If your doctor ordered a DEXA scan and you got a printout with numbers like "-1.8" and "-2.1" — and nobody took more than two minutes to explain what those numbers mean — you are not alone. Bone density testing is one of the most under-explained screenings in medicine. Adults over 60 are handed results showing "osteopenia" or "osteoporosis," sent home with a prescription or a pamphlet about calcium, and left wondering: how bad is this? Can it be reversed? What do I actually do next?
This guide covers everything your doctor probably didn't: exactly who should get a DEXA scan and when, what your T-score and Z-score actually mean (they're different, and the difference matters), how Medicare covers it, and the three lifestyle interventions with the strongest scientific evidence for improving bone density after 60 — broken down by age decade.
What this article covers:
- The exact Medicare eligibility rules for free DEXA scans — including who qualifies before age 65
- How to read your T-score and Z-score results — and why your T-score alone can be misleading
- An age-by-decade breakdown: what "normal" bone loss looks like at 60–64, 65–69, 70–74, and 75+
- The FRAX tool: what doctors should be using (and often don't) to assess your true fracture risk
- Lifestyle interventions ranked by evidence strength — not generic advice, but specific numbers and protocols
- When medications are actually necessary — and which drug class has the best evidence for 60+
Who Should Get a DEXA Scan After 60 — By Age Group
The guidelines on bone density screening are more nuanced than most primary care doctors communicate. Here is an age-by-decade breakdown of who should be screened, how often, and what to watch for at each stage:
| Age Group | Women — Recommendation | Men — Recommendation | Key Risk Factors to Watch |
|---|---|---|---|
| 60–64 | Screening recommended if risk factors present (early menopause, low body weight under 127 lbs, smoking, glucocorticoid use, family history of hip fracture, rheumatoid arthritis). Not yet universal screening. | Not yet routine unless high-risk factors present (low testosterone, steroid use, history of fracture). | Steroid use (prednisone, etc.) is the #1 missed risk factor — even short courses accelerate bone loss significantly. |
| 65–69 | Universal screening recommended — USPSTF Grade B recommendation. Medicare covers at no cost. This is the most important window to establish a baseline. | Baseline scan recommended for most men, especially if any risk factors are present. Some guidelines recommend universal screening at 70, but getting a baseline at 65–69 is valuable. | Alcohol use (3+ drinks/day doubles bone loss rate), low vitamin D, calcium below 1,000 mg/day. |
| 70–74 | Repeat scan every 1–2 years if osteopenia; every 2 years if normal. If on bisphosphonate therapy, scan to monitor response. | Universal screening now recommended for men at 70+ by most guidelines. Testosterone decline accelerates bone loss in this decade. | Hip fracture risk rises steeply in this decade. Falls (see our fall prevention guide) become as important as bone density itself. |
| 75+ | High-priority group. Repeat scanning every 1–2 years if osteopenia or on treatment. Focus shifts to fracture prevention (balance, fall risk, home modifications) alongside bone density. | High-priority group. All men 75+ with no prior diagnosis should be tested if not already done. Vertebral fracture risk increases significantly. | Vertebral (spine) fractures often occur with minimal trauma and may be silent — causing only chronic back pain, not acute pain. Many are never diagnosed. |
🔑 The Key Thing Your Doctor May Not Have Said
Men are dramatically undertested for osteoporosis. While osteoporosis is often framed as a "women's disease," approximately 2 million American men have osteoporosis and another 12 million have osteopenia. Men who fracture a hip after 65 have a significantly higher mortality rate than women — yet most men have never had a bone density scan. If you are a man over 65, ask your doctor about a baseline DEXA scan, particularly if you have ever taken steroid medications, have low testosterone, or drink alcohol regularly.
Medicare Coverage for DEXA Scans: The Exact Rules
Medicare Part B covers bone density testing at zero cost to you (no copay, no deductible applies) every 24 months when you meet at least one of the following criteria:
Medicare DEXA Coverage Eligibility Checklist
- You are a woman whose doctor determines you are estrogen-deficient and at clinical risk for osteoporosis
- Your spine X-ray shows vertebral abnormalities suggesting osteoporosis, osteopenia, or vertebral fracture
- You are on long-term glucocorticoid (steroid) therapy — this includes prednisone, prednisolone, and others
- You have been diagnosed with primary hyperparathyroidism (overactive parathyroid glands)
- You are already on FDA-approved osteoporosis drug therapy and need monitoring
- You have had a previous osteoporotic fracture (spine, hip, or wrist)
Can it be covered more frequently than every 24 months? Yes — Medicare can cover more frequent testing when medically necessary. If you are being treated for osteoporosis and your doctor needs to monitor treatment response, or if you have conditions causing rapid bone loss (such as high-dose steroid therapy), documentation supports more frequent coverage. Your doctor must provide the medical justification.
