Most people don’t think about their bones until they break. But by then, it’s often too late. Osteoporosis doesn’t cause pain or symptoms until a fracture happens - a hip, spine, or wrist fracture that can change your life forever. That’s why DEXA scan screening isn’t just a test - it’s a preventive lifeline. If you’re over 50, especially if you’re a woman or have risk factors like low body weight, smoking, or a family history of fractures, this one quick scan could be the most important health check you’ll ever have.
What a DEXA Scan Actually Measures
A DEXA scan - short for dual-energy X-ray absorptiometry - is the gold standard for measuring bone mineral density. It’s not an MRI or a CT scan. It’s quick, quiet, and uses less radiation than a cross-country flight. You lie on a table while a scanner passes over your lower spine and hip. The machine sends two low-dose X-ray beams through your bones, one high-energy and one low-energy. The difference in how much each beam is absorbed tells the computer exactly how dense your bone is - in grams per square centimeter.
It’s not guessing. It’s measuring. And it’s been the standard since the 1990s because nothing else has proven as accurate at predicting who’s likely to break a bone. The U.S. Preventive Services Task Force, the World Health Organization, and every major bone health group agree: DEXA is the only test recommended for routine screening.
Most scans take under 10 minutes. You don’t need to fast. You don’t need to change clothes unless you’re wearing a belt or metal zipper. The radiation you get is less than what you’d absorb from the sun in two days. Yet, 28% of people still worry about it - even though the dose is so low, your body naturally repairs it within hours.
Understanding Your T-Score: The Real Story Behind the Number
Your DEXA results come back as a T-score. This isn’t just a number - it’s your bone’s story compared to a healthy 30-year-old adult of the same sex and ethnicity. Here’s what it means:
- T-score of -1.0 or higher: Normal bone density. Your bones are strong.
- T-score between -1.0 and -2.5: Osteopenia. Your bones are thinner than average but not yet osteoporotic. This is your warning sign.
- T-score of -2.5 or lower: Osteoporosis. Your bones are fragile and at high risk of breaking.
Let’s say your T-score is -2.7. That doesn’t mean you’ll definitely break a bone. But it does mean your risk is 4 to 5 times higher than someone with a normal T-score. A 68-year-old woman in Perth with a T-score of -2.7 was diagnosed after a minor fall caused a compression fracture. She had no pain before. No symptoms. Just a silent disease - until the bone gave way.
Don’t confuse T-scores with Z-scores. Z-scores compare you to people your own age. That’s useful if you’re under 50 or have a condition like rheumatoid arthritis. But for osteoporosis screening, T-scores are what matter. They’re the benchmark used globally to define disease.
Why DEXA Is Still the Best - Even With New Tech
You might hear about other tests: ultrasound of the heel, peripheral DEXA on the wrist, or even CT scans. But here’s the truth: none of them are as reliable as a central DEXA scan of your spine and hip.
Peripheral DEXA machines - the ones you sometimes see in pharmacies - only measure the forearm or heel. They’re convenient, but they miss the most important areas where fractures happen. A 2023 study in Bone showed these devices miss nearly 30% of people who actually have osteoporosis when tested with a full DEXA.
Quantitative CT scans give more detail, but they use 100 times more radiation. They’re expensive - up to $500 - and not covered by Medicare unless there’s a special reason. DEXA costs between $150 and $250 and is covered for most eligible people.
Even newer tools like Trabecular Bone Score (TBS) - which looks at the texture of your bone structure - are now being added to DEXA reports. TBS can improve fracture risk prediction by up to 18%. But it’s still built on the DEXA scan. It doesn’t replace it. It enhances it.
Fracture Risk Isn’t Just About Bone Density
Here’s something many doctors don’t say out loud: your T-score alone doesn’t tell the whole story. A 72-year-old woman with a T-score of -2.1 might have a higher fracture risk than a 65-year-old with a T-score of -2.8 - if the older woman smokes, takes steroids, or has had a previous fracture.
That’s why doctors use FRAX. It’s a free online tool developed by the World Health Organization. You plug in your age, sex, weight, height, whether you smoke, if you’ve had a fracture, if you take corticosteroids, and your T-score. FRAX then calculates your 10-year risk of a major osteoporotic fracture - hip, spine, forearm, or shoulder.
Studies show FRAX improves accuracy by 15-22% compared to using T-score alone. If your 10-year risk is over 20%, treatment is usually recommended. If it’s under 10%, lifestyle changes may be enough. The tool doesn’t replace the scan - it gives context to it.
Who Should Get Screened - And When
Medicare and most private insurers cover DEXA scans every two years for:
- Women 65 and older
- Men 70 and older
- Anyone over 50 who’s had a fracture after age 40
- People taking long-term steroid medications (like prednisone)
- Those with rheumatoid arthritis, type 1 diabetes, or hyperthyroidism
- Women who went through early menopause (before 45)
- People with low body weight (BMI under 19)
But here’s the gap: only 38% of eligible women in Australia get screened. And the numbers drop even lower for Indigenous, Black, and Hispanic women - even though their fracture risk is just as high. If you’re eligible and haven’t had a scan, don’t wait for your doctor to bring it up. Ask for it.
