Questions for your doctor: Bone density screening

Why this conversation matters

The US Preventive Services Task Force recommends DEXA scans starting at age 65 — but women with risk factors (low body weight, family history, early menopause, smoking) should screen earlier. Many women only learn they have osteoporosis after a fracture, which is a preventable tragedy. Insist on the scan if you have any concerns.

6 questions to ask

• Am I a candidate for an earlier DEXA scan based on my risk factors? — Family history, body weight under 127 lb, smoking, early menopause, or prolonged steroid use all warrant earlier screening.
• When we get results, can we discuss them in person rather than via portal? — T-scores need context. Lumbar T-score of -2.0 with normal femoral neck is different from T-score of -2.0 at the hip.
• If I have osteopenia, what specifically can I do to halt or reverse it? — You want concrete recommendations (calcium, vitamin D, weight-bearing exercise, possibly bisphosphonates), not vague guidance.
• Should I be referred to an endocrinologist or rheumatologist? — For osteoporosis or rapid bone loss, specialist evaluation matters. PCPs may not catch secondary causes.
• What labs should we check to rule out secondary causes of bone loss? — Thyroid, parathyroid, vitamin D, calcium, kidney function, and sometimes celiac disease can all cause secondary bone loss.
• How often should we re-scan? — Typically every 2 years if on treatment, 5 years if stable. Annual scans are usually overkill.

What to bring

• Symptom log — at least 2 weeks of daily entries (severity, time of day, triggers)
• List of current medications and supplements with doses
• Family history of relevant conditions
• Recent lab results, if any (especially hormones, thyroid, vitamin D, lipids)
• A written list of questions — easy to forget under time pressure

Red flags to escalate

• Height loss of 1.5+ inches over decades (silent vertebral fractures)
• New back pain that does not resolve in 2 weeks
• Wrist or hip fracture from a minor fall
• Stooped posture (kyphosis) that worsens

If they dismiss you

If your doctor says "you're too young to worry about bones" but you have risk factors, push back. Insist on a baseline DEXA. This is one of the easiest tests to get and the consequences of missing osteoporosis are severe.

Frequently asked