What if you don't meet Medicare criteria? A DEXA scan out-of-pocket typically costs $100–$250 at most imaging centers. Some retail health clinics offer it for as low as $50–$75. This is genuinely worth paying for if you are approaching 65 and want a baseline, because early osteopenia caught at 60–62 allows years of intervention before reaching the fracture-risk threshold of osteoporosis.
For more information on making the most of your Medicare benefits, see our complete Medicare benefits guide.
How to Read Your T-Score and Z-Score: What Doctors Don't Always Explain
Your DEXA report will contain two scores. Most doctors spend most of their time on the T-score — but the Z-score is equally important, for different reasons.
T-Score: What It Is and What It Means
Your T-score compares your bone density to the bone density of a healthy 30-year-old adult of the same sex. It is expressed in standard deviations above or below that peak. The World Health Organization (WHO) classification system:
| T-Score Range | Classification | What It Means Practically | Typical Next Step |
|---|---|---|---|
| -1.0 and above (e.g., -0.5, +0.3) | Normal | Bone density within the expected range. Low fracture risk from bone density alone. | Maintain lifestyle. Rescreen in 2–5 years depending on age and risk factors. |
| -1.0 to -2.4 (e.g., -1.5, -2.1) | Osteopenia | Low bone mass — below the young adult mean but not yet at the osteoporosis threshold. Increased fracture risk, especially if you have other risk factors. | Lifestyle intervention (exercise, calcium, vitamin D, protein). FRAX assessment. Rescreen in 1–2 years. |
| -2.5 and below (e.g., -2.7, -3.2) | Osteoporosis | Significantly reduced bone density. High fracture risk. Hip, spine, and wrist fractures can occur from minor falls or even ordinary activities. | Medication evaluation (bisphosphonates, denosumab). Lifestyle intervention. Fall prevention assessment. Rescreen annually while on treatment. |
| -2.5 and below + prior fracture | Severe Osteoporosis | Established osteoporosis with fragility fracture. Highest fracture risk category. | Medication typically required. May need specialist referral (endocrinologist, rheumatologist). Fall prevention is critical. |
Z-Score: The Number That Can Reveal a Hidden Cause
Your Z-score compares your bone density to other people of your same age, sex, and ethnicity. A Z-score of 0 means you are exactly average for your age group. A Z-score of -1.0 means you are one standard deviation below the average for people your age.
Why does this matter? Here is what many doctors don't explain: a T-score of -2.0 in a 70-year-old might be accompanied by a Z-score of -0.2 (perfectly normal for your age) or a Z-score of -2.5 (dramatically below what a 70-year-old should have). These two situations require completely different investigations.
If your Z-score is below -2.0 (meaning your bones are much weaker than expected for your age), it strongly suggests a secondary cause of bone loss that needs investigation:
- Vitamin D deficiency — extremely common in adults over 60; causes bone loss and muscle weakness simultaneously
- Celiac disease or malabsorption — often undiagnosed in older adults, prevents calcium absorption
- Hyperparathyroidism — overactive parathyroid glands actively leach calcium from bones
- Hyperthyroidism — accelerates bone turnover and loss
- Chronic steroid use — even low-dose prednisone taken for months to years significantly reduces bone density
- Rheumatoid arthritis — systemic inflammation drives bone loss independent of mobility
- Low testosterone in men — testosterone directly supports bone maintenance
The FRAX Tool: What Your Doctor Should Be Using (But May Not)
The T-score tells you about bone density. The FRAX tool (Fracture Risk Assessment Tool, developed by the World Health Organization) tells you about your actual 10-year probability of fracturing a hip or major bone. These are related but not identical — and the difference matters enormously for treatment decisions.
FRAX incorporates your T-score plus 11 additional clinical risk factors including age, sex, body weight, prior fracture history, smoking, alcohol use, family history of hip fracture, glucocorticoid use, rheumatoid arthritis, and secondary osteoporosis causes. You can access the FRAX calculator free at frax.shef.ac.uk.
The current treatment thresholds: The National Osteoporosis Foundation recommends initiating pharmacologic treatment when FRAX shows a 10-year probability of hip fracture ≥ 3% or any major osteoporotic fracture ≥ 20%. This means some people with osteopenia should be treated, while some people with osteoporosis (particularly younger people with no other risk factors) may be safely managed with lifestyle changes alone.
