Hormones and menopause | 5 min read
Bone Density Screening After Menopause: When Do You Need a DXA Scan?
Editorial draft — clinical review pending.
Short answer: The U.S. Preventive Services Task Force recommends osteoporosis screening, usually with a DXA bone density scan, for all women 65 and older. It also recommends screening postmenopausal women under 65 who have a higher risk of fracture, based on a risk assessment. Bone loss speeds up after menopause, so your forties and fifties are the time to understand your risk. [1,2]
Key takeaways
- Screening is recommended at 65 for all women and earlier for postmenopausal women with risk factors. [1]
- Bone loss accelerates in the years after menopause. [2]
- Calcium, vitamin D, strength and balance exercise, and avoiding smoking all help protect bone.
Why menopause affects bone
Estrogen helps keep bone breakdown and rebuilding in balance. When it falls, bone breaks down faster than it's replaced. Bone loss is fastest in the first several years after menopause, which raises the risk of osteoporosis and fractures later. [2]
Risk factors that may mean earlier screening
- A previous fracture from a minor fall after age 50.
- A parent who broke a hip.
- Low body weight.
- Smoking or heavy drinking.
- Long-term steroid use or certain other medicines.
- Early menopause, before 45.
- Conditions such as rheumatoid arthritis.
Clinicians often use a tool such as FRAX to estimate your 10-year fracture risk and decide whether a scan is useful before 65. [1]
What a DXA scan involves
A DXA scan is a quick, painless, low-radiation X-ray of the hip and spine. Results are given as a T-score:
- −1.0 or higher: normal.
- Between −1.0 and −2.5: low bone mass (osteopenia).
- −2.5 or lower: osteoporosis.
The result is combined with your other risk factors to decide whether treatment is needed.
Protecting your bones now
- Calcium: women 51 and older need about 1,200 mg a day from food and supplements combined. [3] Food first.
- Vitamin D: 600 IU a day up to age 70 and 800 IU after. [3]
- Exercise: weight-bearing activity like walking, plus strength training and balance work.
- Avoid smoking and limit alcohol.
- Reduce fall risk: good lighting, sturdy shoes and fixing trip hazards.
Check whether your multivitamin already contains calcium or vitamin D before adding more.
If treatment is suggested
Several medicines lower fracture risk. Hormone therapy is FDA approved to prevent bone loss and may be considered if you also have menopause symptoms. Ask about benefits, side effects, how long you'd take it and how it will be monitored.
Frequently asked questions
At what age should women get a bone density test?
At 65, or earlier after menopause if you have risk factors for fracture. [1]
Can I get a DXA scan in my 40s?
Usually only if you have specific risk factors or conditions. Ask your clinician.
Does hormone therapy protect bones?
Yes, it's approved to prevent postmenopausal bone loss, but it's usually chosen when there are also symptoms to treat.
Next step
Add bone health to your next midlife check-in. A HerScripts clinician can review your risk and whether screening makes sense now. Learn about strength and body changes.
Sources
[1] USPSTF, Osteoporosis to Prevent Fractures: Screening, 2025
[2] Office on Women's Health, Menopause and your health
[3] NIH Office of Dietary Supplements, Calcium fact sheet
Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.