Do you need a bone density test before 65? Doctors break down the guidelines

Routine bone density screenings are generally recommended for women beginning at age 65, but health experts say there are circumstances where earlier testing may be appropriate.

The topic recently gained attention after Kim Kardashian revealed on a podcast that she and her sisters undergo annual bone density scans through a mobile medical service that visits their community.

While the practice may sound proactive, specialists say most younger women do not need routine screening unless they have specific risk factors for osteoporosis or bone loss.

Why Bone Density Matters

Bone density refers to the strength and thickness of bones. Women typically reach peak bone mass in their late 20s, after which bone density generally remains stable for many years.

According to experts, significant bone loss usually begins during late perimenopause and accelerates around menopause due to declining estrogen levels. The most rapid decline often occurs between ages 45 and 55, before slowing later in life.

Other factors that can contribute to bone loss include poor nutrition, smoking, excessive alcohol use, certain medications such as steroids, low body weight, hormonal disorders, and conditions that affect nutrient absorption.

How Bone Density Scans Work

The most common screening tool is a DEXA scan, short for dual-energy X-ray absorptiometry. The painless test uses low-dose X-rays to measure bone mineral density, typically in the hip and spine.

Results help physicians identify osteoporosis or osteopenia, a condition marked by lower-than-normal bone density that can increase fracture risk.

Current recommendations call for routine screening at age 65 for women at average risk. Women with elevated risk factors may benefit from testing sooner.

When Earlier Screening May Be Appropriate

Experts say younger women generally have a low risk of fractures, making routine screening unnecessary in most cases.

However, earlier testing may be recommended for individuals with a family history of osteoporosis, a history of low-impact fractures, eating disorders, irregular menstrual cycles, celiac disease, long-term steroid use, or medications that suppress estrogen.

Some specialists also believe screening during late perimenopause or shortly after menopause may help identify bone loss earlier, although research has not yet conclusively shown that widespread early screening improves long-term outcomes.

Cost can also be a factor. Insurance plans often do not cover DEXA scans before age 65 unless a healthcare provider determines there is a medical reason for the test.

Focusing on Prevention

Rather than pursuing screening at a young age without clear risk factors, experts emphasize maintaining strong bones through lifelong healthy habits.

Adequate calcium, vitamin D, and protein intake are considered essential for bone health. Regular physical activity—particularly resistance training and weight-bearing exercise—can help preserve bone density and reduce fracture risk.

Health professionals also recommend avoiding smoking, limiting alcohol consumption, and incorporating balance exercises later in life to reduce the risk of falls.

While bone density naturally declines with age, experts say building and maintaining strong bones is a lifelong process, and preventive measures taken early can have lasting benefits.