DEXA and bone density in a private check

DEXA is a dual-energy X-ray scan of bone mineral density, usually at the hip and spine. It is useful when fracture risk is the question. It is not a gift that should be added to every private check because the machine is in the building. At The Health Screening Clinic it sits on Advanced and Elite, on a Health MOT, when clinically indicated after the assessment. Ultimate replaces DEXA and chest X-ray with MRI. That is package composition, not a claim that MRI produces a T-score.

If you have a new fracture after a simple fall, sudden severe back pain, or height loss you can measure, this is not a screening conversation first. See a GP. NICE's osteoporosis guideline (NG259) treats fragility fractures as a reason to assess risk, and in several groups to offer a DXA scan, rather than as a reason to wait for a MOT diary. Use 999 or A&E if you cannot walk, have lost bladder or bowel control, or the pain is sudden and severe. A preventative package is built for people who feel well enough to be screened.

The clinic has practised at 117a Harley Street since 1984 and is CQC registered. A laboratory flag on calcium or alkaline phosphatase is not a diagnosis of osteoporosis. A T-score is not a sentence about your future. Both still need a doctor who has taken a history of fractures, medicines, menopause and falls.

When bone density is the question, and when it is not

Bone mineral density is one part of fracture risk. Age, previous fragility fracture, parental hip fracture, smoking, alcohol, rheumatoid disease, oral steroids, low body weight and, for women, the menopause all change that risk. NICE NG259, published in July 2026, covers how adults should be identified for fragility-fracture risk assessment and when a DXA scan should be offered. It is not a brochure for private add-ons.

NICE recommends offering DXA, with or without a risk tool, to people aged 30 and over who have already had a hip or vertebral fragility fracture, a major osteoporotic fracture in the last two years, or two or more fragility fractures. It recommends offering DXA when the estimated ten-year risk of major osteoporotic fracture is 10 per cent or more. People under 30 with a possible fragility fracture are a specialist conversation, not a screening add-on. That is the opposite of scanning every reader.

The National Osteoporosis Guideline Group (NOGG) remains widely used in NHS practice for treatment thresholds after FRAX and DXA. NICE notes that local criteria have often followed NOGG, and that NG259 is a change in how scans and treatment are targeted. This article will not freeze a treatment algorithm. It will say that DEXA is a decision after risk is considered, not a default extra.

Menopause belongs here as risk context. Oestrogen decline accelerates bone loss. That is why a midlife MOT sometimes leads to a bone conversation. It is not a reason to turn this page into an HRT clinic. Hormone replacement, when it is used, is a separate medical decision with its own benefits and harms. A DEXA result can inform that conversation. It does not start it, and it does not replace it.

Men get osteoporosis too. Steroids, alcohol, hypogonadism, previous fracture and a family history of hip fracture are reasons to think about bone in a male MOT. Do not file DEXA under women's health and walk past it.

How Advanced and Elite use DEXA

DEXA remains when clinically indicated, not as a guaranteed line on every invoice. The Elite Health MOT includes everything in Advanced, then adds sex-specific ultrasound and tumour markers. Elite is £1,850 for men and £2,095 for women, 2.5 to 3 hours, minimum four-hour fast. Women's Elite runs on Thursday and Friday specialist days; men's Elite is available Monday to Friday. If the live question is bone plus pelvic or testicular imaging, Elite is a wider visit. If the live question is bone plus a metabolic baseline, Advanced may already be enough.

DEXA uses a small amount of ionising radiation, much less than a CT. You lie on a table while the arm of the machine passes over hip and spine. Metal in both hips, severe spinal degeneration, or an inability to lie flat can make the scan technically difficult. NICE is honest that DXA is not always feasible or tolerated, and that treatment decisions sometimes have to be made without it. A private clinic cannot magic those limits away.

A T-score compares your density with a young adult reference. WHO categories are familiar: a T-score of -2.5 or below at the femoral neck or spine is the density threshold called osteoporosis, and a score between -1 and -2.5 is often called osteopenia. Those labels are not diagnoses of how you will live, because fracture risk also depends on age, falls and previous breaks. A Z-score compares you with people of your own age and can matter more in younger adults. The doctor who indicated the scan should explain which number they are using and whether anything needs to happen.

Calcium, phosphate, alkaline phosphatase, vitamin D and, on higher tiers, hormones sit in the same MOT. They can explain some low-density pictures, and they can be abnormal when density is fine, so a flag on those bloods is not osteoporosis and a normal vitamin D is not a T-score.

What Ultimate replaces, and what MRI cannot do

The Ultimate Health MOT starts at £2,950 without gynaecology and £3,350 with it.

