Osteoporosis rarely announces itself. The National Institute on Aging calls it a silent disease because people often notice nothing until a bone breaks, usually in the hip, spine or wrist. A bone density test can find thinning bones years before that happens, while there is still time to act.

What osteoporosis is

Bone is living tissue that the body constantly breaks down and rebuilds. NIA explains that osteoporosis develops when more bone is broken down than replaced, leaving bones thinner and more fragile. Osteopenia is the in-between stage, when bone density is lower than normal but not yet in the osteoporosis range.

NIA reports that osteoporosis affects about one in five women over 50, but only one in 20 men. Women of White and Asian descent are more likely to develop it. NIA lists other risk factors including a family history of broken bones or osteoporosis, a broken bone after age 50, surgery to remove the ovaries before natural menopause, and too little calcium or vitamin D in the diet.

Fractures are the real concern. According to the CDC, nearly 319,000 older people are hospitalized for hip fractures each year, and most hip fractures are caused by falls. A broken bone after a minor fall, such as a wrist fracture from tripping on a step, deserves a conversation about bone health, even if no one has mentioned osteoporosis before.

The test: a DXA scan

The standard test is a DXA scan, a low-dose x-ray that measures calcium and other minerals in your bones, usually at the hip and spine. It is painless, takes a few minutes and you stay clothed for most of it.

Results are usually reported as a T-score, which MedlinePlus explains compares your bone density with that of a healthy young adult of the same sex. The lower the score, the higher the risk of fracture. The Bone Health and Osteoporosis Foundation explains that a T-score of -2.5 or below indicates osteoporosis, assuming there is no other reason for such a low score, and that a spine or hip fracture after 50 points to osteoporosis whatever the T-score.

Your doctor will read the score together with your age, history and other risk factors, often using a fracture risk calculator, rather than by the number alone.

Who should be screened: women

The US Preventive Services Task Force updated its recommendation in 2025. It recommends screening for osteoporosis in all women 65 and older, and in postmenopausal women younger than 65 who are at increased risk based on a clinical risk assessment.

The Bone Health and Osteoporosis Foundation gives examples of risk factors that can prompt earlier testing: a family history of osteoporosis or fracture, frequent falls, vitamin D deficiency, smoking, heavy drinking, conditions that affect absorption, and some medicines such as prednisone.

Who should be screened: men

Men lose bone too, though usually later in life. The USPSTF found the evidence insufficient to recommend for or against screening men, which is a statement about the research, not a finding that men are safe.

Other groups give firmer advice. The Endocrine Society’s guideline on osteoporosis in men recommends testing men aged 70 and older, and men aged 50 to 69 with risk factors such as low body weight, a prior fracture as an adult or smoking. The Bone Health and Osteoporosis Foundation suggests talking with your provider about a test if you are a woman 65 or older, a man 70 or older, or have broken a bone since age 50.

What Medicare covers

Medicare Part B covers a bone mass measurement once every 24 months, or more often if medically necessary, for people who meet certain conditions, such as women at risk for osteoporosis. You pay nothing if your provider accepts assignment. The Medicare page lists the qualifying conditions.

Protecting your bones

  • Weight-bearing and strength exercise. Walking, stair climbing and resistance training load the bones. See strength training after 50.
  • Enough calcium and vitamin D, preferably from food, with supplements only if your doctor suggests them. See our article on vitamin supplements.
  • No smoking, and modest or no alcohol.
  • Fall prevention, since most fractures start with a fall. See balance and fall prevention.
  • A medicine review, because some medicines thin bone and others raise fall risk.

If a scan shows osteoporosis, effective treatments exist, and the choice among them depends on your fracture risk, kidney function and other medicines.

Kidney function is part of choosing among bone medicines, an area where Dr. Shtern’s background in Nephrology is useful. At Legacy Medical, she can review your risk, order a scan when it is due and go through the result with you. To meet her, book a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.