Bone density screening is typically recommended only after age 65, but women with risk factors may benefit from earlier testing to catch bone loss before it becomes serious. A DXA (dual-energy X-ray absorptiometry) scan, a low-dose X-ray that measures bone mineral density, can reveal whether your bones are weakening years before a fracture occurs. Yet most women never request one until they're in their mid-60s, potentially missing a critical window to take preventive action.

Health journalist Niki Bezzant discovered this gap firsthand when she requested a DXA scan in her 50s based on family history. Despite years of strength training and hormone replacement therapy, her scan revealed osteopenia at her hip, a condition where bone density falls between normal and osteoporosis levels. Her T-score of negative 1.8 at the femoral neck (the narrow part of the thighbone at the hip) placed her in the osteopenia range, defined as a T-score between negative 1.0 and negative 2.5.

Why Does Family History Matter So Much for Bone Health?

Bezzant's case highlights a critical risk factor many women overlook: genetics. Family history accounts for up to 75% of the bone density you'll have throughout your life, according to endocrinologist Anna Fenton, one of the experts interviewed for Bezzant's research. Bezzant's mother has osteoporosis, as do her three aunts, making her genetic predisposition substantial. This means that even with excellent exercise habits and good nutrition, some people face inherent challenges in maintaining bone density.

Beyond genetics, several other factors accelerate bone loss in midlife women. Menopause itself is a major culprit: estrogen is a powerful protector of bone, and when estrogen levels drop during menopause, bone protection diminishes significantly. Additionally, being naturally thin or having lost weight at any stage of life can compromise bone health. Bezzant, who has maintained a lower body weight throughout her life, notes that bones don't thrive in thin bodies, and her peak bone mass was likely never optimal to begin with.

What Screening Recommendations Do Experts Actually Suggest?

Current guidelines recommend bone density screening for all women beginning at age 65. However, women with specific risk factors should discuss earlier testing with their healthcare provider. These risk factors include family history of osteoporosis, a personal history of fracture, certain medical conditions like rheumatoid arthritis or diabetes, and being naturally thin or having experienced significant weight loss.

The challenge is that many women don't know they have these risk factors until they ask. Bezzant's doctor was far less concerned about her osteopenia diagnosis than Bezzant herself was, explaining that a DXA scan requires interpretation by a specialist who considers the whole person, not just the numbers. Her endocrinologist noted that her lumbar spine was within normal range for a young adult, and her FRAX score (a calculation of hip fracture risk over the next 10 years) was excellent at 0.7, indicating very low fracture risk.

How to Strengthen Your Bones at Any Age

• Strength Training: Regular resistance exercises, particularly working muscles to near failure, build bone density and muscle mass simultaneously. Bezzant has been strength training since her mid-40s and added an extra session weekly, focusing on pushing each exercise to the point of fatigue.
• Impact and Jumping Exercises: Emerging evidence suggests that jumping with sufficient ground reaction force can help bones rebuild. Dr. Tracey Clissold, an expert Bezzant interviewed, has studied jumping with rebounds as a bone-building strategy, though current research focuses on pre-menopausal women.
• Balance Training: Since bone loss only becomes a health problem if you fall and fracture, balance exercises like single-leg deadlifts and lunges reduce fall risk and improve your ability to catch yourself if you do stumble.
• Adequate Calcium Intake: Bones require regular calcium in good amounts. Bezzant, who had consumed little dairy throughout her life, is now prioritizing calcium-rich foods over supplements, as some evidence suggests calcium supplements may have negative cardiovascular effects.
• Vitamin D Supplementation: Vitamin D is essential for calcium absorption. Bezzant's scan revealed low vitamin D levels, and she was prescribed monthly vitamin D pills to boost her levels, a common intervention when deficiency is detected.

The broader lesson from Bezzant's experience is that waiting until age 65 to check bone health may be too late. Many women discover weakened bones only after falling and experiencing a serious fracture. In her research, Bezzant interviewed women her age who had not discovered their bone loss until a fall resulted in a significant fracture, a scenario that could have been prevented with earlier screening and intervention.

"Family history accounts for up to 75% of the bone density we end up with," explained Anna Fenton, an endocrinologist.

Anna Fenton, Endocrinologist

If you have risk factors for osteoporosis, such as family history, a history of fracture, or certain medical conditions, your doctor may recommend a DXA scan earlier than age 65. The test is non-invasive, quick, and can reveal whether your bones are weakening before symptoms appear. For women concerned about their bone health, asking for a DXA scan could be literally revealing, offering the chance to take preventive action while there's still time to make a meaningful difference.