Know your risk. Ask better questions. Get the complete record.
Understanding bone health is the start. This is the part that helps you act on it — a structured way to have a productive conversation with a licensed clinician. Nothing here tells you which test you personally need; it helps you prepare for, and follow up on, the right conversation.
Before Your Appointment
Screening or diagnostic? Build your history and questions.
What Testing to Discuss
The bone-testing roadmap and secondary-cause evaluation.
Understanding Your Results
The DXA quality checklist and a longitudinal tracker.
When Testing Is Denied
An insurance appeal toolkit and editable templates.
Pick a pack for what you're doing today — or fine-tune the sections below, then print.
Which conversation do you need?
The single most useful distinction in bone health: a screening guideline is not the same as a diagnostic workup. Routine population screening is broadly recommended for women 65 and older. For men, several bone-health organizations recommend DXA at 70+, while the USPSTF currently finds the evidence insufficient to make a population-wide recommendation for men — individual risk factors can still justify evaluation at any age. Routine age-based screening is meant for people without symptoms, fractures, or a known bone-losing condition. Anyone with a fragility fracture, height loss, a bone-affecting medication, or a secondary condition may need an evaluation even if they don't meet a simple age rule.
Answer a few questions and this builds a tailored list of topics to raise with a licensed clinician — plus whether your situation leans toward screening or a diagnostic evaluation. It doesn't diagnose or recommend any specific test.
Pick the option that best describes you to begin.
My Appointment Pack
Fill this in (on screen or on paper) and bring it. It gives your clinician the full picture and makes sure the right questions get asked.
Page 1 · My bone-health history
Page 2 · Questions for my clinician
“Based on my risk factors, do I meet criteria for a central DXA of the hip and lumbar spine?”
“Because I have [a fracture / height loss / a bone-affecting medication / a medical condition], should this be a diagnostic evaluation rather than routine preventive screening?”
“Would vertebral imaging, a Trabecular Bone Score, or a check for secondary causes change my risk assessment or treatment?”
“Which results would change what we do next?”
Page 3 · Appointment outcome
One-page summary for my clinician
A patient-completed summary of why I'm asking about a bone evaluation — my questions, not instructions. My clinician's judgment governs.
“I'd like to discuss whether my situation warrants a diagnostic bone evaluation rather than routine screening.”
My risk factors
Questions I'd like to cover
The bone-testing roadmap
Not every test has the same purpose or the same weight of evidence. This is the order things generally sit in — foundational first, more specific tests when there's a reason, and newer tools as complements.
Foundational evaluation
Standard of care- Central DXA of the lumbar spine and hip
- Clinical fracture-risk assessment
- FRAX 10-year risk estimate, when appropriate
- History of fractures, falls, medications & secondary causes
Additional evaluation, when indicated
Add when there's a reason- Vertebral fracture assessment (VFA) or spinal imaging
- Trabecular Bone Score (TBS) — a quality adjunct
- Forearm DXA (in defined circumstances)
- Laboratory investigation for secondary causes
Emerging & complementary tools
Complement, not replacement- REMS (radiation-free ultrasound + Fragility Score)
- Other developing bone-quality technologies
Secondary-causes discussion guide
Not everyone needs every lab. This is a menu to discuss — a common baseline, plus tests added based on your history or first findings.
Frequently considered baseline
Considered based on history / findings
Could I have an unrecognized vertebral fracture?
Many spine fractures are never noticed when they happen — yet finding one can change the diagnosis and the treatment. A DXA number alone is not the whole evaluation.
Ask for the complete report
Don't settle for “normal,” “osteopenia,” or “osteoporosis.” Request the full DXA report — the numbers and the technical details decide whether a result is trustworthy and whether a change over time is real.
DXA quality checklist
My results tracker
One place for your numbers over time. You have a right to the complete report — request it, don't rely on a portal summary.
| Date | Facility / scanner | Spine BMD / T | Total hip BMD / T | Femoral neck BMD / T | TBS | FRAX | Height | Fractures / falls | Meds & labs |
|---|---|---|---|---|---|---|---|---|---|
If an insurer or clinician says no
Coverage varies by plan and by your medical circumstances, so this is about organizing facts — not asserting you're entitled to a particular test. A denial is often a starting point, not the end.
Insurance denial & appeal toolkit
- Ask for the written denial and the specific coverage criterion it cites.
- Confirm whether the request was submitted as preventive screening or diagnostic evaluation — this often matters.
- Ask your clinician whether added documentation of risk factors, fractures, medications, or medical necessity is appropriate.
- Request the applicable medical policy from the insurer.
- Follow the insurer's internal appeal process.
- Request an external review when available.
- Keep copies of orders, reports, correspondence, and every appeal deadline.
Template · Request for reconsideration
“I am requesting reconsideration of the denial dated ______ (reference ______). My clinician ordered ______ as a diagnostic evaluation based on ______ [fracture / medication / condition]. Please provide the specific medical policy applied and the steps for internal appeal and external review.”