Understanding Osteoporosis Screening: Timing, Risk Factors and Next Steps

Questions about bone density testing are incredibly common. Each year, people of all ages ask whether screening is tied to age or sex, what their bone density numbers actually represent and whether abnormal results automatically mean osteoporosis. Understanding test results can sometimes feel overwhelming, but we're here to break down the essentials and answer the most common questions so you can feel informed and confident about your bone health.

How Your Bone Health Changes as You Age

When you think of your bones, you probably assume they're solid and unchanging, but they're actually living tissue that's constantly rebuilding itself. Their strength comes from a combination of three key elements: living bone cells, collagen and mineral compounds made of calcium and phosphorus.

During childhood and early adulthood, your bones grow faster than they break down. Most people reach their highest level of bone strength — known as peak bone mass — between their late teens and mid-twenties. Having strong bones during this peak period reduces your risk of fractures and osteoporosis later in life.

As we age, however, we tend to lose more bone mass than we form. And it speeds up once we hit middle age. For women, menopause plays a major role, as declining estrogen levels are closely linked to faster bone loss.

Osteoporosis Risk Factors

Osteoporosis develops when the body breaks down bone faster than it can rebuild it or when it produces too little new bone. Over time, bones become thinner, weaker and more porous, increasing the likelihood of fractures — even from everyday movements or minor falls.

Osteoporosis rarely causes noticeable symptoms in its early stages, and many people are unaware they even have low bone density until they break a bone. Osteoporosis is very common, affecting millions of people around the world. However, certain risk factors can increase your risk of developing the condition. You may be at increased risk for osteoporosis if you:

• Are 50 years of age or older
• Are a woman experiencing or past menopause
• Have a parent who has broken a hip
• Have experienced previous bone fractures as an adult
• Have low levels of vitamin D
• Live with rheumatoid arthritis
• Smoke or consume alcohol regularly
• Use certain medications, including long-term steroids or proton pump inhibitors

Identifying low bone density early makes it possible to take steps that protect your bone health before you experience fractures.

Screening for Bone Density Loss

A bone density scan, also called a dual-energy X-ray absorptiometry (DEXA or DXA), is a quick, noninvasive test that assesses bone strength and fracture risk. It's the standard test used to diagnose osteoporosis and identify early bone loss. Using a low-dose X-ray, the scan typically focuses on the hips and lower spine and takes about 10 minutes to complete.

Your trabecular bone score (TBS) is determined from your DEXA scan and helps your doctor assess your risk of future fractures more accurately, with no additional radiation or time required.

Evaluating bone mineral density alone can be misleading as it’s affected by degenerative endplate sclerosis, facet arthrosis and other factors that affect bone microarchitecture, but not always bone density. TBS offers valuable context that can lead to earlier detection, more accurate diagnosis and more individualized treatment plans.

Generally, experts recommend that women begin routine screening for bone density loss at age 65 and men at age 70. Earlier screening may be advised for anyone at risk for significant bone loss or fracture, regardless of age or gender.

Preventing and Treating Osteoporosis

Bone health matters at every stage of life, and it's never too early to start supporting your bones. Here are some simple strategies to care for your bone health:

• Eat a calcium-rich diet
• Maintain healthy vitamin D levels
• Stay physically active

If testing shows an elevated fracture risk, your doctor may also suggest medications or supplements.

Helping You Live a Pain-Free Life

At AdventHealth, our compassionate orthopedic teams are dedicated to caring for your bone health so you can stay stronger, longer. Take the next step today and let us help you find relief.