How osteoporosis testing works

The standard test for osteoporosis is a DEXA scan (dual-energy X-ray absorptiometry), which measures bone density in your hip, spine, and sometimes your forearm. The scan takes 10 to 30 minutes, involves no needles, and uses a very small amount of radiation — less than a chest X-ray. You lie on a padded table while a machine passes over your bones, and a computer compares your bone density to that of a healthy young adult.

Your doctor orders the DEXA scan based on your age, sex, and risk factors. The results come back as a T-score, which tells you whether your bones are normal, show early bone loss (called osteopenia), or have osteoporosis. A T-score of -1.0 or higher is normal. A score between -1.0 and -2.5 means osteopenia. A score of -2.5 or lower means osteoporosis.

Some people also get a FRAX score, which predicts your 10-year risk of a hip or major osteoporotic fracture. Your doctor may use this alongside your DEXA results to decide whether treatment is needed.

Key Takeaways

  • A DEXA scan is a quick, painless X-ray that measures bone density and is the standard way to diagnose osteoporosis.
  • Your doctor will recommend testing based on your age and risk factors, not because you have symptoms — osteoporosis has no early warning signs.
  • Results come back as a T-score that shows whether your bones are normal, have early loss, or have osteoporosis.
  • You should have the test at a hospital, imaging center, or bone health clinic that has a DEXA machine and trained technicians.
  • Medicare covers DEXA screening for women 65 and older and for men 70 and older, and for younger people with risk factors.

Who should get tested and when

The U.S. Preventive Services Task Force recommends DEXA screening for all women 65 and older and all men 70 and older, even if they have no symptoms or known risk factors. Younger people should be tested if they have risk factors such as a family history of osteoporosis, a previous fracture as an adult, long-term use of corticosteroid medications, rheumatoid arthritis, or low body weight.

If you are a postmenopausal woman under 65 or a man under 70, talk to your doctor about whether testing makes sense for you. Your doctor will consider your personal and family history, medications, and other health conditions. If your first DEXA shows normal bone density, you typically do not need another scan for 10 years. If you have osteopenia, your doctor may recommend repeat testing in 1 to 2 years.

You do not need to wait for symptoms to get tested. Osteoporosis causes no pain, weakness, or other signs until a bone breaks. By then, significant bone loss has already happened.

What to do before your DEXA scan

Preparation for a DEXA scan is minimal. Wear loose, comfortable clothing without metal zippers, buttons, or snaps — these can interfere with the image. Remove jewelry, watches, and any metal objects from your pockets. You can eat and drink normally before the scan.

Tell your technician if you have had a barium X-ray or injected contrast dye within the past week, because these can affect results. Also mention if you are pregnant or think you might be, though DEXA uses so little radiation that it is considered safe during pregnancy if medically necessary.

Bring your insurance card and photo ID. If this is your first DEXA, your doctor's office will send a referral to the imaging center. Ask your doctor's office whether they need any additional information from you before your appointment.

Where to get tested

DEXA scans are available at hospitals, outpatient imaging centers, bone health clinics, and some large medical practices. Your primary care doctor can give you a referral and recommend a location near you. You can also call your local hospital and ask for the radiology or bone density department.

Make sure the facility has a DEXA machine and staff trained to perform bone density scans. Not all imaging centers have this equipment. If you are having trouble finding a location, your doctor's office can help you locate one in your area.

Medicare covers DEXA screening for women 65 and older and men 70 and older once every two years, and more often if medically necessary. Many private insurance plans also cover the scan. Call your insurance company before your appointment to confirm coverage and ask about any out-of-pocket costs.

What happens during the scan

When you arrive, a technician will ask you to lie on a padded table. You will be asked to remove your shoes and any metal objects. The technician will position your body — usually your lower spine and hip are scanned first — and ask you to stay still while the scanning arm moves slowly over your bones. You will not feel anything during the scan.

The technician may ask you to move to a different position for additional scans. The whole process usually takes 10 to 30 minutes depending on which bones are being measured. You can get up and leave when ready after the scan is complete. There are no side effects or recovery time.

Understanding your results

Your doctor will receive a written report with your T-score and images within a few days. Your doctor will explain what the results mean and whether you need treatment. A normal T-score means your bones are healthy. An osteopenia result means you have some bone loss but not yet osteoporosis, and your doctor may recommend lifestyle changes or medication depending on your other risk factors.

An osteoporosis result means your bones are weak and you have a higher risk of fracture. Your doctor will likely recommend medication, calcium and vitamin D, weight-bearing exercise, and fall prevention strategies. Do not assume an osteoporosis diagnosis means you will break a bone — many people with osteoporosis never have a fracture, especially if they start treatment early.

Ask your doctor for a copy of your results to keep in your records. If you move or change doctors, you can share these results with your new doctor to avoid repeating the scan unnecessarily.

Questions to ask your doctor

Before your DEXA scan, ask your doctor why they are recommending the test and what they will do with the results. Ask whether you should have any blood work done at the same time to check calcium, vitamin D, and thyroid function — these can affect bone health and may be ordered alongside DEXA.

After you get your results, ask your doctor what your T-score means for you personally, whether you need treatment, and what lifestyle changes might help. Ask how often you should be retested. If your doctor recommends medication, ask about side effects, how long you will need to take it, and what to watch for.

Frequently Asked Questions

Does a DEXA scan hurt?

No. A DEXA scan is painless. You lie still on a padded table while a scanning arm passes over your bones. You will not feel anything during the procedure. The scan uses a very small amount of radiation, similar to a dental X-ray.

Can I get a DEXA scan without a doctor's referral?

Most imaging centers require a doctor's order to perform a DEXA scan. Contact your primary care doctor to request a referral. If you do not have a primary care doctor, you can call a local hospital or imaging center and ask how to get a referral.

What if my insurance does not cover the scan?

Ask the imaging center about the cost before your appointment — DEXA scans typically cost between $100 and $300 without insurance. Some centers offer discounts for uninsured patients or payment plans. Your doctor may also know of community health centers that offer lower-cost bone density screening.

How often do I need to be retested?

If your first DEXA shows normal bone density, you typically do not need another scan for 10 years. If you have osteopenia, your doctor may recommend retesting in 1 to 2 years. If you have osteoporosis and start treatment, your doctor will decide when to retest based on your response to medication and other factors.

Can I get a DEXA scan if I am pregnant?

DEXA uses so little radiation that it is considered safe during pregnancy if medically necessary, but most doctors will postpone the scan until after delivery unless there is an urgent reason to do it now. Tell your technician if you are pregnant or think you might be.