Understanding When Bone Density Testing Is Essential
Less than 2 in 10 patients who should be investigated after a fracture actually receive appropriate testing. This gap in care means osteoporosis often remains undiagnosed until further fractures occur.
Osteoporosis is a clinical diagnosis, but the DEXA (DXA) scan remains the single most helpful investigation for assessing bone mineral density and fracture risk. Knowing who should — and who should not — have a DEXA scan is critical for early detection, prevention, and effective treatment.
At London Osteoporosis Clinic, we use DEXA scanning as part of a comprehensive bone health assessment, ensuring scans are performed when they are clinically appropriate, accurate, and meaningful.
What Is a DEXA Scan?
A DEXA (Dual-Energy X-ray Absorptiometry) scan is a quick, painless, low-radiation test used to measure bone mineral density (BMD).
What to expect:
-
You lie comfortably on your back on an X-ray table
-
The scan typically takes 10–15 minutes
-
No injections, needles, or discomfort
-
No special preparation required
-
In most cases, you can remain fully clothed (metal fasteners must be removed)
DEXA scans are most commonly performed at the hip and spine, the sites most predictive of fracture risk. Know more about why you need a DEXA scan.
Who Should Have a DEXA Scan?
Age-Based Screening Recommendations
Routine screening is recommended for:
-
All women aged 65 years and older
-
All men aged 70 years and older, even if asymptomatic
These age groups carry a significantly higher risk of osteoporosis and fractures.
Women Under 65 With Additional Risk Factors
Women below screening age should undergo DEXA scanning if they have:
-
Oestrogen deficiency (peri-menopausal or post-menopausal)
-
Discontinuation of hormone therapy
-
Early or premature menopause (before age 45)
-
History of amenorrhoea for more than one year before age 42
-
Family history of maternal hip fracture after age 50
Men and Women With Clinical Risk Factors
DEXA scanning is strongly indicated for individuals of any age with:
-
Fragility fractures (fractures from low-impact trauma)
-
Eating disorders (current or past)
-
Hypogonadism or testosterone deficiency (men under 70)
-
Long-term corticosteroid use (e.g. Prednisolone ≥5 mg for more than 3 months)
Medication-Related Risk
Bone density testing is recommended for patients receiving medications known to adversely affect bone health, including:
-
Long-term steroids
-
Anticoagulants (warfarin, heparin)
-
Anti-epileptic drugs
-
Aromatase inhibitors (e.g. breast or prostate cancer treatments)
-
GnRH or LHRH analogues
-
Prolactin-raising antipsychotics
-
Certain chemotherapy and radiotherapy regimens
Radiological or Structural Indicators
DEXA is appropriate for individuals with:
-
Evidence of osteopenia
-
Vertebral deformity (kyphosis)
-
Vertebral compression fractures detected on imaging
Medical Conditions Associated With Bone Loss
DEXA scanning is advised in patients with conditions affecting bone development or metabolism, such as:
-
Osteogenesis imperfecta
-
Hyperthyroidism
-
Rheumatoid arthritis
-
Inflammatory bowel disease (IBD)
-
Growth hormone deficiency
Lifestyle and Nutritional Risk Factors
DEXA may be indicated for those with:
-
Height loss >2 cm
-
Low BMI (<18 kg/m²)
-
Severe malnutrition or poor nutrition
-
Excessive alcohol intake
-
14 units/week (women)
-
21 units/week (men)
-
-
Smoking history
-
Excessive exercise with inadequate caloric intake
Medications Known to Increase Osteoporosis Risk
Certain medications may accelerate bone loss, including:
-
Chemotherapy and radiation therapy
-
Thyroxine (if over-replaced)
-
Anti-epileptic medications (e.g. phenytoin, phenobarbitone)
-
Long-term heparin or warfarin
-
Lithium
-
Proton pump inhibitors (PPIs)
-
Loop diuretics (e.g. furosemide)
-
Aromatase inhibitors (e.g. Arimidex)
Patients on these medications should be individually assessed for bone density testing.
Who Should NOT Have a DEXA Scan?
DEXA scanning may be inappropriate or unreliable in certain situations:
Absolute Contraindications
-
Pregnancy
Temporary or Technical Limitations
-
Recent gastrointestinal contrast studies or radionuclide imaging
-
Severe degenerative spinal changes or deformities
-
Inability to lie flat or remain still during scanning
-
Extreme obesity or extremely low BMI affecting measurement accuracy
In such cases, alternative assessment strategies may be recommended.
Why Early and Appropriate DEXA Testing Matters
Osteoporosis is often silent until a fracture occurs. A timely DEXA scan:
-
Identifies osteoporosis before fractures happen
-
Helps stratify fracture risk
-
Guides personalised prevention and treatment plans
-
Reduces the risk of future fractures and disability
When to Seek a Bone Health Assessment
If you fall into any of the risk categories above — or have experienced a fracture from a minor fall — a specialist bone health assessment is recommended.
At London Osteoporosis Clinic, we go beyond numbers, combining:
-
DEXA scanning
-
Clinical risk assessment
-
Blood investigations
-
Personalised prevention and treatment strategies
Book a DEXA Scan or Bone Health Consultation
If you are concerned about osteoporosis risk, bone loss, or fractures, early assessment can make a meaningful difference.
👉 Book your appointment at London Osteoporosis Clinic today
👉 Arrange a DEXA scan with expert interpretation and follow-up care