Ask your doctor to run your FRAX score at your next appointment. If they have not done this, you can calculate it yourself at home using the online tool and bring the result to your next visit.
Watch: Why Creatine Supports Bone & Muscle Health After 40
The 3 Lifestyle Interventions With the Strongest Evidence for Bone Density After 60
Dozens of supplements and lifestyle changes are marketed for bone health. Most have weak or no evidence. Here is a ranking of what actually works, based on the clinical trial literature — with specific protocols, not generic advice:
| Intervention | Evidence Level | Effect on BMD | Specific Protocol for 60+ | Important Notes |
|---|---|---|---|---|
| Resistance + Weight-Bearing Exercise | Strong | +1–3% BMD per year at loaded sites; slows loss 30–50% | 2–3x/week resistance training with progressive overload; daily walking 30 min; stair climbing | Must be weight-bearing: swimming and cycling do NOT stimulate bone formation. Bone responds to mechanical load specifically. See our exercise guide for 60+. |
| Calcium + Vitamin D3 | Strong | Prevents further loss; modest improvement when deficient | Calcium: 1,200 mg/day total (food + supplements) for women 51+, men 71+; Vitamin D3: 800–2,000 IU/day; target 25-OH vitamin D blood level of 30–50 ng/mL | ⚠️ Calcium supplements (not food calcium) may increase cardiovascular risk at high doses. Prefer dietary calcium first; supplement only the deficit. Take calcium supplements with meals for best absorption. |
| Adequate Dietary Protein | Strong | High protein intake associated with 6% lower hip fracture risk in large studies | 1.0–1.2 grams protein per kg of body weight per day. A 150 lb person = 68 kg = 68–82g protein/day minimum. Higher end (1.2g/kg) for those doing resistance training. | Protein deficiency is widespread in adults over 65 and is an independent predictor of bone loss and fracture. Most seniors eat far less than the optimal amount. See our nutrition guide for seniors. |
| Creatine Supplementation | Moderate | When combined with resistance training, 1–2% additional BMD benefit; significant muscle mass gains that protect bones indirectly | 3–5 grams creatine monohydrate daily. No loading phase needed for older adults. Take with meals. | A 2021 meta-analysis in Nutrients found creatine + resistance training produced significantly greater bone-protective effects than exercise alone in adults over 55. Strongest evidence at hip and spine — the fracture sites that matter most. |
| Smoking Cessation | Strong | Smokers lose bone density at 2–3x the rate of non-smokers; cessation partially reverses this | Cessation at any age produces bone density improvements. Even cessation after 60 reduces fracture risk. Effect is dose-dependent. | Smoking impairs calcium absorption, reduces estrogen in women, and directly inhibits osteoblast (bone-forming cell) activity. |
| Limiting Alcohol | Moderate | 3+ drinks/day associated with 40% higher fracture risk; moderate drinking (1–2/day) appears neutral | Stay at or below 1 drink/day (women) or 2 drinks/day (men) if you have osteoporosis or osteopenia. | Alcohol impairs calcium absorption, reduces testosterone, and increases fall risk — a compounding risk factor. |
| Magnesium | Moderate | Deficiency associated with lower BMD; supplementation shows modest benefit in deficient adults | 320 mg/day for women 31+, 420 mg/day for men 31+. Many adults over 60 are deficient, especially those taking proton pump inhibitors (PPIs). | Often overlooked. PPIs (omeprazole, pantoprazole) reduce magnesium absorption — a major reason why seniors on PPIs have higher osteoporosis rates. |
| Vitamin K2 (MK-7) | Emerging | Some trials show improved bone density; K2 activates osteocalcin, a protein that binds calcium to bone | 90–180 mcg K2 (MK-7 form) daily if not on warfarin. Japanese population studies show consistent benefit. | ⚠️ Contraindicated with warfarin (blood thinner). Do not supplement without checking with your doctor if you are anticoagulated. |
For a broader review of evidence-based supplements for older adults, see our guide to supplements with real evidence for adults over 60.
The Exercise Protocol That Specifically Builds Bone
Not all exercise builds bone equally. The key principle is osteogenic loading — applying force through bones that exceeds normal daily activities, stimulating osteoblasts (bone-building cells) to lay down new bone matrix. Here is what the evidence specifically shows works:
- Progressive resistance training (lifting weights, resistance bands): 2–3 times per week targeting major muscle groups. The "progressive" part is essential — bones only respond to loads greater than what they're already accustomed to. Gradually increasing resistance over weeks and months is what drives bone formation. Research shows that high-intensity resistance training (at 70–80% of maximum strength) produces the greatest bone gains, but even moderate intensity is beneficial for beginners.
