APEX PWR | Female Fitness
In October, Oprah Daily published an essay with a title that does a lot of work in one line.
“If We Really Cared About Preventing Osteoporosis, We’d Start Giving Women DXA Scans at Age 50, Not 65.”
Bone loss accelerates two years before menopause, yet screening guidelines for osteoporosis start over a decade later.
Jocelyn Wittstein, MD Orthopaedic surgeon, Duke University. Published in Oprah Daily, October 20, 2026. Read the full essay
We are a wellness facility that sells bone density scans, so take our enthusiasm for that headline with the appropriate grain of salt. Which is exactly why the rest of this article is going to be careful about what the guidelines actually say, where Dr. Wittstein is making an argument rather than reciting consensus, and what a scan can and cannot do for you.
The US Preventive Services Task Force updated its osteoporosis screening recommendation in January 2025. Most coverage reduced it to "65." The full version has three parts.
| Who | Recommendation | Grade |
|---|---|---|
| Women 65 and older | Screen with bone density testing to prevent osteoporotic fractures | B |
| Postmenopausal women under 65 at increased fracture risk | Screen, after a two-step process: check risk factors, then apply a clinical risk assessment tool | B |
| Men | Evidence insufficient to recommend for or against. Clinical judgment | I |
Read that middle row again, because it is the row nobody talks about.
If you are postmenopausal and under 65, the current national guideline already says you should be screened if you carry increased fracture risk. The risk factors the Task Force names include low body weight, a parent who fractured a hip, smoking, and excessive alcohol use. The two-step process exists precisely so that women under 65 get identified.
The most common reason a 56 year old woman has never had a bone density scan is not that she failed to qualify. It is that nobody ran the two-step assessment on her.
So before you conclude the system has nothing for you until 65, ask your physician directly: do I meet the criteria for screening under 65? For a meaningful number of women in Tigard and Beaverton reading this, the answer is going to be yes.
Her argument is about the default, not the exception. Rather than a risk-factor pathway that identifies some women under 65, she advocates for a DXA scan at around age 50, or roughly at the menopause transition.
In the notes accompanying her essay, she lays out when she believes earlier testing is warranted:
She is equally clear about who does not need one: most women in their twenties and thirties do not.
She also cites a pair of figures worth sitting with. By her account, only about a quarter of women between 50 and 65 currently get a DXA scan, and among those who do, roughly 13% are found to have osteoporosis. Those are her numbers from her essay rather than ours, and we have not independently verified them. If they hold, the implication is uncomfortable: the testing is finding disease at a meaningful rate in exactly the age band that mostly goes untested.
Dr. Wittstein's essay puts the acceleration of bone loss at two years before menopause. The Study of Women's Health Across the Nation, which has tracked bone health through the menopause transition in a large multiethnic cohort for decades, places the start of rapid loss at about one year before the final menstrual period.
The two sources differ on the exact month. They agree completely on the thing that matters.
Put those together with a screening age of 65. A woman whose final period arrives at 51 can spend roughly fourteen years losing bone in a process that has no symptoms, no pain and no warning, and then be measured for the first time after most of the loss has already happened.
SWAN also found that women who lost more bone density during the transition went on to have more fractures afterward, which is the part that turns a number on a page into a hip in an emergency room.
Screening guidelines are written to catch fractures. They were never designed to catch the decade when you could still do something about it.
That is the fair reading of why 65 exists, by the way. Population guidelines weigh evidence that screening and treating at a given age prevents fractures, and that evidence is strongest where fracture rates are highest, which is in older women. It is a defensible way to build a national recommendation. It also leaves a gap, and you are allowed to care about the gap even if the guideline cannot.
This is the distinction we spend more time explaining than any other, and it costs people real money when they get it wrong.
| Body composition DEXA | Site-specific bone density DEXA | |
|---|---|---|
| What it measures | Lean mass, fat mass, body fat percentage, visceral fat, plus a total body bone figure | Bone mineral density at the lumbar spine and the hip |
| The question it answers | What am I made of, and is it changing? | How strong is my skeleton, specifically where it breaks? |
| What physicians want to see | Not this one | This one |
| Rescan interval | Every 3 to 5 months | Annually |
| Physician review at APEX | Not applicable | Included, no extra charge, no separate appointment |
A whole-body composition scan does print a total bone number, and it is tempting to treat that as a bone density result. Research in nearly 700 adults found that total body bone density agreed with dedicated site-specific scans at the group level but disagreed about individual people, and specifically under-detected osteoporosis at the femoral neck. That is the hip fracture site. If bone is your question, the site-specific scan is the test that answers it. We covered the mechanics of this in more depth in our piece on the muscle index on your DEXA report.
Bone density results at APEX PWR go to Dr. Jordan Senn, DO, the physician on our wellness team, for review and interpretation. There is no additional charge for that and no separate physician appointment to book. You hear back within 7 business days or less.
We say "7 business days" rather than anything faster on purpose. A bone density result that matters deserves a physician reading it, and that takes the time it takes. A same-day printout would be faster and worth less.
Call before you book. We work with community healthcare providers across the Portland metro to help patients choose between the two, because they answer different questions and the wrong one is wasted money. Sometimes the answer is that you do not need either one yet, and we will tell you that too.
(971) 294-2669
A scan is a measurement. Measurements are only worth the money if something happens afterward.
Dr. Wittstein's closing line is the one we would underline: osteopenia is preventable, and progression from osteopenia to osteoporosis is also preventable. Bone is living tissue that responds to what you ask of it.
Resistance training pulls on bone, and that pull is the signal that tells bone to stay dense. Published trial evidence in postmenopausal women with low bone mass has found that supervised, high-intensity resistance and impact training can improve bone mineral density at the spine and hip. Those qualifiers matter. High intensity, supervised, in women who already had low bone mass. It is an argument for doing the right work with someone watching, rather than loading a barbell alone after reading an article.
What it looks like in practice: two to three full-body sessions a week, compound movements that load the spine and hip directly, loads that are genuinely hard in the final repetitions, progression written down, and impact work where it is appropriate for your joints and your current bone status.
Our strength programming for women in Tigard and Beaverton is run by Coach Nicole Hinkle, a Certified Menopause Coaching Specialist through Girls Gone Strong who is navigating this stage herself. If starting in a group feels like too much, personal training exists for that reason.
Bone needs adequate protein, calcium and vitamin D, and it needs enough total energy coming in. Underfuelling is its own risk factor for bone, which is the entire reason relative energy deficiency in sport appears on Dr. Wittstein's list of reasons to scan a young athlete.
The right calcium and vitamin D numbers for you depend on what you already eat and what your labs say, which makes them a conversation with your physician rather than a figure from a blog post. Protein we can help with: our nutrition coaching is led by Jennie Carolan, MS, and runs remotely, so distance is not the obstacle it is for training.
Site-specific bone density scanning of the spine and hip, reviewed by our physician at no additional charge and with no separate appointment. Results back within 7 business days or less. No referral needed, and we can obtain one on your behalf when it is required. Tigard, Oregon, off Highway 217, minutes from Beaverton. Scheduling five days a week including Saturdays.
Book a Bone Density Scan Strength Training for WomenOur new client special on the DEXA body composition scan is $127 for a single scan, or two scans for $237, with the second scan taken within 16 weeks so you can see what changed rather than just where you started. Purchase first, then schedule, which is how our booking works.
A body composition scan is a different test from a bone density scan and does not replace it. If bone health is your question, book the bone density scan above.
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