DEXA and bone density in a private check

Your mother broke her hip in her seventies. Or you've been through the menopause, or spent a few years on steroid tablets, and you've started to wonder what's happening to your bones.

A DEXA scan answers that. It's a dual-energy X-ray scan that measures bone mineral density, usually at the hip and spine, and it's most useful when fracture risk is the question. In our Health MOTs it's part of Advanced and Elite, and the doctor uses it when your assessment shows it's clinically indicated.

If you'd like a doctor-led check that can include your bones, you can book the Advanced Health MOT at our Harley Street clinic, or compare every Health MOT tier. No GP referral is needed. The clinic has practised at 117a Harley Street since 1984 and is CQC registered.

If you've had a new fracture after a simple fall, sudden severe back pain or height loss you can measure, see your GP first. NICE's osteoporosis guideline (NG259) uses fragility fractures as a reason to assess risk and, in several groups, to offer a DXA scan. Call 999 or go to A&E if you can't walk, have lost bladder or bowel control, or the pain is sudden and severe.

Who is a bone density scan useful for?

Bone density is one part of fracture risk. Age, a previous fragility fracture, a parent who broke a hip, smoking, alcohol, rheumatoid disease, oral steroids, low body weight and, for women, the menopause all change that risk. A doctor weighs them together, which is why the scan follows the assessment.

NICE NG259, published in July 2026, sets out how adults should be identified for fragility-fracture risk assessment and when a DXA scan should be offered. It recommends offering DXA, with or without a risk tool, to people aged 30 and over with a past hip or vertebral fragility fracture, a major osteoporotic fracture in the last two years, or two or more fragility fractures. It also recommends DXA when the estimated ten-year risk of a major osteoporotic fracture is 10 per cent or more. People under 30 with a possible fragility fracture need a specialist opinion.

The National Osteoporosis Guideline Group (NOGG) is still widely used in NHS practice for treatment thresholds after FRAX and DXA. NICE notes that local criteria have often followed NOGG, and that NG259 changes how scans and treatment are targeted. Both start from clinical risk, which is how we decide when DEXA earns its place.

Menopause, men and bone

Menopause is an important part of the picture, because falling oestrogen speeds up bone loss. That's why a midlife MOT sometimes leads to a conversation about bone. Hormone replacement, if you're thinking about it, is a separate medical decision with its own benefits and harms, and a DEXA result can help inform it.

Men get osteoporosis too. Steroids, alcohol, low testosterone (hypogonadism), a previous fracture and a family history of hip fracture are all reasons to think about bone in a male MOT. It belongs in men's health as much as women's.

How Advanced and Elite use DEXA

On Advanced and Elite, DEXA is used when clinically indicated after the assessment, so it's there when it's useful rather than as a fixed line on every invoice. If bone plus a metabolic baseline is what you want, Advanced may be all you need.

The Elite Health MOT includes everything in Advanced, then adds sex-specific ultrasound and tumour markers. It costs £1,850 for men and £2,095 for women, takes 2.5 to 3 hours, and needs a minimum four-hour fast. Women's Elite runs on Thursday and Friday specialist days, and men's Elite is available Monday to Friday. If you'd like bone assessed alongside pelvic or testicular imaging, Elite is the wider visit.

What the scan is like

You lie on a table while the arm of the machine passes over your hip and spine. DEXA uses a small amount of ionising radiation, much less than a CT. Metal in both hips, severe wear in the spine, or being unable to lie flat can make the scan technically difficult. NICE recognises that DXA isn't always feasible or tolerated, and that treatment decisions sometimes have to be made without it. If you already have a recent, good-quality DXA from an NHS service, bring it, because it may save you a repeat.

How to read a T-score

A T-score compares your bone density with that of a young adult. The World Health Organization categories are the familiar ones. A T-score of -2.5 or below at the femoral neck or spine is the density threshold called osteoporosis. A score between -1 and -2.5 is often called osteopenia.

Those labels describe density rather than your future, 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 recommended the scan will tell you which number they're using and whether anything needs to happen.

Your MOT bloods help here too. Calcium, phosphate, alkaline phosphatase, vitamin D and, on higher tiers, hormones can explain some low-density results. They can also be abnormal when density is fine, so a flag on calcium or alkaline phosphatase is a reason to look closer rather than a diagnosis of osteoporosis.

What about the Ultimate MRI?

The Ultimate Health MOT starts at £2,950 without gynaecology and £3,350 with it. In Ultimate, DEXA and chest X-ray are replaced by full-body MRI: brain, intracranial and carotid MRA, whole spine and torso, in a 60 to 90 minute scan inside a 3 to 4 hour visit.

MRI can show vertebral fractures, marrow change and degenerative discs, but it doesn't produce a DXA T-score. So if a measured bone density is what you want, Advanced or Elite with DEXA when indicated is the better match.

If a T-score, a vertebral fracture or a history of steroid use needs a specialist opinion, the clinic can refer you, and our consultants page introduces the team. A Health MOT isn't an osteoporosis treatment service, so when treatment needs a specialist, we refer you on.

Getting ready for your scan

• Tell the doctor if you've broken a bone in a simple fall, lost height, taken oral steroids, gone through the menopause, or have a parent who broke a hip, because these decide whether DEXA is indicated.
• Bring previous DXA reports, fracture letters and a list of medicines, including steroids, aromatase inhibitors, anti-epileptics and long-term proton-pump inhibitors if you take them.
• Carry on with your regular medicines unless the clinic has told you otherwise.
• Fast for Advanced and Elite because of the blood tests; DEXA itself doesn't need an empty stomach.
• Wear clothes without metal around the hips if you can, and tell the team about hip replacements or metal in the spine.
• Keep your review appointment, where a doctor who knows your falls history turns the T-score into a plan.

When you're ready, book online for the tier that measures what you want to know, or call 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?

DEXA is part of Advanced and Elite, used when clinically indicated after the assessment. Essential doesn't include it, and Ultimate replaces DEXA and chest X-ray with MRI.

Should every reader have a bone-density scan?

It's most useful when your risk calls for it. NICE NG259 targets DXA at people with relevant fracture histories or a raised estimated ten-year fracture risk, and NOGG likewise starts from clinical risk, often using FRAX.

Does menopause mean I need DEXA today?

Not automatically. Menopause speeds up bone loss, so it's part of the risk picture your doctor weighs. HRT, if you want to discuss it, is a separate decision from the screening visit.

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

No. It's a density threshold, read with the rest of your fracture risk, and a flag on a MOT blood test isn't osteoporosis either. The doctor who recommended the scan will explain whether anything needs to happen.

Does Ultimate MRI replace a T-score?

It replaces DEXA in the package, but it doesn't produce the same density measurement. MRI can show vertebral fractures and marrow. Choose Advanced or Elite if a measured bone density is what you're after.

Do I need a GP referral?

No. You can book yourself in at 117a Harley Street, where the clinic has been since 1984 and is CQC registered. For a new fracture or sudden severe back pain, see your 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