Unfortunately, there’s no one-size-fits-all answer. The National Osteoporosis Foundation recommends that all women 65 and over get a bone density test once. Bone loss is typically so slow that repeating a bone density test more often than every two years is not necessary. Most insurers, including Medicare, will pay for testing every two years.
Assessing a woman’s risk for more rapid bone loss is too complex for blanket recommendations, said Dr. Robert Neer [cq], director of the Osteoporosis Center at Massachusetts General Hospital in an email. And some women – as well as some men – need a bone density X-ray test to look for signs of bone thinning even before age 65 if they have certain medical problems,
People who need earlier or more frequent testing include women with early menopause (before age 42) and men with androgen deficiency, because both these hormonal conditions can lead to bone-thinning. Anyone who gets a fracture after minimal trauma and people with rheumatoid arthritis should also ask their doctors about earlier or more frequent testing. So should people who take cortisone or prednisone, which can adversely affect the bone, and people with sprue or cystic fibrosis or inflammatory bowel disease.
The trouble is, it can be tough to get insurance coverage for earlier or more frequent testing. In theory, Medicare will pay for more frequent testing when it’s “medically necessary.” But in nearly all cases, Medicare does “not accept a letter from a physician as proof of medical necessity,” said Neer. This makes it difficult to assess whether a newly-prescribed medication has stopped bone loss, he added. Medicare has also reduced its payments for the bone X-rays and plans to do so again next year. “As a result, many small providers have stopped or will stop performing bone density tests,” said Neer.
Even so, it makes sense to ask your doctor about bone density testing even before age 65 if you think you are at higher-than-normal risk of osteoporosis.