The Bone Health and Osteoporosis Foundation (BHOF) recommends that all women receive bone density screenings beginning at age 65 and all men receive screenings at age 70. Younger adults receive bone density screenings if they have a high risk for osteoporosis or have already experienced an osteoporosis fracture.

Bone density, reported as a T-score and measured by a dual xray absorptiometry (DXA) test, becomes a central focus for patients with osteoporosis. Medications aim to increase bone density, and patients and doctors are thrilled when the T-score increases.

But low bone density is only a number on a test. It’s not the most important thing to consider with osteoporosis. After all, having a low bone density test number won’t kill you. Breaking a bone is the most important risk with osteoporosis. Osteoporosis hip fractures kill up to 40% of people who get them.

So the most important question about this–or any other osteoporosis test–is how well does it predict or reduce fracture risk. The answers might surprise you, but they can also put you on the road to making smarter to keep your bones strong.

How well, then, does a bone density scan predict fractures? A bone density scan predicts less than half of all people with osteoporosis who will get an osteoporosis fractures. One study concluded that a bone density test only predicted 44% of women and 21% of men who fracture. And when it comes to bone density, the North American Menopause Society (NAMS) has correctly concluded that fracture risk depends on factors largely other than bone density.

While all the science and technical jargon around osteoporosis might seem overwhelming, just remember this one simple question and keep asking it about every test and every approach someone suggests to you.

Here are some examples:

• How much does a bone density test predict fracture risk?
• How much does a medication reduce fracture risk? A hip fracture can be deadly, so ask how much it reduces fracture risk at specific sites on the body, such as hip and spinal fractures.
• Have clinical trials shown that the ingredients in a bone health supplement reduce fractures?
• Has research on a diet you’re being recommended conclude that eating a specific way reduces fractures?

Becoming a savvy healthcare consumer means knowing the right questions to ask. Fortunately, with osteoporosis, that question is simple. I think what you’ll find when you start asking it, however, will surprise you.

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