This must-have tool can prevent a silent, stealthy disease — every woman over 30 should know about it
Osteoporosis may seem like an old person's problem — the 'silent' condition gradually reduces bone mass and density, making your inner scaffolding weaker, thinner and more prone to fractures.
The disease is actually becoming increasingly common among younger people due to poor eating habits, certain underlying health issues and medication use.
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Dr. Pooja Gidwani, a concierge physician in L.A., is particularly worried about women taking GLP-1 drugs like Ozempic, which can cause a decrease in bone density along with rapid weight loss.
8 Osteoporosis makes bones weaker, thinner and more prone to fractures. It's becoming more prevalent in younger people.
Evgeniy Kalinovskiy – stock.adobe.com
She recommends women undergo a 'baseline' dual-energy X-ray absorptiometry (DEXA) scan in their early to mid-30s to help predict future health risks.
The test measures the strength and quality of bones while also quantifying body fat, lean mass and visceral fat.
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'It's a favorite in research, clinical medicine and elite athletic programs for this reason,' Gidwani told The Post.
Here's everything you need to know about this enlightening technology.
How does a DEXA scan work?
An X-ray provides detailed images of bone shape and structure, but it cannot accurately measure bone density or forecast fracture risk.
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8 In a DEXA scan (shown here), a high-energy and a low-energy X-ray beam are directed at your bones as you lie still on a padded table.
dizfoto1973 – stock.adobe.com
A DEXA scan harnesses the power of X-rays to reveal a clearer picture of bone strength.
The machine directs two X-ray beams, one high-energy and one low-energy, at your bones as you lie still on a padded table.
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The beams are absorbed by bone and soft tissue at different rates.
The scanner detects this difference and calculates bone mineral density and body composition with an error rate typically within 1% to 2%.
'The scan is painless, noninvasive and usually takes less than 30 minutes start to finish,' Gidwani said.
'It uses far less radiation than a standard X-ray and is designed to catch bone loss well before it becomes visible or leads to fractures.'
8 Dr. Pooja Gidwani, a concierge physician in L.A., suggests women in their 30s undergo a DEXA scan, especially if they are taking GLP-1 drugs like Ozempic.
Courtesy of Dr. Pooja Gidwani
Gidwani noted that the exam doesn't involve injections or contrast dyes. She advised getting scanned in the morning.
These tests are generally not recommended for pregnant women, and calcium supplement users may need to stop taking the tablets 24 hours beforehand.
What can a DEXA scan reveal?
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DEXA scans are primarily used to diagnose and monitor osteoporosis and osteopenia, a milder, earlier stage of bone loss.
It can also detect nuanced conditions such as:
Sarcopenia: low skeletal muscle mass
Sarcopenic obesity: low muscle and high fat
Osteosarcopenic obesity: low muscle, low bone density and high fat
Abnormal visceral fat distribution linked to metabolic disease
Unexplained fractures or suspected secondary osteoporosis (due to medications, hormonal disorders, etc.)
8 DEXA scans are primarily used to diagnose and monitor osteoporosis and osteopenia, a milder, earlier stage of bone loss, but they can also detect other concerning conditions.
RFBSIP – stock.adobe.com
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'It's more reliable than body fat scales and more detailed than MRI for whole-body composition,' Gidwani said of DEXA.
'Its precision makes it ideal for tracking changes over time, especially during weight loss, strength training or hormone transitions like perimenopause and menopause.'
Should I get a DEXA scan if I'm otherwise healthy?
Bone mass tends to peak around age 30. The bone remodeling process continues, but the breakdown of old bone starts to slightly outpace the formation of new bone.
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Genetics and personal habits such as diet, exercise, cigarette use and alcohol consumption influence bone health. Hormonal shifts — particularly a decrease in estrogen — can accelerate bone breakdown.
'Estrogen levels can begin to fluctuate in the mid-to-late 30s,' Gidwani explained, 'due to a range of factors, including early or natural perimenopausal transition, chronic stress, postpartum recovery, disrupted ovulatory cycles, low body fat, overtraining or preexisting gynecological or endocrine conditions like PCOS or hypothalamic amenorrhea.'
8 Hormonal shifts — particularly a decline in estrogen — can accelerate bone breakdown. Estrogen levels decrease in menopause.
Valerii Honcharuk – stock.adobe.com
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Women are also at risk of early bone density decline if they have a family history of early osteoporosis, a lack of strength training, insufficient calcium, protein or vitamin D intake, disordered eating, sedentary behavior or rapid weight loss.
GLP-1 drugs, which suppress appetite, can cause speedy slimdowns.
'While GLP-1s can be incredibly helpful when done right, they can also lead to unintended losses in lean muscle and bone density if not paired with proper nutrition and resistance training,' said Gidwani, who treats women on GLP-1s and focuses on hormone health and longevity.
'In women in their 30s and 40s using GLP-1s,' she added, 'DEXA is especially valuable for detecting early loss of muscle or bone, often long before symptoms or complications arise.'
