In general, we don’t recommend that women your age have a bone density test. For the average woman who doesn’t have any risk factors for osteoporosis, the recommendation of the National Osteoporosis Foundation is to begin having bone density screening tests at age 65.
We reach our greatest bone mass at around age 20, and from age 20 to about age 50, it stays the same. It starts to decline a bit at age 50 and then there’s a bigger dip after age 50. However, if a woman has risk factors for osteoporosis, then it is a good idea to start screening earlier, usually at around age 50.
But believe it or not, nutritional and exercise habits aren’t on the list of risk factors that we consider when deciding to test a woman earlier. These factors do affect bone mass, but for the most part, if you’re eating a healthy American diet and getting some form of exercise, even if it’s just walking and doing normal day-to-day activities, then you may not be at high risk for osteoporosis.
If you have a history of anorexia, or if you have a low body mass index (BMI), those are potential risk factors that would lead me to consider screening you earlier, since both of those can lower your bone density to a greater degree.
Some other risk factors for osteoporosis include undergoing a hysterectomy where your ovaries have also been removed and taking certain medications for rheumatologic issues or breast cancer, since these drugs can sometimes cause bone loss. And we’d also think about starting testing earlier if a woman has a family history of osteoporosis or hip fractures, or a personal history of fractures, chronic smoking, or excess alcohol intake. The most important risk factor for osteoporosis is a previous history of fracture.
The gold standard is a test known as a dual-energy X-ray absorptiometry (DEXA). This test uses a small dose of radiation to measure your bone density in your spine and hip, and in some cases, also your thigh and wrist. The result of that test can help us determine if you have osteoporosis or osteopenia (when your bone density is lower than normal, but not low enough to qualify as osteoporosis).
There are medications that can improve bone density and decrease fracture risk, but we generally don’t recommend that women take them if they only have osteopenia because they do have side effects. The most common are acid reflux, nausea, and muscle aches, but there is also a small risk of developing something called osteonecrosis of the jaw, which is a nonhealing ulcer of the jaw, and other rare conditions.
However, it’s important to keep in mind that for women who have osteoporosis and are at high risk for having a fracture, the benefits of these medications far outweigh the risks of these side effects. We know that there are about 1.5 million osteoporosis-related fractures in the U.S. annually, so it’s a huge problem.
If you’re concerned about your risk, see your primary care provider who can review your history and decide whether a bone density test would be beneficial for you.