- Impact loading: Activities that involve brief high-force impacts stimulate bone formation at hip and spine. Jumping (if safe for you), dancing, and brisk walking produce beneficial bone-stimulating forces. A 2025 study found that 50 single-leg hops per leg, performed 3 days/week, significantly improved hip bone density in postmenopausal women over 12 months.
- What doesn't work for bone: Swimming and cycling, while excellent for cardiovascular fitness and joint health, are non-weight-bearing and do not stimulate bone formation. Seniors who rely exclusively on these activities often have unexpectedly low bone density despite being physically fit.
🔑 The Combination That Works Best
A 2024 meta-analysis published in Nature Scientific Reports found that the combination of aerobic exercise plus resistance training (AE+RT) had the best effect on bone mineral density in postmenopausal women — significantly better than either type of exercise alone. A 2024 NIH-funded study confirmed that combining calcium/vitamin D supplementation with resistance exercise produced greater BMD improvements than supplementation or exercise alone. These aren't additive — they're synergistic. The muscle contractions of weight training actually improve how efficiently your body uses calcium to build bone.
When Medication Is Needed: The Evidence for Bisphosphonates in Adults Over 60
Lifestyle changes are the foundation of bone health management, but they have limits. When your FRAX score shows high fracture risk (≥ 3% hip fracture risk or ≥ 20% major fracture risk over 10 years), or when you have a T-score ≤ -2.5, medication discussion becomes appropriate.
First-Line Treatment: Bisphosphonates
Bisphosphonates (alendronate/Fosamax, risedronate/Actonel, zoledronic acid/Reclast) are the most widely used and best-studied osteoporosis medications. They work by slowing the activity of osteoclasts (bone-resorbing cells), which reduces bone breakdown and allows bone density to stabilize and gradually improve.
What the evidence shows for adults over 65:
- Alendronate reduces hip fracture risk by approximately 40–50% in women with osteoporosis over 3–4 years
- Zoledronic acid (IV, given once yearly) reduces vertebral fracture risk by 70% and hip fracture risk by 41% — with compliance advantages for seniors who have difficulty with weekly oral medications
- Most benefit is seen in the first 3–5 years; after 5 years, a "drug holiday" (brief treatment pause) is often appropriate, with the decision based on ongoing FRAX reassessment
The Senior-Specific Concerns Your Doctor Should Discuss
Atypical femur fractures (AFF): After 5+ years of bisphosphonate use, there is a small but real risk of atypical stress fractures in the thigh bone. The absolute risk is very low (approximately 3–5 per 10,000 patient-years), but awareness is important. Thigh or groin pain during bisphosphonate therapy should be evaluated promptly.
Osteonecrosis of the jaw (ONJ): Extremely rare with oral bisphosphonates at osteoporosis doses (risk is primarily associated with high-dose IV bisphosphonates used in cancer treatment). However, inform your dentist if you are on bisphosphonate therapy before any invasive dental procedures.
Esophageal irritation: Oral bisphosphonates must be taken on an empty stomach with a full glass of water, remaining upright for 30 minutes afterward. For seniors with acid reflux or esophageal conditions, once-yearly IV zoledronic acid is often a better choice.
Bone Density After 60: Your Age-Specific Action Plan
Rather than generic advice, here is what you should specifically do based on where you are in the bone-health journey:
If You Are 60–64 and Have Never Had a DEXA Scan
Consider asking your doctor for a baseline scan, especially if you have any risk factors. Even if not yet covered by Medicare, the out-of-pocket cost ($100–$250) is worthwhile as it establishes a reference point for tracking future bone loss. Start resistance training now — this is the window where lifestyle intervention has the greatest long-term impact on fracture prevention.
If You Are 65–69 and Have Osteopenia (T-score -1.0 to -2.4)
This is the most common and most actionable finding. Osteopenia does not automatically require medication — but it does require action. Focus on: resistance training 2–3x/week, 1,200 mg/day calcium (food first, then supplement the gap), 1,000–2,000 IU vitamin D3 daily (get your blood level checked), protein at 1.0g/kg/day minimum, and schedule a repeat DEXA in 1–2 years. Have your FRAX score calculated at your next appointment.
