stage approach rather than an automatic age cutoff. A clinician first reviews risk factors and then uses a validated clinical risk-assessment tool to determine whether the person is at increased risk and should have DXA.
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Risk assessment can include factors such as age, body size, family or personal fracture history, smoking, alcohol use, falls, and medicines or illnesses that weaken bone. The exact tool and threshold are clinical decisions; a checklist alone does not establish osteoporosis.
Men
The USPSTF says evidence is insufficient to determine the balance of benefits and harms of routine screening in men. An “I” statement means the evidence is incomplete, not that testing is harmful or that men should never be tested. A man with fractures, substantial risk factors, or a condition or medicine associated with bone loss should discuss individualized evaluation rather than applying the women’s screening rule.
People outside the routine screening population
The USPSTF statement applies to adults age 40 and older who do not already have diagnosed osteoporosis and have no history of a fragility fracture. It does not cover secondary osteoporosis caused by conditions such as cancer, metabolic bone disease or hyperthyroidism, or chronic use of medicines associated with bone loss, including glucocorticoids. Those situations call for clinical management and may justify testing regardless of a routine screening schedule.
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Why bone health matters
The USPSTF reported that, in U.S. adults age 65 and older, age-adjusted osteoporosis prevalence was 27.1% among women and 5.7% among men. Among community-dwelling U.S. residents age 50 and older, the reported age-adjusted prevalence was 12.6%. These figures describe populations, not an individual’s probability of disease.
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A free scan shows the junk files, broken settings and background clutter dragging Windows down - then fixes them in one click.Free scan · Windows 10 & 11Hip fractures can have consequences beyond the bone itself. The USPSTF reports that only 40% to 60% of people who experience a hip fracture recover their pre-fracture mobility and ability to perform activities of daily living. A density test is one way to identify risk early enough for a clinician to consider prevention or treatment.
What happens during a DXA scan?
Before the appointment
- Follow the imaging center’s current instructions. RadiologyInfo states that DXA generally needs little to no special preparation.
- Ask whether to stop calcium supplements. RadiologyInfo says patients may be asked not to take them for at least 24 hours before the scan.
- Tell the facility if pregnancy is possible.
- Report a recent barium examination, an injection of contrast material for CT, or a radioisotope scan. Residual contrast can interfere with imaging, and the facility may recommend waiting.
- Wear clothing that allows easy access to the lower spine and hips, and follow any instructions about metal fasteners or changing clothes.
During the scan
- You lie on the examination table while the scanner passes over the lower spine and hip region.
- The machine sends two low-energy X-ray beams through the selected areas.
- A detector measures how much of each beam is absorbed, and software calculates BMD.
- You must remain still while images are acquired. The procedure is painless and does not require an injection.
RadiologyInfo describes the examination as simple, quick and noninvasive. The technologist can explain positioning and facility-specific timing. The scan does not by itself show every cause of bone weakness, and it is not a substitute for evaluating symptoms such as sudden back pain after a possible vertebral fracture.
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What does my T-score mean?
For postmenopausal women and men age 50 or older, a T-score compares measured BMD with the average BMD of a healthy young-adult reference population. NIAMS lists these commonly used categories:
| T-score | Usual interpretation | What it does—and does not—tell you |
|---|---|---|
| −1 or higher | Healthy or normal bone mass | Lower fracture risk than low-density categories, but not zero risk. |
| Between −1 and −2.5 | Low bone mass, often called osteopenia | Signals lower density; overall fracture risk still depends on clinical factors. |
| −2.5 or lower | May indicate osteoporosis | Usually meets the densitometric threshold for osteoporosis at an accepted site. |
NIAMS summarizes the relationship this way: “The lower your T-score, the higher your risk of bone fracture.” The value must still be interpreted with the scan site, image quality and medical history. The Bone Health and Osteoporosis Foundation notes that a person can be diagnosed with osteoporosis even when the T-score is above −2.5—for example, after a qualifying broken bone or when fracture risk calculated with FRAX is high.
When is a Z-score used?
Premenopausal women, men younger than 50 and children are generally assessed with a Z-score. It compares BMD with people of similar age and relevant demographic reference categories rather than with a young-adult peak-bone-mass group. NIAMS describes a Z-score of −2.0 or less as low and recommends the wording “below the expected range for age.” Adult T-score categories should not be transferred to these groups as if the measures were interchangeable.
DXA, ultrasound and QCT: how the tests differ
These approaches can all be used in bone-health evaluation, but their results are not interchangeable.
| Approach | Typical measurement site | Role | Imaging and radiation | Standard T-score use |
|---|---|---|---|---|
| Central DXA | Hip, femoral neck, total hip and lumbar spine | Common screening and diagnostic BMD measurement | Two-energy X-ray; very low ionizing-radiation dose | Directly supports standard T-score classification at validated sites |
| Peripheral ultrasound | Often heel or forearm | Can screen for low bone mass | Ultrasound; no ionizing radiation | A result suggesting bone loss still requires DXA for diagnosis |
| Quantitative CT (QCT) | Can assess vertebral or other regions, depending on protocol | Alternative imaging approach in some settings | Computed tomography; radiation exposure is higher than DXA and varies by protocol | Not generally interchangeable with central DXA categories |
RadiologyInfo describes QCT as less commonly used than DXA. A peripheral ultrasound device can be useful as a screening signal, but a low result should not be treated as a definitive osteoporosis diagnosis without appropriate DXA or other clinical evaluation.
How clinicians use the result
A clinician checks which sites were measured, whether the images are technically adequate, and which score is appropriate for the patient’s age and menopausal status. The result is combined with fracture history, family history, medication exposure, falls, other illnesses and, when appropriate, a fracture-risk calculator such as FRAX.
A low score may lead to advice about fall prevention, nutrition, physical activity, medication review, treatment or additional evaluation for secondary causes. A normal score does not eliminate fracture risk, particularly when falls or other major risk factors are present. Conversely, a single low number should not be interpreted without checking for artifacts, differences between sites and the patient’s broader history.
How often should I repeat the test?
There is no single repeat-testing interval supported for everyone. The 2025 USPSTF statement says evidence about appropriate rescreening intervals is limited. Follow-up timing depends on the initial result, age, new fractures, changes in medicines or health conditions, and whether a new measurement is likely to change care.
Ask what decision the next scan is intended to inform. Repeating a test too soon may produce a change smaller than the scanner’s measurement error, while waiting may be inappropriate for someone whose risk has changed substantially. The ordering clinician and imaging facility can determine a clinically useful interval.
Quick Recap
Questions to take to your clinician or imaging center
- Do my age, menopause status and risk factors make DXA appropriate now?
- Am I being evaluated under routine screening guidance, or because of a fracture, illness or medication?
- Which sites will be measured, and will the report include hip and lumbar-spine results?
- Should I pause calcium supplements, and for how long?
- Could a recent contrast study or radioisotope scan affect scheduling?
- Which score applies to me: T-score or Z-score?
- How will the result be combined with fracture history or FRAX?
- What change in my health would justify repeating the scan?
Key limits to keep in mind
- DXA estimates density; it does not directly measure bone strength, bone quality or your exact chance of a fracture.
- The test uses ionizing radiation, although the dose is very small.
- A peripheral ultrasound result cannot replace diagnostic central DXA when osteoporosis needs to be established.
- Routine screening rules do not cover every patient, especially people with known osteoporosis, previous fragility fractures, secondary osteoporosis or chronic bone-loss-associated medication use.
- Screening guidance differs by country and organization, so the 2025 USPSTF recommendation should not be presented as a universal global rule.
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