The DEXA Dilemma: Why Waiting Until 65 Is Too Late
The truth about bone density, menopause, and why early testing could save your strength—and your life.
Let’s get real about bone health — especially for women in the thick of hormonal shifts (yes, I’m talking peri-, post-, and all the “pause” in between).
We’re going to break down the good, the bad, and the “wait—what?!” of bone density screening — specifically the DEXA scan — and why current guidelines might be failing too many women.
Dr. Bardi’s Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
What is a DEXA scan (again)?
A DEXA scan (Dual-Energy X-ray Absorptiometry) measures your bone mineral density (BMD), usually at the hip and lumbar spine. It gives you two key numbers:
T-score: compares your bone density to a healthy young adult
Z-score: compares your bone density to others of your same age, race, and sex
Here’s how your T-score is classified:
≥ -1.0: “Normal” bone density
Between -1.0 and -2.5: “Low bone mass” (osteopenia)
≤ -2.5: Osteoporosis (in postmenopausal women)
Why It Matters for Women
Estrogen protects bones by slowing bone breakdown (resorption). When estrogen drops after menopause, bone loss accelerates — and the risk for fracture climbs dramatically.
That’s not theory; that’s biology. And it starts earlier than most people think.
The Standard Guidelines for Women — and Why It’s Nonsense.
The U.S Preventive Services Task Force (USPSTF) recommends bone-density screening with a DEXA scan for all women aged 65 years or older. This sounds reasonable… until you look at the data.
“When does bone loss start?” you might ask.
Bone loss accelerates right around menopause — the average age being 51–52. During the first 5–7 years after menopause, women lose 1–2% of bone density per year, and in some cases up to 3–5% annually if they’re thin, sedentary, or not on hormone therapy.
That means many women lose up to 20% of their total bone mass before they even qualify for their first DEXA scan.
So when guidelines say, “We’ll check you at 65,” what they really mean is: We’ll wait until you’ve potentially lost a fifth of your bone mass before we look.
It’s like waiting until the house is on fire to install a smoke detector.
The Overlooked Half: DEXA Body Composition Scans
Here’s where things get even more interesting.
That same DEXA machine that measures bone density can also measure body composition — breaking down your muscle mass, fat mass, and visceral fat (the deeper fat around your organs).
Why does this matter? Because bone and muscle health are inseparable.
Your muscles are what protect your bones — they absorb impact, stabilize your joints, and literally hold you upright. When muscle mass declines (a process called sarcopenia), your risk of falls and fractures skyrockets, even if your bone density isn’t technically in the “osteoporosis” range.
And fractures are not just painful or inconvenient — they can be deadly.
Hip fractures, in particular, are one of the leading causes of disability and mortality in older adults. Nearly one in three adults over 50 dies within a year of a hip fracture, largely due to complications from immobility, infection, and muscle wasting.
So when we talk about bone density, we can’t ignore muscle mass. DEXA composition scans give us a full picture — the structure (your bones) and the support system (your muscle). Both matter if your goal is to stay strong, balanced, and independent into your later decades.
Behind the Scenes: How I Approach This in Practice
In my practice, I encourage women to get a baseline DEXA scan around age 50, right as they enter menopause. From there, we repeat it every two years to track both bone density and body composition over time.
These results help us fine-tune everything — from hormone therapy adjustments to exercise programming (especially resistance and strength training) and protein intake goals.
It’s one of the simplest, most powerful ways to monitor how your body is aging — and how well our interventions are truly protecting your longevity.
Taking the Power Back: Getting a DEXA on Your Own
Here’s the part I love most about where we are in medicine right now — access is shifting.
You no longer need to wait for a doctor to “order” a DEXA scan or meet some arbitrary guideline threshold. Across the country, independent DEXA wellness centers have popped up where you can schedule your own scan, pay out of pocket, and get results the same day.
The cost? Usually between $75–$150 — far less than most lab panels or imaging tests. And the value? Huge.
You get clear, data-driven insight into how your bones and muscles are changing right now, not years down the line. No gatekeeping, no insurance denials, no waiting until you’re “old enough.”
This is what I mean by taking your health into your own hands — not in rebellion, but in partnership with your future self.
If your results show early changes, that’s good news. It means you have time to act.
Getting a DEXA scan is one of the simplest, smartest investments in your longevity.
The Takeaway
The DEXA scan is more than a diagnostic — it’s a roadmap.
It tells the story of how your body is adapting, strengthening, and responding to time. And the earlier we start tracking that story, the more influence you have over how it unfolds.
As always, I’m happy to help.
References:
NIH Osteoporosis and Related Bone Diseases Resource Center. Osteoporosis Overview. National Institutes of Health. Updated March 2024. Available at: https://www.bones.nih.gov
North American Menopause Society (NAMS). The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause.2023;30(7):766–787.
Ensrud KE, Crandall CJ. Osteoporosis. Ann Intern Med. 2017;167(3):ITC17–ITC32. doi:10.7326/AITC201708010
Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2020;105(3):dgaa048. doi:10.1210/clinem/dgaa048
Chen Z, et al. Accelerated bone loss after menopause: quantification and clinical implications. Bone.2017;95:19–27. doi:10.1016/j.bone.2016.11.008
Landi F, Calvani R, Tosato M, et al. Sarcopenia: an overview on current definitions, diagnosis and treatment.Curr Protein Pept Sci. 2018;19(7):633–638. doi:10.2174/1389203718666170607111356
Panula J, et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011;12:105. doi:10.1186/1471-2474-12-105