If You Are 70–74 and Have Osteoporosis (T-score -2.5 or below)
Medication discussion with your doctor is appropriate. Start with the FRAX calculator to determine your actual fracture probability. If treatment is indicated, bisphosphonates have the strongest evidence. Continue lifestyle interventions — they enhance medication effectiveness. Fall prevention is equally important at this stage: a healthy T-score means nothing if you fall on a hard floor.
If You Are 75+ and Concerned About Fracture Risk
At 75+, the focus expands beyond bone density to the complete picture of fracture prevention: bone strength, muscle strength, balance, home safety, and medication review. Many falls in seniors 75+ are caused or contributed to by medications — blood pressure drugs causing orthostatic dizziness, sedatives, antihistamines. Review your medication list with your doctor through the lens of fall and fracture risk. See the Beers Criteria guide for medications that increase fall risk in older adults.
Frequently Asked Questions
At what age should you get a bone density scan?
All women 65 and older should be screened — this is a USPSTF Grade B recommendation, meaning Medicare covers it with no copay. Men should be screened at 70 or earlier if risk factors are present (low body weight, smoking, steroid use, low testosterone, alcohol use). Women under 65 with risk factors — especially early menopause, low body weight (under 127 lbs), or prior fracture — should be screened before age 65.
What is a good T-score for a 70-year-old?
A T-score of -1.0 or above is considered normal regardless of age. Between -1.0 and -2.5 is osteopenia. -2.5 or below is osteoporosis. However, for a 70-year-old, your doctor should also calculate your FRAX fracture risk score — because the T-score alone does not capture your full fracture risk. A T-score of -2.1 in someone with prior fractures, low body weight, and smoking history carries far more practical risk than the same T-score in someone without those factors.
Does Medicare cover DEXA bone density scans?
Yes. Medicare Part B covers DEXA scans at zero cost to you (no copay, no deductible) every 24 months for eligible beneficiaries. Coverage requires at least one medical indication: estrogen deficiency with fracture risk, vertebral abnormalities, long-term steroid use, hyperparathyroidism, or ongoing osteoporosis treatment monitoring. It can be covered more frequently when medically necessary.
Can bone density be improved after 60?
Yes — while you cannot fully restore the bone density of your 30s, you can meaningfully improve it through consistent effort. The combination of resistance/weight-bearing exercise + adequate calcium + vitamin D3 + dietary protein is the evidence-based foundation. A 2024 meta-analysis found this combined approach significantly improves BMD in postmenopausal women. Creatine supplementation combined with resistance training adds additional benefit at the hip and spine. Medications (bisphosphonates) can improve BMD by 5–10% over 3 years when lifestyle is insufficient.
What is the difference between T-score and Z-score on a DEXA scan?
A T-score compares your bone density to a healthy 30-year-old — this is used to classify normal, osteopenia, or osteoporosis. A Z-score compares you to people your own age and sex. A Z-score below -2.0 means your bones are significantly weaker than expected for your age, which should prompt your doctor to investigate secondary causes: vitamin D deficiency, celiac disease, hyperparathyroidism, steroid use, hyperthyroidism, or low testosterone. Both numbers matter, but for different reasons.
How long does a DEXA scan take?
The entire appointment takes 20–30 minutes. The actual scanning takes only 5–10 minutes. You lie on a padded table fully clothed (removing metal items) while a low-radiation X-ray arm scans your spine and hip. No injections, no tunnel (not an MRI), no recovery time. The radiation dose is equivalent to about one-tenth of a standard chest X-ray — extremely safe. Results are typically sent to your doctor within 1–3 business days.
References
- US Preventive Services Task Force. (2018). "Osteoporosis to Prevent Fractures: Screening." USPSTF
- National Osteoporosis Foundation. (2025). "Clinician's Guide to Prevention and Treatment of Osteoporosis." BHOF
- Candow DG, et al. (2021). "Creatine supplementation for older adults: Focus on sarcopenia, osteoporosis, frailty and brain health." Nutrients, 13(6), 2013. PubMed
- Wang X, et al. (2024). "Effect of different types of exercise on bone mineral density in postmenopausal women." Nature Scientific Reports. Nature
- Kanis JA, et al. (2019). "FRAX and its applications to clinical practice." Bone, 130, 115048. PubMed
- Black DM & Rosen CJ. (2016). "Postmenopausal Osteoporosis." New England Journal of Medicine, 374(3), 254–262. PubMed
- Weaver CM, et al. (2016). "The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors." Osteoporosis International. PubMed
- Medicare.gov. (2026). "Bone Mass Measurements — Coverage and Costs." Medicare.gov