Bone densitometry DEXA

Overview

A bone densitometry DEXA (dual-energy X-ray absorptiometry) scan is a safe, painless test that measures the strength and density of your bones. It uses a very small amount of X-rays to check if your bones are becoming thin and weak, which could mean you have osteoporosis (a condition where bones are more likely to break). The scan is quick, usually takes 10 to 20 minutes, and is often done on your hip and lower spine.

Yes, DEXA scans are widely used. Millions of people around the world have them each year, especially those at risk for osteoporosis, which is a common condition affecting many older adults.

DEXA scans are typically recommended for women over 65 and men over 70, or for younger people with risk factors like a family history of osteoporosis, long-term use of certain medications (such as steroids), low body weight, or a previous fracture after a minor fall.

Symptoms

Common symptoms

• You usually do not have any symptoms before a DEXA scan. The scan is often done because you have risk factors for osteoporosis, not because of symptoms.
• Some people may have had a broken bone after a small bump or fall, which can be a sign of weak bones.

Symptoms in older adults

• In older adults, a DEXA scan may be suggested if you have lost height, developed a stoop (curved upper back), or had a broken bone easily.

Causes

Main causes

• A DEXA scan is done to check for low bone density. The main cause of low bone density is osteoporosis, which happens when your body loses bone faster than it can replace it.
• Other causes include long-term use of medications like steroids, hormonal changes (especially after menopause), and certain medical conditions such as rheumatoid arthritis or thyroid problems.

Risk factors

• Being over 65 years old
• Being female and having gone through menopause
• Having a parent who had a hip fracture
• Smoking or drinking too much alcohol
• Having a low body weight (BMI under 21)
• Long-term use of steroid tablets
• Having certain digestive conditions that affect nutrient absorption, like Crohn's disease or coeliac disease
• Being physically inactive for a long time

When to see a doctor

See a doctor urgently if:

• See a doctor urgently if you have sudden back pain after a minor fall or if you think you may have broken a bone.
• If you have lost more than 2 cm (about 1 inch) in height or notice a change in your posture, make an appointment soon.

Book a routine appointment if:

• Talk to your doctor about a DEXA scan if you are a woman over 65 or a man over 70.
• If you are younger but have risk factors (like a family history of osteoporosis, a previous fracture, or long-term steroid use), ask your doctor if a DEXA scan is right for you.
• If you have been diagnosed with osteoporosis and are on treatment, your doctor may suggest follow-up scans every 1 to 2 years to see how you are doing.

Diagnosis

A DEXA scan is the main test used to diagnose osteoporosis. Your doctor will refer you for the scan if you have risk factors or if you have already had a fragility fracture (a break from a minor fall). The scan takes pictures of your hip and lower spine to measure bone density.

Tests that may be done

• DEXA scan (the gold standard)
• Sometimes a peripheral DEXA (pDXA) scan is done on the forearm, heel, or finger for initial screening, but results may need confirmation with a central DEXA.
• A FRAX score (a calculator that estimates your 10-year risk of fracture) may be used alongside the DEXA result.

What to expect at your appointment

The test is simple and painless. You will lie on a padded table while a scanning arm passes over you. You need to stay still for a few minutes. No injections or special preparation are needed, but avoid taking calcium supplements for 24 hours before the scan. Wear comfortable clothes without metal zips or buttons. The whole appointment usually takes about 30 minutes.

Treatment

If your DEXA scan shows that you have low bone density (osteoporosis or osteopenia), your doctor will recommend a treatment plan to strengthen your bones and reduce the risk of fractures. Treatment usually combines lifestyle changes, supplements, and sometimes medications.

Self-care at home

• Make sure you get enough calcium and vitamin D from your diet or supplements (as advised by your doctor).
• Do regular weight-bearing exercises like walking, dancing, or climbing stairs to help keep bones strong.
• Do muscle-strengthening exercises (like lifting light weights or using resistance bands) at least twice a week.
• Stop smoking and limit alcohol intake to no more than 2–3 units per day (a unit is about half a pint of beer or a small glass of wine).
• Take steps to prevent falls at home, such as removing loose rugs, using grab bars in the bathroom, and wearing non-slip shoes.

Medical treatments

If your bone density is very low or if you have already broken a bone, your doctor may prescribe medications that help slow bone loss or increase bone formation. These are usually tablets or injections taken regularly. Your doctor will decide the best option for you based on your age, sex, and overall health. Treatment may be needed for several years, with regular check-ups to monitor progress.

When is surgery considered?

Surgery is not a treatment for low bone density itself. However, if you have a broken bone due to osteoporosis (for example, a hip fracture or a vertebral compression fracture), surgery may be needed to repair the fracture. This is managed by an orthopaedic surgeon.

Living with this condition

If you have low bone density, you can still live a full and active life. The key is to make your home safe, stay physically active with gentle exercises, and follow your treatment plan. Avoid high-impact activities like jumping or heavy lifting, but keep moving. Many people with osteoporosis live well for many years without breaking any bones.

Lifestyle tips

• Keep your home well-lit and clutter-free to prevent falls.
• Wear shoes with good grip, especially in winter.
• Use a walking stick or frame if you feel unsteady.
• Stay socially active — loneliness can lead to inactivity, which is bad for bones.
• Talk to your doctor before starting any new exercise programme.

Diet and exercise

Eat a balanced diet rich in calcium (dairy products, leafy green vegetables, fortified cereals, and fish with edible bones like sardines) and vitamin D (oily fish, eggs, and fortified foods). Aim for 10–20 minutes of sunlight on your skin most days (but not for too long). Exercise regularly: walking, tai chi, yoga (avoid extreme twists), and gentle weight training are all good options. Avoid high-impact or contact sports.

Mental health and emotional wellbeing

Being told you have low bone density can be worrying, but it is very manageable. Some people feel anxious about falling or breaking a bone. It is normal to feel this way. Talking to your doctor, a family member, or a support group can help. Focus on the things you can control — your diet, exercise, and safety habits — rather than worrying about the future. If you feel very anxious or depressed, seek help from a mental health professional.

Prevention

Osteoporosis is not always preventable, but you can reduce your risk by adopting a bone-healthy lifestyle early in life. Building strong bones in childhood and young adulthood helps later on. Even in older age, it is never too late to make changes that can slow bone loss.

Screening programmes

Routine screening for osteoporosis is not recommended for everyone, but if you have risk factors, talk to your doctor about having a DEXA scan. In some countries, women over 65 are offered a scan as part of a national screening program. Check with your local health service for guidance.

Complications

If left untreated

• Untreated low bone density can lead to fractures from minor bumps or falls, especially in the hip, spine, and wrist.
• Hip fractures can make it hard to walk and may require surgery and a long recovery.
• Spine fractures can cause chronic back pain, loss of height, and a hunched posture (kyphosis).
• Multiple fractures can lead to disability and loss of independence.

Long-term outlook

The outlook for most people with low bone density is positive. With early diagnosis through a DEXA scan, you can take steps to strengthen your bones and lower your risk of fractures. Many people live active, independent lives for many years after diagnosis. Treatment and lifestyle changes are very effective. Even if you have already had a fracture, you can still improve your bone health and prevent further breaks.

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