The Menopause Clinic
Request

Treatment

Bone health, DEXA, and osteoporosis treatment

A DEXA scan is a low-dose X-ray that measures bone density at the hip and spine, and it is the standard test for diagnosing osteoporosis. Screening is recommended for all women at 65, and earlier when risk factors are present. Because bone density alone underestimates who will fracture, we combine the scan with FRAX — a calculator that estimates your 10-year fracture risk — and treat based on that combined picture rather than on a T-score in isolation.

Who this is for

  • All women at age 65, whether or not they have symptoms
  • Women under 65 with risk factors: a fracture after 50, menopause before 45, oral steroids for three months or more, rheumatoid arthritis, low body weight, a parent who fractured a hip, current smoking, or heavy alcohol use
  • Any woman who has broken a bone from a fall from standing height after age 50
  • Women who have lost more than about an inch and a half from their tallest adult height
  • Women already on osteoporosis treatment who need monitoring

What a DEXA scan is

Dual-energy X-ray absorptiometry passes two low-energy X-ray beams through bone and measures how much each is absorbed. The difference gives bone mineral density, reported at the lumbar spine and the hip. It takes about ten minutes, you stay dressed, and the radiation dose is a small fraction of what a chest X-ray delivers.

The result comes back as a T-score. That number is the entry point to the conversation, not the conclusion of it.

Why the scan is not the whole answer

Here is the part that surprises people: more fractures happen in women whose scans read as osteopenia than in women whose scans read as osteoporosis. There are simply many more women in the osteopenia range. Treating only by T-score means missing the majority of the fractures you were trying to prevent.

FRAX exists to solve this. It combines age, sex, weight, height, previous fracture, parental hip fracture, smoking, steroid use, rheumatoid arthritis, secondary osteoporosis, alcohol intake, and femoral neck density into a 10-year probability of major osteoporotic fracture and of hip fracture. Those probabilities are what treatment thresholds are based on.

We also count things a scan cannot see. A fracture from a fall from standing height after 50 is a clinical diagnosis of osteoporosis on its own. So is a vertebral compression fracture found on imaging, even if you never knew it happened.

What happens at your visit

We take a bone-focused history, measure your height and compare it with your tallest adult height, and review medications that affect bone. Where indicated we check kidney function, calcium, vitamin D, and thyroid, and we screen for secondary causes when the picture does not fit.

If you are due for a scan, we order it — same day at locations with DEXA on site. Where vertebral fracture assessment is indicated, it is done in the same sitting.

Then we sit down with the numbers together. If treatment is warranted, we go through the realistic options, including what happens when each one stops, because that is the part most often left out. If treatment is not warranted, we say that plainly and set a date to look again.

Options

Osteoporosis treatments, named generically. Which one fits depends on your fracture risk, kidney function, and what you can realistically take.
Option How it is taken Typical use
Oral bisphosphonate (alendronate, risedronate) A weekly or monthly tablet, on an empty stomach, upright for 30 minutesFirst-line for most women at high fracture risk. Inexpensive, long track record, reduces vertebral and hip fractures.
Intravenous bisphosphonate (zoledronic acid) An annual infusionUseful when oral tablets cause reflux, or when adherence to a weekly tablet is unrealistic.
Denosumab (including biosimilars) An injection under the skin every 6 monthsEffective, and usable in kidney impairment where bisphosphonates often are not. It must not be stopped without transitioning to another agent — bone loss rebounds quickly.
Romosozumab A monthly injection for 12 months, then a follow-on agentBone-building rather than only resorption-blocking. Reserved for very high fracture risk. Not used in women with recent heart attack or stroke.
Teriparatide A daily self-injection for up to 24 months, then a follow-on agentAnother bone-building option for very high risk, particularly after vertebral fractures.
Systemic hormone therapy Patch, gel, or tabletA bone-protective option for women under 60 or within 10 years of menopause, especially when hot flashes also need treating.

What the evidence supports

Each claim below carries a rating. Strong means randomized trials and current specialty guidelines support it. Moderate means the evidence is real but has meaningful limits. Limited means early, small, or indirect evidence — and where we say Limited, that is us telling you not to count on it.

  • DEXA identifies women at increased fracture risk

    Evidence for DEXA identifies women at increased fracture risk: Strong evidence

    Bone mineral density measured by DEXA at the hip and spine predicts fracture, and it is the measurement that diagnostic thresholds and treatment trials are built on.

  • FRAX improves on density alone for deciding who to treat

    Evidence for FRAX improves on density alone for deciding who to treat: Strong evidence

    Many fractures occur in women whose density falls in the osteopenia range rather than the osteoporosis range. Combining clinical risk factors with density identifies those women, which density alone does not.

  • Bisphosphonates and denosumab reduce fractures

    Evidence for Bisphosphonates and denosumab reduce fractures: Strong evidence

    Large randomized trials show reductions in vertebral and, for several agents, hip fractures. This is among the better-evidenced areas in preventive medicine.

  • Systemic hormone therapy reduces fractures

    Evidence for Systemic hormone therapy reduces fractures: Strong evidence

    The Women's Health Initiative showed reductions in hip, vertebral, and total fractures — a randomized fracture outcome, which is rare. It is a reasonable option within 10 years of menopause and less commonly started for bone alone well beyond that.

  • Calcium and vitamin D supplements alone prevent fractures

    Evidence for Calcium and vitamin D supplements alone prevent fractures: Limited evidence

    Adequate calcium and vitamin D are necessary background, and deficiency is corrected. On their own, in women at high fracture risk, supplements do not produce the fracture reduction that prescription treatment does.

What this treats

Common questions

How often do I need a DEXA scan?

It depends on the first result and your risk. Normal density with no risk factors may not need repeating for several years. Osteopenia close to the treatment threshold is often rechecked in about two years. On treatment, monitoring is usually every one to two years. Medicare covers screening DEXA every two years when criteria are met, and more often when medically necessary.

What does my T-score mean?

A T-score compares your bone density to that of a healthy young adult. Minus 1.0 and above is normal. Between minus 1.0 and minus 2.5 is osteopenia. Minus 2.5 or below is osteoporosis. But a T-score is one input — a fracture after 50 means you have osteoporosis clinically no matter what the number says.

What is a vertebral fracture assessment?

It is a low-dose image of the spine taken on the same DEXA machine at the same visit. It looks for compression fractures in the spine, which are common, frequently painless, and often never diagnosed. Finding one changes your risk category and usually changes your treatment, so it is worth the extra few minutes when indicated.

I don't want to take a bisphosphonate. What are my options?

Several. Denosumab is given twice a year by injection. Hormone therapy is an option within the right window. Romosozumab and teriparatide are used for very high risk. And if your calculated risk does not warrant medication, the honest answer may be that you do not need one yet — in which case we set a recheck interval and focus on exercise, nutrition, and fall prevention.

Do you do the scan on site?

Several of our locations have DEXA on site, so the scan can often be done the same day as your visit. Not every location does. When you schedule, our team books you where the services you need are available.

Is weight-bearing exercise enough?

Exercise matters and we will always recommend it — weight-bearing activity plus resistance training plus balance work, which reduces falls. But in a woman with established osteoporosis and high calculated fracture risk, exercise is a complement to medication, not a replacement for it.

Medically reviewed by PLACEHOLDER — Medical Director, MD · Reviewed · Updated
PLACEHOLDER: replace with the reviewing clinician before launch.

Ready to talk to someone who treats this every day?

Insurance-based visits across metro Atlanta. No membership, no cash-pay program, no obligation to start hormones.

Request an appointment Call (770) 800-0000