Menopause and Bone Health: When Should Women Get a DEXA Scan?
Osteoporosis is often called a silent disease because bone loss can progress for years without obvious symptoms. For some women, the first indication that their bones have become fragile is a fracture after a relatively minor fall.
That is why bone health deserves attention long before the first broken bone.
The menopause transition is particularly important. Declining estrogen levels can accelerate bone loss, while changes in muscle mass, nutrition, physical activity and other health factors may further influence fracture risk.
A DEXA scan, also called a DXA scan or bone density test, is one of the main tools used to assess bone mineral density and help identify women who may be at increased risk of osteoporosis and fractures.
But does every woman need one at menopause?
Not necessarily.
The timing of a DEXA scan should be based on age, menopausal status and individual fracture risk.
Why Does Menopause Affect Bone Health?
Bone is not an inactive structure. It is living tissue that is continuously being broken down and rebuilt through a process called bone remodelling.
Estrogen plays an important role in maintaining the balance between these two processes.
As estrogen levels decline during the menopause transition, bone resorption the breakdown of bone—can begin to outpace bone formation.
As a result:
• Bone mineral density can decline.
• Bone structure may become weaker.
• Osteoporosis risk increases.
• The likelihood of fractures later in life rises.
Bone loss can accelerate during the menopause transition and the first several years after the final menstrual period.
This does not mean that every woman entering menopause automatically has osteoporosis. It means that midlife is an important opportunity to identify risk factors and start protecting bone health early.
What Is a DEXA Scan?
DEXA stands for dual-energy X-ray absorptiometry. The abbreviation DXA is also commonly used medically.
A central DXA scan is the standard clinical test used to measure bone mineral density (BMD), usually at the:
• Lumbar spine
• Total hip
• Femoral neck
The test is painless, non-invasive, relatively quick and uses a very low dose of radiation.
Your results are often reported as a T-score, which compares your bone density with that of a healthy young adult reference population.
But an important point is often overlooked:
Your T-score is not the same thing as your overall fracture risk.
Age, previous fractures, medications, family history, falls, smoking and other health conditions also matter.
When Should Women Get a DEXA Scan in Canada?
There is no single age that applies to every woman.
According to the 2023 Osteoporosis Canada Clinical Practice Guideline, bone mineral density testing should generally be considered in postmenopausal women based on age and clinical risk factors.
Age 70 and older
For postmenopausal women 70 years and older, baseline BMD testing is recommended even when no additional clinical risk factors are present.
Age 65–69
Women between 65 and 69 should generally be considered for BMD testing when they have at least one clinical risk factor for fracture.
Age 50–64
Earlier DEXA testing may be appropriate for women aged 50–64 who have:
• A previous osteoporosis-related or fragility fracture, or
• Two or more important clinical risk factors.
Osteoporosis Canada identifies risk factors including previous fragility fracture after age 40, parental hip fracture, glucocorticoid exposure, secondary causes of osteoporosis, current smoking, high alcohol intake, recurrent falls and a BMI below 20.
The decision should always be individualized.
It is also worth noting that guidelines vary internationally. For example, the U.S. Preventive Services Task Force recommends routine osteoporosis screening in women beginning at age 65 and earlier assessment for postmenopausal women younger than 65 who are at increased risk.
For Canadian women, however, we generally anchor assessment to Canadian fracture-risk guidelines and the individual’s clinical history.
What About Early or Surgical Menopause?
Women who experience early menopause, premature ovarian insufficiency or surgical loss of ovarian function deserve particular attention to bone health because they may experience estrogen deficiency for a longer period of their lives.
A woman who develops menopause substantially earlier than expected should therefore discuss her bone-health risk with her healthcare provider rather than simply waiting until routine screening age.
Other conditions and medications can also accelerate bone loss, including chronic glucocorticoid therapy, certain endocrine disorders, malabsorption conditions and some cancer treatments.
DEXA Is Only Part of the Assessment: What Is FRAX?
Bone density is important, but it does not tell the entire story.
In Canada, FRAX is the preferred tool used alongside BMD to estimate a person’s 10-year risk of major osteoporotic fracture.
FRAX incorporates several clinical factors that affect fracture risk.
These can include:
• Age
• Bone mineral density
• Previous fractures
• Parental history of hip fracture
• Smoking
• Glucocorticoid exposure
• Rheumatoid arthritis
• Certain causes of secondary osteoporosis
• Alcohol intake
This matters because two women with the same T-score may have very different overall fracture risks.
The goal is therefore not simply to ask:
“Do you have osteoporosis?”
A better question is:
“What is your risk of sustaining a fracture, and what can we do about it?”
Signs That Should Prompt a Bone-Health Conversation
Osteoporosis is usually asymptomatic before a fracture occurs, so waiting for symptoms is not a good screening strategy.
However, certain findings deserve further evaluation, including:
• A fracture after minimal trauma
• Significant loss of height
• New or persistent back pain
• Increasingly stooped posture
• Recurrent falls
• Prolonged glucocorticoid use
• Multiple osteoporosis risk factors
A vertebral compression fracture, for example, can sometimes occur with surprisingly little trauma and may present as height loss or back pain.
Protecting Bone Health After 40
A DEXA scan tells us where your bone density stands. It does not replace prevention.
Strong bones depend on much more than taking calcium.
