There’s no pain. No warning sign. No moment where it becomes obvious something is changing until a fracture occurs or a scan reveals years of silent decline.

That’s why bone density testing in midlife is one of the most underused, and most powerful, tools women have to protect their future mobility and independence.

If there’s one message women deserve to hear sooner, it’s this: bone health shouldn’t be an afterthought until 65. Depending on risk factors, earlier bone density testing, potentially in the mid-40s, is worth discussing as it’s not a one-size-fits-all.1

Why Waiting Until 65 Misses the Window for Prevention

Many current guidelines recommend routine bone density testing for women ≥65 and for younger women only if they have an increased risk of fracture1. While this may make sense for population-level screening, it often comes decades too late for meaningful prevention.

Bone loss:

• Can begin in the 30s
• Often accelerates during perimenopause and menopause
• Is cumulative and silent

By age 65, roughly 80% of women already have osteopenia or osteoporosis and an elevated risk of fracture, leaving far fewer opportunities to slow progression without aggressive intervention.

Testing earlier allows bone health to be addressed while there is still time to act.

Rethinking When Bone Density Screening Begins

Bone loss often begins earlier than symptoms appear. For some women, hormonal changes in the mid-40s may start to influence bone remodeling long before menopause is diagnosed.

As perspectives on prevention evolve, some clinicians are exploring whether earlier baseline testing could help identify risk sooner and support more informed long-term bone health decisions.

The DXA Scan: The Current Gold Standard

The most widely used and validated bone density test is the DXA scan (dual-energy X-ray absorptiometry).

A DXA scan:

• Measures bone mineral density (BMD)
• Focuses on key fracture-prone sites, especially the hip (femoral neck) and spine
• Uses very low radiation
• It is fast, noninvasive, and widely available

DXA results help make more accurate predictions about future fracture risk and track changes in bone density over time, making it a cornerstone of bone health assessment.

Understanding Your DXA Results: T-Scores Explained

DXA results are reported as T-scores, which compare your bone density to that of a healthy young adult reference population.

• Normal bone density: T-score of -1.0 or higher
• Osteopenia (low bone mass): T-score between -1.0 and -2.5
• Osteoporosis: T-score of -2.5 or lower

It’s important to understand that fracture risk is not binary; it doesn’t suddenly begin once someone crosses the threshold into osteoporosis. Fracture risk increases progressively as bone density declines.

In fact, research shows that approximately 54% of hip fractures in women occur in individuals with osteopenia, not osteoporosis2. This is largely because far more women fall into the osteopenic range, and bone strength is already meaningfully compromised.

Osteopenia is not a diagnosis of disease, but it is a signal. Often, it’s the most actionable moment to intervene, when bone loss can still be slowed before fracture risk accelerates further.

Why the Hip (Femoral Neck) Deserves Special Attention

Not all bone loss carries the same consequences.

The femoral neck, part of the hip, is one of the most critical areas measured because hip fractures are strongly linked to loss of independence. Why?

• Recovery can be prolonged and incomplete: Only 40-60% of people with a hip fracture fully recover their mobility3.
• Mortality risk increases significantly after hip fracture: Hip fractures are associated with 22% all-cause mortality in the year post-fracture4.

Protecting bone density at the hip is one of the most impactful ways to preserve long-term mobility and quality of life.

REMS: A New, Radiation-Free Bone Density Option

In addition to DXA, an emerging technology called REMS (Radiofrequency Echographic Multi Spectrometry) is gaining attention.

REMS:

• Uses ultrasound-based radiofrequency signals, not X-rays
• Is radiation-free
• Can assess bone density at the hip and spine
• Is increasingly studied for early detection of bone loss

Because REMS does not involve radiation, it may be particularly appealing for:

• Earlier or more frequent screening
• Younger women in midlife
• Situations where DXA access is limited

While DXA remains the gold standard, REMS may serve as a complementary or alternative screening tool, especially for earlier assessment.

What Bone Density Tests Don’t Show

Both DXA and REMS measure bone density, but they don’t explain why bone loss is occurring.

They don’t directly assess:

• Inflammation
• Hormonal shifts
• Gut health or nutrient absorption
• The balance between bone breakdown and rebuilding

That’s why bone density testing is most powerful when paired with a broader, biology-informed prevention strategy.

What to Do After Testing, Especially at 45+

If testing reveals early bone loss, or even low-normal bone density, there is often a significant opportunity to slow progression.

Next steps may include:

• Monitoring bone density over time
• Strength and resistance training
• Supporting calcium and vitamin D absorption
• Addressing inflammation
• Paying attention to gut health
• Choosing interventions supported by rigorous clinical evidence

Bone health is not about a single result. It’s about what you do with the information.

A Clinically Studied Preventive Option to Know About

As bone health research shifts earlier, prevention-focused strategies are expanding beyond calcium alone.

One example is Bōndia, a plant-sourced, live-culture synbiotic developed by Sōlaria Biō. In a 12-month, randomized, double-blind, placebo-controlled clinical trial involving 286 early postmenopausal women5, Bōndia significantly slowed the rate of bone density loss in groups of women most at risk for elevated bone loss, with the strongest protection observed at the hip.

For women interested in learning more about clinically validated approaches to preserving bone density earlier in life, additional research and trial data are available at solaria.bio.

The Bottom Line

Bone loss is invisible, but it’s not unpredictable.

Starting bone density testing in your mid-40s, rather than waiting until 65, gives women the chance to understand their risk, track change, and act while prevention is still powerful.

Your skeleton carries you through every stage of life. It deserves attention long before it breaks.

Disclosure: The author serves as a scientific advisor to Sōlaria Biō. This article is intended for educational purposes only and does not constitute medical advice. Readers should consult a qualified healthcare professional regarding individual health decisions.

References

1 US Preventive Services Task Force recommendation statement. JAMA 333, 498–508 (2025)

2 Trajanoska 2018. (doi:10.1016/j.bone.2018.06.004)

3 Trajanoska 2018. (doi:10.1186/s12877-016-0332-0)

4 Haleem, S., Choudri, M. J., Kainth, G. S. & Parker, M. J. Injury 54, 620–629 (2023)

5 Schott EM et al. Osteoporos Int. 2025;36(10):2019-2030.