What Happens After the Scan
If your T-score is normal, you’re in the clear - for now. Keep doing weight-bearing exercise, get enough calcium and vitamin D, and avoid smoking. Re-screen in 5-10 years unless something changes.
If you have osteopenia, it’s not a death sentence. Many people stabilize or even improve with simple changes: walking 30 minutes a day, strength training twice a week, and taking 1,200 mg of calcium and 800-1,000 IU of vitamin D daily. Your doctor might also check your blood for vitamin D levels or thyroid function - both can affect bone health.
If you’re diagnosed with osteoporosis, treatment options include:
- Bisphosphonates (like alendronate or risedronate) - taken orally or by injection
- Denosumab - an injection every 6 months
- Teriparatide or abaloparatide - daily injections that build new bone
- Romosozumab - monthly injections that both build bone and reduce breakdown
These drugs reduce fracture risk by 30-70% over 3-5 years. They’re not magic pills - they work best with lifestyle changes. And they’re not for everyone. Your doctor will weigh your risks: stomach issues, kidney problems, or jawbone concerns before prescribing.
Common Misconceptions and Pitfalls
Many people misunderstand their results. Here’s what you need to know:
- My T-score is -1.8, so I’m fine. Not true. Osteopenia is a red flag. It’s not normal. It’s your body saying, “Fix this before it’s too late.”
- I’m young - I don’t need this. If you’ve had a fracture after 40, or you’re on long-term steroids, you do. Age isn’t the only factor.
- My scan was normal last year, so I’m good. Bone loss can happen fast, especially after menopause. Re-screening every 2 years is standard for high-risk people.
- Calcium supplements will fix everything. No. You need vitamin D to absorb it. And without exercise, your bones won’t respond. Supplements alone won’t stop fractures.
Another pitfall: metallic implants. Hip replacements, spinal screws, or even old fractures can mess up the scan. Always tell the technician if you’ve had surgery. They’ll adjust the scan or choose a different site.
What to Expect During the Scan
You’ll be asked to lie still on a padded table. For the spine scan, your legs will be supported on a cushion to flatten your lower back. For the hip, your foot will be placed in a brace to rotate your leg inward. You won’t feel anything. No needles. No noise. Just a soft hum as the machine moves.
Technologists are trained to position you correctly - poor positioning causes 65% of errors. That’s why certified technicians are required. You’ll get your results in 1-2 weeks. Ask for a printed copy. Don’t just rely on your doctor’s memory.
Next Steps: What to Do After Your DEXA Scan
Once you have your results, here’s your action plan:
- Get your T-score and FRAX risk score together.
- Ask your doctor: “Is my fracture risk high enough to need medication?”
- If no medication is needed, ask: “What lifestyle changes will make the biggest difference?”
- Request a copy of your report - keep it in your health file.
- Schedule your next scan based on your risk level - not just when your insurance allows it.
If you’re over 50 and haven’t had a DEXA scan, make the call today. Bone loss doesn’t wait. But with early detection, it’s one of the most preventable diseases we have.
What’s the difference between osteopenia and osteoporosis?
Osteopenia means your bone density is lower than normal but not low enough to be called osteoporosis. It’s a warning sign - your bones are thinning. Osteoporosis means your bones are significantly weakened, with a T-score of -2.5 or lower. At this point, your risk of breaking a bone is much higher. Osteopenia doesn’t always turn into osteoporosis, but it’s a signal to act before it does.
Can I get a DEXA scan without a doctor’s referral?
In Australia, Medicare requires a referral from a doctor or specialist for a DEXA scan to be bulk-billed. Some private clinics offer scans without a referral, but you’ll pay out-of-pocket - around $200-$300. If you’re eligible under Medicare guidelines (age 65+, history of fracture, steroid use), get a referral. It’s free or low-cost with coverage.
How often should I get a DEXA scan?
If your T-score is normal and you have no risk factors, you can wait 10-15 years. If you have osteopenia, get retested every 2-5 years. If you’re on treatment for osteoporosis, your doctor will likely repeat the scan every 1-2 years to see if your bone density is improving. Don’t get scanned too often - radiation, though low, adds up. And frequent scans don’t improve outcomes if your risk hasn’t changed.
Does walking help improve bone density?
Yes - but not just any walking. Brisk walking for 30 minutes a day, 5 days a week, helps maintain bone density. For actual improvement, you need impact and resistance. Try stair climbing, heel drops, or light weightlifting. A 2022 study showed women who did resistance training twice a week for a year increased their hip bone density by 1.2%. Walking alone won’t reverse osteoporosis - but it’s a vital part of keeping bones strong.
Can men get osteoporosis?
Absolutely. One in five men over 50 will break a bone due to osteoporosis. Men are less likely to get screened, and when they do, it’s often after a fracture. Testosterone levels drop with age, and many men take medications like steroids or proton-pump inhibitors that weaken bones. If you’re a man over 70, or have risk factors like smoking, low weight, or a previous fracture - get a DEXA scan. You’re just as vulnerable as women.
Are DEXA scans covered by private health insurance?
Most private insurers in Australia follow Medicare’s guidelines. If you qualify for a Medicare-subsidized scan, your private health fund will usually cover the gap. If you’re not eligible for Medicare coverage, some funds offer rebates for DEXA scans under their “preventive health” benefits. Always check with your insurer before booking - coverage varies by policy.
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