8 The loss of bone mass can accompany rapid weight loss with GLP-1 drugs like Ozempic.
Wild Awake – stock.adobe.com
Gidwani said she's seen female patients as young as 32 show low bone density on scans.
For men, Gidwani suggests that those with a family history of osteopenia/osteoporosis, a history of fractures, long-term steroid use, low muscle mass, very low testosterone or long-term GLP-1 use consider a DEXA scan earlier than the standard guideline of age 70.
Where can I get a DEXA scan?
Hospitals, diagnostic imaging centers, women's health or endocrinology clinics and increasingly, wellness and fitness centers offer DEXA scans.
'Companies like BodySpec and DexaFit specialize in mobile or consumer-accessible DEXA scanning, often used for fitness tracking,' Gidwani said.
'Just be sure to confirm whether the scan is being done for diagnostic purposes (bone density) or wellness (body composition).'
DEXA costs vary widely, from $40 to $300 or more out of pocket, depending on the facility, the extent of the scan and the specific reason for it.
8 Dismissing bone health in youth can lead to significant problems later in life.
zinkevych – stock.adobe.com
Scans are typically covered by insurance for women over the age of 65, men older than 70, postmenopausal women with risk factors, people with certain medical conditions or those taking medications that increase fracture risk.
'Hopefully, as awareness around early bone loss and changes in body composition increases (especially in the context of GLP-1 use and hormonal shifts in younger women),' Gidwani said, 'screening guidelines will begin to reflect this need for earlier, proactive intervention.'
What are the treatment options for low bone density?
If a scan reveals low bone density, the first step is to identify the cause.
8 Strength training stimulates bone growth and slows bone loss.
Microgen – stock.adobe.com
Gidwani said a treatment plan typically includes:
Strength training to improve bone and muscle
Increased protein intake — aim for at least 0.8 to 1.2 grams of protein per pound of body weight, especially if you're on GLP-1s or losing weight.
Calcium and vitamin D supplementation
Hormone therapy, particularly for perimenopausal and postpartum patients
Fall prevention and balance training
Lifestyle changes such as reducing alcohol intake, quitting smoking and addressing nutritional deficiencies
In moderate to severe cases, medications like bisphosphonates and denosumab slow bone breakdown while teriparatide stimulates the formation of new bone.
'In your 30s or 40s, the most impactful strategy is prevention,' Gidwani said, 'identifying early losses, tailoring lifestyle interventions and checking progress over time with repeat DEXA scans.'
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But don't comment on their bodies. Bottom line: As I've often said, if it's curiosity that's driving you, curb it. Matt Hughes, a town commissioner in Hillsborough, North Carolina, told me he's hesitant to make the disclosure about using a GLP-1 because 'it's almost as if someone worked less hard to lose the weight,' he said. Even if that's not your intention, asking people if they are taking a GLP-1 might be mistaken for 'Ozempic shaming,' which is when people are criticized or judged for taking a drug to lose weight rather than relying on diet and exercise, even though lifestyle changes don't work for the vast majority of people. 'Weight stigma is deeply ingrained and almost unconscious,' said Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital. She reminded me that GLP-1s are treatments for medical conditions — just like those for high blood pressure, cancer or anything else — which can empower those to reply to intrusive queries by being direct, humorous or just deflecting the question. Some snappy responses I've heard include: Bottom line: It's no one's business but your own, and you don't need to discuss your prescriptions with anyone but your doctor. People who start taking GLP-1s often experience major changes in appetite or have side effects like nausea, which can limit how much they want to eat. Some people find they are less interested in drinking alcohol as well. That means in social situations, you may not be able to eat or drink like you have in the past. If you're dining at a friend's house and can't eat as much as you used to, a simple 'no, thank you' should suffice — and a considerate host won't press the issue. When dining out, there's the age-old dilemma about splitting the check: 'I only had a salad. You had a steak.' Or, 'I don't drink alcohol, and you had three cocktails.' When someone is having smaller portions or fewer courses, splitting a check can be even more difficult. Hax reminds people 'to be mindful of fairness and not hide behind expediency to get the 'sober dieting vegans' to cover their champagne and lobster.' She also suggests 'reading the room,' which means sometimes you can get separate checks, or take half of your meal home, and sometimes you just overpay, for the pleasure of everyone's company. Post also has some specific strategies, like telling friends you dine with regularly: 'Hey guys, I'm eating a lot less these days. Is it okay if I get my own check?' Or offer to use check-sharing apps like Billr or Divvy so that all diners pay what they owe. When I host, I've started asking guests not only if they have any food allergies or preferences, but also: 'Is there anything else I need to know in preparing dinner?' That allows room for someone to let me know either that they're on a GLP-1, or simply that they're only able to eat certain amounts or types of food these days. For that reason, I'm also inclined to serve buffet style, letting everyone decide how much they want on their plate. Bottom line: Be prepared to communicate your needs ahead of time and don't pry for details if a friend's eating habits change. I've faced many well-meaning but intrusive questions myself, which is why I smiled when Hax told me: 'Too bad there isn't a GLP-1 for ignorance.'
