Bone Density Scans: Who Should Get Tested for Osteoporosis

You are in your 60s, your mother broke a hip, or you recently fractured a wrist after a small fall. Now you wonder if you need a bone density scan. Or you had one, and the report says "osteopenia." This guide explains who should be tested, what the scores mean, and how Canadian and US advice compares.

What osteoporosis is

Osteoporosis means bones have become thin and weak. Weak bones break more easily, often from a minor fall or even a cough. These are called fragility fractures. The most common sites are the hip, spine, wrist, and upper arm [4].

Osteoporosis has no symptoms until a bone breaks. Hip fractures in older adults can lead to loss of independence. This is why finding high risk early matters.

What a bone density scan measures

The standard test is dual-energy X-ray absorptiometry (DXA or DEXA). You lie on a table while a scanner passes over your hip and lower spine. It takes about 10 to 20 minutes and uses very little radiation [4].

Reading your T-score

The T-score compares your bone density with that of a healthy young adult [4].

• -1.0 or higher: normal.
• Between -1.0 and -2.5: low bone mass (often called osteopenia).
• -2.5 or lower: osteoporosis.

A Z-score compares you with people your own age. It is used for premenopausal women, men under 50, and children.

What your doctor looks at

Fracture risk, not just the T-score

The T-score is only one part of the picture. Clinicians estimate your chance of a fracture over the next 10 years using a risk tool [3]. The most common tool is FRAX. Canada also uses CAROC.

These tools combine:

• Age and sex.
• Body weight and height.
• A past fragility fracture.
• A parent who broke a hip.
• Smoking and heavy alcohol use.
• Long-term steroid medicines.
• Rheumatoid arthritis and some other conditions.
• The bone density result, when available.

A person with a T-score of -2.0 and a past fracture may be at higher risk than a person with -2.6 and no other risk factors. Osteoporosis Canada's 2023 guideline bases treatment decisions on overall fracture risk measured with a validated tool [3].

A past fracture changes everything

If you have already had a hip or spine fracture from a minor fall, your risk of another is high. Clinicians usually discuss treatment even before a scan.

Who should be tested: US and Canada

US guidance

The US Preventive Services Task Force (USPSTF) 2025 recommendation [1]:

• Women 65 and older: screen (grade B).
• Postmenopausal women under 65 at increased risk, based on a clinical risk tool: screen (grade B).
• Men: not enough evidence to recommend for or against (an "I" statement).

Canadian guidance

The Canadian Task Force on Preventive Health Care 2023 guideline took a different approach [2]:

• Women 65 and older: start with a fracture risk estimate using the Canadian FRAX tool, without a scan. Then discuss the result. Order a DXA scan if you are interested in treatment, and recalculate risk with the T-score.
• Women aged 40 to 64 and men 40 and older: do not screen routinely.

The Task Force calls this "risk assessment first." Other guidelines, including in the US, usually start with the DXA scan [2]. The Task Force ended its mandate in March 2026, and its guideline remains posted for reference.

Osteoporosis Canada's 2023 guideline covers postmenopausal women and men aged 50 and older, and it supports using a validated risk tool to guide testing and treatment [3]. In practice, many Canadian clinicians still order DXA scans for older adults and for people with risk factors.

Repeat scans

The Canadian Task Force found that repeating a DXA scan 3 to 8 years later did not improve fracture prediction for people who were not on treatment [2]. Your clinician may still repeat scans if you are on treatment or your risk changes.

Reducing fracture risk

Whatever your score, these steps help keep bones strong [3]:

• Regular weight-bearing and muscle-strengthening exercise.
• Balance training, such as tai chi, to prevent falls.
• Enough calcium and vitamin D, mainly from food.
• Not smoking and limiting alcohol.
• Making your home safer to prevent falls.

Several medicines lower fracture risk in people at high risk. Your clinician or pharmacist can explain the benefits and side effects for you.

Questions to ask your clinician

• What is my 10-year fracture risk, and which tool did you use?
• Do I need a DXA scan, or is a risk estimate enough for now?
• What does my T-score mean for me?
• Would treatment lower my fracture risk enough to be worth it?
• Do any of my medicines or conditions weaken bones?
• When, if ever, should I repeat the scan?

When to get care quickly

Go to the emergency department or call 911 if you:

• Fall and cannot stand or put weight on your leg.
• Have sudden, severe back pain after a minor fall or lifting, especially with leg weakness or numbness.
• Have a deformed limb or severe pain after a fall.

Bottom line

A bone density scan gives a T-score, but your fracture risk depends on much more. The US recommends DXA screening for women 65 and older and younger postmenopausal women at higher risk. Canada's task force advised a risk calculator first for women 65 and older, with a scan if treatment is on the table. A past fragility fracture is the strongest warning sign.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.