DEXA and chest X-ray are replaced by full-body MRI: brain, intracranial and carotid MRA, whole spine and torso, in a 60-minute scan inside a 3 to 4 hour visit. MRI can show vertebral fractures, marrow change and degenerative discs. It does not produce a DXA T-score. If the question you brought is quantified bone density, Ultimate is the wrong instrument even though the package is longer.

That is an honest limit, not a reason to add a second paid DEXA on the quiet. If density is the question and MRI is not, Advanced or Elite with DEXA when indicated is the matching booking. If you already have a recent DXA from an NHS service, bring it. Repeating a technically good scan because a private menu lists one is noise.

The consultants list is there when a T-score, a vertebral fracture or a steroid history needs a specialist opinion rather than another screening visit. The clinic can refer. A MOT is not an osteoporosis treatment service.

Tips and tricks

• Say if you have broken a bone from a simple fall, lost height, taken oral steroids, gone through menopause, or have a parent who broke a hip. Those facts change whether DEXA is indicated, although they do not mean every reader should buy one.
• Bring previous DXA reports, fracture letters and a medicine list that includes steroids, aromatase inhibitors, anti-epileptics and long-term proton-pump inhibitors if you take them.
• Continue regular medicines unless the clinic told you otherwise.
• Fast for Advanced and Elite because of the bloods, not because DEXA itself needs an empty stomach.
• Wear clothes without metal around the hips if you can.
• Tell the team about hip replacements or spinal metal, because those sites may not be readable.
• Keep the review appointment, since a T-score without a doctor who knows your falls history is a number rather than a plan.
• If you want ultrasound, markers and bone in the same visit, look at Elite.
• If you want MRI, understand that it replaces DEXA rather than duplicating it.
• Book the tier that matches the instrument, not the longest list.

Things to avoid

• Do not buy DEXA because you are a woman over 40 and the brochure mentioned bone.
• Indication is clinical.
• Do not treat this page as a DEXA-price list.
• Do not treat a T-score as a diagnosis of how you will live, and do not treat a score above -2.5 as proof you will not fracture.
• Do not treat Ultimate MRI as a bone-density scan.
• Do not turn a menopause conversation into an HRT clinic in the same breath as a screening MOT.
• Do not skip a GP because you have sudden back pain or a new fracture.
• Do not invent a stop list of tablets before the visit.
• If bone density when indicated, plus a doctor-led baseline, is the question, review Advanced and Elite on the Advanced Health MOT page, or contact The Health Screening Clinic on 020 7183 7056.

For why Ultimate swaps DEXA for MRI, read MRI-only versus a doctor-led MOT. To match a tier to your age, see Health MOT under 40 versus over 40.

Frequently asked questions

Is DEXA included in every Health MOT?

No. Essential does not include it. Advanced and Elite use DEXA when clinically indicated after the assessment. Ultimate replaces DEXA and chest X-ray with MRI.

Should every reader have a bone-density scan?

No. NICE NG259 targets DXA at people with relevant fracture histories or a raised estimated ten-year fracture risk, not at every adult who books a private check. NOGG likewise starts from clinical risk, often using FRAX.

Does menopause mean I need DEXA today?

Not automatically. Menopause is a risk context because bone loss accelerates. It is not, on its own, a voucher for a scan, and this clinic is not booking HRT in the same visit as a default.

Is a T-score of -2.5 a diagnosis of how I will live?

No. It is a density threshold used with the rest of your fracture risk. A flag on a MOT blood test is not osteoporosis either. The doctor who indicated the scan should explain whether anything needs to happen.

Does Ultimate MRI replace a T-score?

It replaces DEXA in the package. It does not produce the same density measurement. MRI can show vertebral fractures and marrow. Choose Advanced or Elite if quantified density is the question.

Do I need a GP referral?

No. The clinic at 117a Harley Street accepts self-referral, has been there since 1984, and is CQC registered. A new fracture or sudden severe back pain still belongs with a GP or urgent care first.

Sources

• NICE. Osteoporosis: risk assessment (NG259)
• National Osteoporosis Guideline Group. Clinical guideline for the prevention and treatment of osteoporosis
• UK National Screening Committee. Principles of screening
• NHS. Osteoporosis
• General Medical Council. Medical register, Penelope Sheehan, 6056535

Written By

Stephen Lingam

Managing Director

Managing Director of Medical Express Clinic and the Health Screening Clinic since 1984. Over 40 years of operational experience in private healthcare on Harley Street, overseeing patient care, clinical standards, and service delivery.

Medically Reviewed

Dr Penny Sheehan

MBBS, MRCGP

General Practitioner

GMC: 6056535

Specialising in women's health, hormonal balance, and menopause management within screening contexts.

Last reviewed: 25/09/2026