Bone Health After 50: Who Needs a Bone Density Test
Updated: 5 hours ago
By Dr. Harman Virk, DO — Board‑Certified Internal Medicine, The Modern Medicine Group (Fresno, CA)
Medical disclaimer: This article is educational and not medical advice. If symptoms are severe, worsening, or you’re worried—seek urgent care or call 911.
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Quick take
Osteoporosis is silent. The first symptom is usually a broken bone, which is exactly what screening exists to prevent.
Screening is generally recommended for women at 65, and earlier for postmenopausal women with risk factors. Men with risk factors should also be assessed.
A hip fracture after 65 is a life-altering event, not just an orthopedic one. Prevention is the whole point.
A fracture from a minor fall — falling from standing height — is itself a red flag, regardless of your last scan.
Weight-bearing exercise, adequate calcium and vitamin D, not smoking, and limiting alcohol are the foundation. Medication is added when risk is high.
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Table of Contents
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1) What osteoporosis is and why it stays silent
Bone is living tissue that is continuously broken down and rebuilt. Through mid-life, the balance shifts and breakdown begins to outpace rebuilding. Bone becomes less dense and more porous.
There are no symptoms during that process. No pain, no warning, nothing you would notice.
The first sign is usually a fracture — a wrist after catching yourself, a hip after a minor fall, or spinal compression fractures that cause height loss and a rounded upper back, sometimes without a memorable injury at all.
This is why screening exists. Waiting for a symptom means waiting for a broken bone.
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2) Who should be screened
Women. Screening is generally recommended beginning at 65. Screening earlier is appropriate for postmenopausal women under 65 whose fracture risk is comparable to that of a 65-year-old, based on risk factors.
Men. There is no universal screening age, but assessment is appropriate for men with risk factors — long-term steroid use, low testosterone, prior fracture, significant smoking or alcohol use, or certain medical conditions.
Anyone, at any age, should be evaluated after:
A fracture from a fall at standing height or less
Height loss of more than about an inch and a half
Long-term steroid use
A new spinal compression fracture found on imaging
Risk factors that lower the screening threshold include a parent with a hip fracture, low body weight, early menopause, smoking, heavy alcohol use, rheumatoid arthritis, and chronic kidney or liver disease.
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3) What a bone density scan involves
The standard test is a DEXA scan — dual-energy X-ray absorptiometry.
Practically: you lie on a padded table, fully clothed, while a scanner passes over your hip and lower spine. It takes roughly ten to fifteen minutes, is painless, requires no injection, and uses a very small radiation dose — less than a standard chest X-ray.
There is no recovery and no restriction afterward. Avoid calcium supplements for about 24 hours beforehand if instructed, and mention any recent scan involving contrast dye.
Most insurance plans and Medicare cover screening for those who qualify, commonly every two years when repeated.
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4) Understanding your T-score
Results are reported as a T-score, comparing your bone density to that of a healthy
young adult:
-1.0 and above: normal
Between -1.0 and -2.5: low bone mass, sometimes called osteopenia
-2.5 and below: osteoporosis
A Z-score, comparing you to others your own age, is used in younger adults and can suggest a secondary cause when unusually low.
Two cautions. First, osteopenia is not a disease requiring medication in most people — it is a signal to address the modifiable factors and monitor. Second, a normal score is not permanent; bone density changes, so the interval for repeating matters.
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5) What protects bone
Weight-bearing and resistance exercise. Walking, stair climbing, dancing, and strength training signal bone to maintain density. Swimming and cycling are excellent for health generally but do less for bone.
Balance and strength work. Reduces falls, which is what actually causes fractures.
Calcium, preferably from food — dairy, fortified alternatives, canned fish with bones, leafy greens, tofu. Supplements are used when intake is inadequate; more is not better, and excess has downsides.
Vitamin D, needed to absorb calcium. Levels can be checked, and supplementation should be discussed rather than guessed at.
Protein, adequate intake, which is frequently low in older adults.
Stopping smoking and limiting alcohol.
Fresno note: summer heat drives people indoors for months, reducing both weight-bearing activity and sun exposure. Plan indoor walking and strength routines rather than losing the season.
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6) Falls: the other half of the equation
Weak bone alone does not cause a hip fracture. Weak bone plus a fall does.
Fall prevention is therefore inseparable from bone treatment:
Review medications that cause dizziness or drowsiness
Check blood pressure lying and standing
Have vision checked annually
Improve home lighting and clear walking paths
Install bathroom grab bars
Wear supportive shoes with backs, indoors included
Build lower body strength and balance
Use a cane or walker if recommended — and use it consistently
For the full home walkthrough, Modern Medicine’s related article, Home Safety Checklist for Fresno Seniors Living Alone, pairs directly with this one.
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7) Frequently Asked Questions
At what age should I get a bone density scan?
Generally 65 for women, earlier with risk factors. Men are assessed based on risk rather than a universal age. Ask your doctor what applies to you.
Does osteopenia mean I need medication?
Usually not by itself. It typically means addressing modifiable factors and monitoring, with medication considered if calculated fracture risk is high.
Is a DEXA scan uncomfortable?
No. You lie still, fully clothed, for about ten to fifteen minutes. There is no injection and the radiation dose is very low.
Can I rebuild bone I have already lost?
Some treatments increase bone density, and lifestyle measures slow further loss. The primary goal is preventing fractures rather than returning to a prior number.
Do men get osteoporosis?
Yes. It is underdiagnosed in men, and outcomes after a hip fracture are often worse. Men with risk factors should be assessed.
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Fresno CTA — The Modern Medicine Group
If you are over 65, have broken a bone from a minor fall, or have lost height, a bone density assessment belongs on your list.
The Modern Medicine Group evaluates fracture risk for Fresno patients, orders bone density testing, checks for treatable causes of bone loss, and combines bone treatment with fall prevention.
Visit: 7053 N. Cedar Ave., Fresno, CA 93720
Phone: 559-369-7787
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