How a DEXA Scan Can Help You Make an Informed HRT Decision
Quick Read
You're weighing whether hormone therapy is right for you, and you want to make that call with real information. Women can lose up to 20% of their bone density in the first few years after menopause, usually without feeling a thing. A DEXA scan is a quick, low-radiation test that shows your bone density, so you and your provider know your starting point. That baseline helps you weigh the benefits of HRT honestly, whatever you decide.
Bone loss is quiet. There's no ache or warning sign while it's happening, and many women first learn about it after a fracture.
Dr. Doug Lucas, a double board-certified orthopedic surgeon and Clinical Lead of Bone Health and Longevity Medicine at LifeMD, wants to change that. His advice for any woman deciding on hormone therapy is simple: “Know your bones first”.
Here's why a DEXA scan deserves a spot at the top of your to-do list, and how to make the most of it.
Feel Like Yourself Again
Connect with a licensed menopause provider who can help you understand your symptoms and determine if hormone replacement therapy is the right next step.
What is a DEXA Scan?
A DEXA scan, short for dual-energy X-ray absorptiometry, is the standard test for measuring bone density. It uses two low-dose X-ray beams to measure how much mineral is packed into your bones, usually at the hip and lower spine.
Your results come back as a T-score, which compares your bone density to that of a healthy young adult.
T-score | What it means |
-1.0 or higher | Normal bone density |
Between -1.0 and -2.5 | Low bone mass, also called osteopenia |
-2.5 or lower | Osteoporosis |
Some DEXA scans can also measure body composition, showing how much of your body is muscle, fat, and bone. Dr. Lucas calls DEXA "such an easy tool" because it can track both your bones and your muscle over time.
Why Should a DEXA Scan Come Before Your HRT Decision?
Here are five reasons to know your bone density before you choose whether to start hormone therapy.
1. Bone loss speeds up fast after menopause
Estrogen helps protect your bones. When it drops at menopause, bone loss accelerates quickly. According to Dr. Lucas, women can lose up to 20% of their bone density in the first three to four years after their periods stop. That's up to a fifth of your bone density in just a few years. "The numbers here are staggering. When I first heard this, I didn't believe it."
2. You can't feel it happening
Bone loss has no symptoms. Most women don't know their bones are thinning until a fall leads to a fracture. A DEXA scan turns that invisible change into a number you can see and act on.
3. Bone protection is one of HRT's biggest benefits
Estradiol is FDA-approved to help prevent osteoporosis. That makes your bone density a key part of the risk-and-benefit picture when you're deciding on HRT. Dr. Lucas puts it this way:
"You can't have a conversation with your provider about hormones that has a complete risk and benefit equation analysis without understanding what your bone density is out of the gate."
4. A DEXA scan can help you make a confident choice either way
Deciding on hormone therapy is personal, and Dr. Lucas is clear that there's room for every choice. Some women choose HRT. Others choose to age without it. What matters is making that choice with the full picture.
"There's no wrong answer, but you have to actually pick one. I want all women to be empowered with the information around their skeleton."
5. It gives you a baseline to track over time
One scan shows where you are today. Follow-up scans show whether you're holding steady, gaining, or losing bone, and whether you're keeping your muscle. That lets you and your provider adjust your plan based on real results.
When Should You Get a DEXA Scan?
Current U.S. guidelines recommend bone density screening for all women 65 and older, and for postmenopausal women under 65 who are at increased risk for fractures.
Dr. Lucas takes it a step further. He recommends a DEXA scan for women in midlife, during perimenopause and around the time periods stop, especially if they're deciding on hormone therapy. Guidelines are built for screening large populations, and he looks at it from the angle of helping each woman make the best decision for her own body.
The best time for your first scan is before you start hormone therapy or soon after, so you have a clear baseline to compare against.
What Happens During a DEXA Scan?
A DEXA scan is one of the easiest tests you'll ever take.
It's quick: Most scans take about 10 to 20 minutes.
It's painless: You lie on a padded table while a scanner arm passes over your body.
It uses very little radiation: The dose is much lower than a standard chest X-ray.
There's minimal prep: Wear comfortable clothes without metal, and skip calcium supplements for 24 hours beforehand if your imaging center asks.
Your provider can order the scan, and results usually come back within a few days.
What Can You Do With Your Results?
Whatever your T-score says, there's a lot you can do to protect your bones and muscle. Dr. Lucas starts with the hormone decision, then builds the rest of the plan around a few core habits.
Decide on hormones with your provider
Your DEXA results give you and your provider a clear starting point to talk through whether HRT makes sense for you.
Lift something heavy
Bones and muscles both get stronger when you put load on them. Dr. Lucas recommends resistance training, like lifting weights or using resistance bands, on top of everyday movement.
"Muscles and bones respond to the kind of stress that you get from actually putting load on your bones and on your muscles."
He calls ‘muscle’ one of the most important tissues for healthy aging. More muscle means more energy, fewer falls, and better metabolic health.
Prioritize protein and sleep
What you eat and how you rest both shape your bones and muscles. Getting enough protein supports muscle repair, and quality sleep helps your body recover. As we age, Dr. Lucas notes, there's less room for error in these daily habits.
Treat supplements as the finishing touch
Supplements can fill gaps, like magnesium, which can be hard to get enough of through food. Dr. Lucas also points to vitamin K2 as an interesting option for bone health. Still, he's clear that lifestyle comes first. In his words, supplements are "like the sprinkles on the icing on the cake." Talk to your provider before adding anything new.
Re-scan to track your progress
A follow-up DEXA scan shows whether your plan is working. If you're losing bone or muscle, it's a signal to adjust your training, nutrition, or treatment.
How Can LifeMD Help You Protect Your Bones?
The LifeMD Women's Health Program connects you with licensed menopause providers who look at the full picture, symptoms, and goals, when building your personalized hormone therapy plan. Your provider can help you understand where your bones stand and whether HRT is the right fit for you.
See if you’re eligible today and make your hormone therapy decision with confidence.
Want to hear more? To learn more about Dr. Doug Lucas’ full conversation, listen to this podcast episode.
The information provided is not a substitute for professional medical advice and is for informational purposes only. Availability of specific treatments and offerings varies by state. Medications prescribed if clinically appropriate based on completion of required consultation.
