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 allergies or asthma, an autoimmune disease like lupus or rheumatoid arthritis, or an inflammatory condition like eczema or inflammatory bowel disease (IBD)—you might be on an oral corticosteroid like prednisone for several months (or years) at a time. Though the long-term course can be a key part of keeping symptoms at bay, it can also hurt your bones, Dr. Templeton says, by hindering your ability to form and maintain bone tissue.
Plenty of these conditions themselves may weaken bone over time too, as a result of the inflammation, Dr. Templeton adds. And with IBD, which includes Crohn’s and ulcerative colitis, your gut may not absorb nutrients like calcium and vitamin D properly, she says, which can negatively impact your bone health in the long run too.
5. You have liver or kidney disease.
Dr. Templeton notes that having either of these diseases is a recipe for low bone mass at some point in life because of how they can disrupt the balance of key vitamins and minerals in your system. Both can impact metabolism of vitamin D, minimizing your ability to absorb calcium from food. If your kidneys are impaired, they also can’t adequately filter out phosphorus, which strips your blood of calcium; and if your liver is diseased it won’t be able to pump out as much insulin-like growth factor, which is necessary for bone formation.
6. You have a history of RED-S or an eating disorder.
“RED-S, or relative energy deficiency in sport, is a condition that crops up more often in women athletes and occurs when you don’t take in enough calories to balance out the amount you’re expending with training,” Dr. Templeton says. The result is typically very low body weight, similar to what can happen in some people with an eating disorder—and in either case, your bones can bear the brunt, she says.
7. You’ve recently lost a significant amount of weight.
Any form of major or rapid weight loss (whether due to diet changes, a GLP-1 drug, or gastric bypass surgery) can impact bone health. “Research suggests we lose about 1% to 2% of our bone mass for every 10% of body weight lost,” Dr. Templeton says. In general, weight loss means less load on your bones, which reduces the stimulus to create new bone cells.
What to do if you find out you have low bone density for your age
Should a DEXA reveal signs of low bone density (a.k.a. osteopenia), it’s important to chat with your doctor about the cause. Maybe you identify that it’s genetics, a known health condition, or weight loss, or perhaps it can be tied to aspects of your lifestyle, like long-term smoking or heavy alcohol use (more than a drink a day) or very low intake of calcium or vitamin D (for instance, in vegans or those with a dairy allergy). But if there isn’t a clear culprit, you may need additional testing for other health conditions, Dr. Templeton says. Sometimes bone loss precedes other symptoms.
Testing aside, if you’re at high risk for bone breakdown, focus on bone-building habits. Dr. Bukata’s list: Avoid smoking and heavy alcohol use; ramp up your intake of calcium, vitamin D, and protein (especially if you’re losing weight on a GLP-1); work weight-bearing, strength-building exercise into your routine; and train your balance to limit fall risk. If you’re approaching menopause, she also recommends speaking with your doctor about hormone therapy (HT) to help restore your levels of bone-supportive estrogen. And if you have a handful of risk factors or poor DEXA results, your doctor may suggest medication (like a bisphosphonate) to stem the tide of bone loss.
But the critical first step is understanding your risk and getting screened, if applicable. That’ll help you determine if you’re working with a lower level of bone density than expected for your age, Dr. Bukata says. And the sooner you become aware of bone loss, the more options you have to intervene and prevent fractures in the future.
Related:
- This Is the Workout That Actually Builds Bone Density
- 3 Things Every Woman Should Eat for Bone Health
- 5 Jumping Exercises to Help You Age Better and Live Longer
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