Your bones could be silently thinning for years before you ever fall and break one in midlife or older age—a fate that strikes up to half of women over 50, double the number of men. At the moment of a fracture, you might not even know you’d developed low bone density, as testing doesn’t usually start until age 65 for women. Suddenly, you’re stuck on the couch until your poor hip heals, staring down a long road of limited mobility and rehab.
“You acquire peak bone mass by the time that you’re about 35, which is the most bone that you’ll ever have,” Kim J. Templeton, MD, professor of orthopedic surgery and sports medicine at the University of Kansas Medical Center, tells SELF. The exact amount hinges on genetics as well as your health and lifestyle up to that point. From then, you may begin to shed bone as early as your 40s—unless you actively embrace healthy bone-maintaining behaviors. Menopause accelerates that loss because of dropping estrogen levels, Susan Bukata, MD, professor and chair of the Department of Orthopaedics at UC San Diego and a scientific advisor at Solaria Bio, tells SELF. Women can lose 1% to 2% of their bone mass per year for the decade around the transition.
The reason guidelines suggest women begin screening for bone density at 65, typically through a noninvasive DEXA (dual-energy X-ray absorptiometry) scan, is because by that age, enough of the population has osteoporosis, a disease of fragile bones, to make widespread screening worth the cost and time, Dr. Templeton says. But experts also agree there are plenty of reasons to consider bone-density screening at an earlier age. For starters, 65 is typically several years into the bone-loss phase of menopause, Dr. Bukata points out. And a handful of lifestyle, health, and genetic factors can amplify your risk for an osteoporosis-driven fracture well before that point.
Below, experts break down the top risk factors for low bone density. If any of these applies to you, Dr. Bukata advises checking in with your doctor about whether a DEXA makes sense—regardless of your age. If you have insurance, there’s a good chance the scan will be covered. “It’s cheaper to pay for a DEXA than to pay for somebody after they break their hip,” Dr. Templeton points out.
7 signs you may need a bone density test before 65
1. You’ve broken a bone with little trauma.
If you’ve suffered an everyday injury and wound up with a fracture, it doesn’t speak well of your bone density. “Your bone, by and large, should be able to withstand minor impact in adulthood,” Dr. Templeton says. So breaking a bone with minimal trauma, particularly if it’s happened more than once, suggests you may want to ask your doctor about a DEXA.
2. Your close family member developed osteoporosis at a young age.
“For some of us, our genetics set us up to be either bad bone builders when we are young or big bone losers when we are middle-aged,” Dr. Bukata says. Having a parent or sibling who developed osteoporosis at a younger-than-usual age, say in their 40s or 50s, points to those suboptimal genetics. (One common way osteoporosis shows up is with a broken hip.)
3. You entered menopause before age 45.
Hitting menopause before 45 means spending additional years with less bone-protecting estrogen in your system, which ups your risk of osteoporosis and fractures.
Early menopause can happen as part of medical treatment, for instance in women who take ovary-suppressing medication for a hormone-sensitive condition like endometriosis or cancer and in those who get their ovaries removed. And it can also occur spontaneously in women whose ovaries prematurely slow down production of estrogen.
4. You’re taking corticosteroids long-term.
If you have chronic immune-related issues—for instance severe all