Understanding Bone Density Tests and Preparation

What Bone Density Tests Measure and Why They Matter

Bone density tests, also called DXA scans or DEXA scans, measure how much mineral (mainly calcium) is packed into a section of your bone. Think of bone like a sponge—it has solid parts and tiny holes throughout. As people age, especially women after menopause, those holes can get bigger and the solid parts can get thinner. A bone density test shows whether your bones are becoming more porous and fragile.

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The test uses a small amount of X-ray radiation to take pictures of bones, usually in your hip, spine, and sometimes your forearm. The machine compares your bone density to that of a healthy 30-year-old adult. Your results get a T-score, which tells you how your bones compare to this standard. A T-score of -1.0 or higher is considered normal bone density. Scores between -1.0 and -2.5 suggest low bone density, often called osteopenia. A T-score below -2.5 indicates osteoporosis, meaning bones are significantly weaker and more likely to break.

About 1 in 3 women over age 70 and 1 in 12 men over age 70 have osteoporosis, according to the National Institutes of Health. However, the condition often develops without any symptoms or pain. You might not know your bones are weakening until you break one from a minor fall. This is why bone density testing is valuable—it can identify bone loss before a fracture happens.

Bone density tests matter because they help predict fracture risk. Someone with osteoporosis has a much higher chance of breaking a hip, spine, or wrist from a fall that wouldn't usually cause injury. A hip fracture often leads to surgery, long hospital stays, and difficulty returning to normal activities. Spine fractures can cause height loss and hunched posture. Knowing your bone density status allows you and your doctor to discuss prevention strategies or treatment options.

Practical Takeaway: Bone density tests provide objective measurements of bone strength and fracture risk. Understanding your results helps inform conversations with your healthcare provider about bone health management.

Who Should Get a Bone Density Test

Various professional organizations provide recommendations about who should have bone density testing. The U.S. Preventive Services Task Force recommends bone density screening for all women age 65 and older, and for postmenopausal women younger than 65 who have risk factors for osteoporosis. For men, they recommend screening starting at age 70, or for men age 50-69 with risk factors.

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Risk factors that may suggest you should get tested include family history of osteoporosis or broken bones, personal history of broken bones as an adult, long-term use of certain medications like corticosteroids, conditions affecting calcium or vitamin D absorption (such as celiac disease or inflammatory bowel disease), smoking, heavy alcohol use, and low body weight. Women who are going through or have gone through menopause face higher risk because their bodies produce less estrogen, a hormone that helps maintain bone density.

Specific health conditions increase osteoporosis risk. These include rheumatoid arthritis, chronic kidney disease, diabetes, hyperthyroidism, and certain cancers. People with these conditions may benefit from bone density testing even if they don't have other risk factors. Additionally, certain medications can weaken bones over time. Corticosteroids used for conditions like asthma, lupus, or rheumatoid arthritis are known to reduce bone density. People taking these medications long-term may be candidates for testing.

Some people have multiple risk factors stacked together. For example, a 55-year-old postmenopausal woman who smokes, has a family history of osteoporosis, and takes corticosteroids for rheumatoid arthritis would have substantially higher risk. Conversely, a healthy 60-year-old with no risk factors and good health habits might not need testing yet. Age, sex, and individual circumstances all factor into whether testing makes sense for a particular person.

Practical Takeaway: Bone density testing is generally recommended for women 65 and older, men 70 and older, and younger people with specific risk factors. Your doctor can assess whether testing would be useful based on your personal health history.

How to Prepare for Your Bone Density Test

Preparing for a bone density test is straightforward because the procedure is quick and requires minimal special preparation compared to many medical tests. The most important thing is to wear comfortable, loose-fitting clothing without metal buttons, zippers, or snaps, since these can interfere with the X-ray images. Remove any jewelry, including necklaces, bracelets, and rings. Many facilities ask you to change into a hospital gown, but some allow you to keep your clothes on if they meet the requirements.

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You should avoid taking calcium supplements for at least 24 hours before your test. This timing recommendation exists because supplements can create artifacts—false signals—on the imaging that might skew results slightly. However, you do not need to stop taking other medications, and you should continue taking them as prescribed. Tell your technician or doctor about any medications you take, especially calcium supplements, vitamin D supplements, or hormone replacement therapy, so they can note this information with your results.

Plan to arrive about 10-15 minutes early to complete paperwork and check-in. Bring your insurance card and photo ID. The test itself takes about 10-30 minutes depending on which bones are being scanned and the specific equipment used. Most of this time involves positioning and taking images rather than active scanning. You'll lie on a padded table while the scanner arm moves over the area being tested. There's no pain, injection, or contrast dye involved.

Pregnant women should not have bone density tests because of radiation exposure, even though the radiation dose is very small. If there's any possibility you're pregnant, mention this before the test. Women who are breastfeeding can still have the test. There's no recovery time needed—you can return to normal activities immediately after. Results usually come back within a few days to a couple of weeks, depending on how busy the facility is and whether your doctor reviews them right away.

Practical Takeaway: Wear metal-free clothing, avoid calcium supplements for 24 hours before the test, arrive a little early, and bring your ID and insurance card. The test itself is painless and quick, with no special recovery needed afterward.

Understanding Your Bone Density Test Results

Your bone density results will include a T-score and sometimes a Z-score. The T-score compares your bone density to the peak bone density of a healthy 30-year-old of the same sex. The Z-score compares your results to people of your same age, sex, and body size. Most doctors focus primarily on the T-score for determining osteoporosis risk, though the Z-score provides useful context.

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The T-score categories are: Normal bone density is a T-score of -1.0 or higher. Low bone density (osteopenia) is a T-score between -1.0 and -2.5. Osteoporosis is a T-score of -2.5 or lower. Severe osteoporosis is a T-score below -2.5 with a history of bone fractures. These categories help your doctor understand your fracture risk. Someone with a T-score of -1.5 is not as concerning as someone with a score of -3.0, though both fall into categories suggesting lower-than-normal bone density.

Your results will show measurements from specific bones, typically the lumbar spine, femoral neck (upper thigh bone near the hip), and total hip. The T-score is calculated from these measurements, and doctors often look at them individually. For example, someone might have normal density in their hip but low density in their spine, or vice versa. If any area shows significantly lower density than others, this might suggest particular fracture risk in that region.

Your doctor will interpret results in the context of your overall health. Someone with a T-score of -2.0 and no risk factors might be managed differently than someone with the same score but multiple risk factors like advanced age, smoking, or a recent fracture. Your doctor considers your 10-year fracture risk using tools that factor in age, sex, T-score, and other health factors. This helps determine whether treatment, lifestyle changes, or simply monitoring over time is