Progressive Resistance Training
Strength training is one of the most important components of healthy aging.
Resistance exercise helps preserve muscle strength and function while placing mechanical stress on bone that supports skeletal adaptation.
Muscle also improves stability and can reduce fall risk.
Weight-Bearing and Impact Activity
Activities performed against gravity such as brisk walking, stair climbing, hiking and dancing can contribute to skeletal health.
Where appropriate and safe, impact-loading exercises may provide additional bone stimulus.
Exercise should be adapted to the person’s fitness level, fracture risk and medical history.
Balance Training
Preventing osteoporosis-related fractures is not only about increasing bone density.
Preventing falls is equally important.
Balance, coordination and lower-body strength become increasingly valuable as we age.
Osteoporosis Canada therefore emphasizes multicomponent exercise that includes resistance and balance training.
Adequate Protein
Protein supports both muscle and bone health.
In midlife and beyond, adequate protein becomes particularly important because loss of muscle mass can contribute to frailty, falls and reduced functional independence.
Calcium and Vitamin D
Calcium and vitamin D remain important components of bone health, but more is not necessarily better.
Calcium needs should ideally be assessed in the context of the entire diet, with supplementation used when dietary intake is insufficient.
Vitamin D requirements should also be considered based on age, dietary intake and individual risk factors.
Avoid Smoking and Excess Alcohol
Smoking is associated with poorer skeletal health, while high alcohol intake increases fracture risk.
Addressing both is part of comprehensive osteoporosis prevention.
What About Menopausal Hormone Therapy?
Because estrogen plays such an important role in skeletal health, menopausal hormone therapy can help prevent bone loss and reduce fracture risk in appropriately selected women.
However, hormone therapy should not be prescribed solely because a woman has entered menopause.
The decision depends on the woman’s:
• Age
• Time since menopause
• Menopausal symptoms
• Personal and family medical history
• Cardiovascular risk
• Breast-health considerations
• Bone and fracture risk
• Individual preferences
Osteoporosis Canada’s 2023 guideline recognizes menopausal hormone therapy as an option for appropriately selected postmenopausal women younger than 60 or within 10 years of menopause who also prioritize treatment of menopausal symptoms.
This is one reason menopause care and bone-health assessment should not occur in isolation.
Bone Health Is More Than Calcium
One of the most common misconceptions is that osteoporosis is simply a calcium-deficiency problem.
Bone health is influenced by many interconnected factors, including:
• Estrogen and other hormonal changes
• Muscle mass and strength
• Protein and overall nutrition
• Vitamin D and calcium intake
• Physical activity
• Thyroid function
• Chronic diseases
• Gastrointestinal absorption
• Medications
• Smoking and alcohol
• Fall risk
• Age and genetics
This is why simply taking a calcium supplement without understanding the bigger picture may miss important contributors to declining bone health.
At ConductMD, we do not look only at the number on a DEXA report.
We ask:
What factors are influencing this woman’s bone and fracture risk?
Through the CONDUCT™ Method, we consider interconnected systems that can influence skeletal health—including ovarian hormones, muscle and body composition, nutrition, thyroid function, cortisol and nervous-system health, digestion and nutrient absorption, and overall lifestyle.
The goal is to identify modifiable risk factors early and develop an individualized strategy to preserve bone, muscle, mobility and long-term independence.
Frequently Asked Questions
Is a DEXA scan painful?
No. A DEXA scan is non-invasive and painless and typically takes only a short period of time.
Should every woman get a DEXA scan when she reaches menopause?
No. Menopause itself does not automatically mean that a DEXA scan is required. Age, previous fractures, medications, early menopause and other clinical risk factors should be considered.
Can you have a fracture even if your DEXA does not show osteoporosis?
Yes. Bone mineral density is only one component of fracture risk. This is why tools such as FRAX, along with clinical history, are important.
Can osteoporosis be prevented?
Not every case is completely preventable, but resistance exercise, adequate nutrition, appropriate calcium and vitamin D intake, avoiding smoking, limiting excess alcohol, preventing falls and addressing relevant medical or hormonal factors can substantially support bone health.
Does hormone therapy help bones?
Yes. Estrogen-containing menopausal hormone therapy helps prevent bone loss and reduces fracture risk in appropriately selected women. The decision to use hormone therapy should be individualized with a knowledgeable healthcare professional.
The Bottom Line
Menopause is an important time to start thinking proactively about bone health but not every woman needs a DEXA scan simply because she has entered menopause.
The right time for a bone density test depends on your age, previous fractures, medications, family history, menopausal history and overall fracture risk.
And a DEXA result should never be viewed in isolation.
Healthy aging requires protecting bone and muscle together.
Knowing your risk early gives you an opportunity to act—through resistance training, adequate nutrition, fall prevention, appropriate medical treatment and, for selected women, menopausal hormone therapy.
Osteoporosis may develop silently. Prevention shouldn’t.
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References
Bone Health & Osteoporosis Foundation (BHOF). Bone Density Exam (DEXA).
The Menopause Society. Osteoporosis and Menopause.
National Institute on Aging (NIA). Osteoporosis.
U.S. Preventive Services Task Force (USPSTF). Osteoporosis Screening to Prevent Fractures.
International Osteoporosis Foundation (IOF). Osteoporosis Facts and Prevention.
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