When should women get a bone density scan?

On Ep. 375, Nikkiey explains why the timing matters. Bone density peaks in your late 20s to early 30s and starts declining after that. The decline speeds up significantly in perimenopause and menopause because estrogen, which protects bone, drops. She notes that women can lose up to 20% of their bone density in the five to seven years after menopause. By 65, the standard screening age, many women are already being diagnosed with osteoporosis or have had a fracture. That is why she calls it too late, and says people in healthcare who know this area would agree.

Her suggestion is to frame it as a baseline, not a diagnosis. She gives the wording she would use with her own doctor: she strength trains consistently, wants to know where her bone density is now, and wants to track it over time so she can address concerns proactively instead of reactively. A baseline gives you a number to compare against later, rather than finding out only once there's a problem.

She stresses pushing for this even harder if you have risk factors, such as a family history of osteoporosis, or if you're in perimenopause or early menopause. In her recap of the episode, the baseline DEXA is number two on her list of tests to bring up, alongside a full hormone panel, deeper metabolic markers, and a proactive perimenopause conversation. Your doctor decides what's appropriate for you, but you're allowed to walk in prepared and ask. If waiting for someone to suggest it hasn't worked, that's a gap in the standard plan, not a failing on your part.