Long-term

DEXA Scans Explained

Creator: Dr Nadira Awal
Published: 2026-01-15

Who needs one on the NHS, what your T-score means and what to do next.

By Dr Nadira AwalBMS Specialist3 min readMedically reviewed 9 July 2026

Medical assessment form and small spine model on a padded exam table

DEXA measures bone density. Learn the FRAX tool, when your GP should refer and how results guide HRT, lifestyle and specific bone medicines.

A DEXA (dual-energy X-ray absorptiometry) scan is the gold-standard test for measuring bone mineral density and diagnosing osteopenia and osteoporosis. It's quick — around 10–15 minutes — painless, and delivers less radiation than a return flight to Spain. Yet in the UK, DEXA scans are rationed on the NHS, and many women who would benefit are only offered one after a fracture that could have been prevented. Given that osteoporosis affects around 1 in 2 women over 50 and is largely silent until a bone breaks, understanding when to push for a DEXA — and what to do with the result — is one of the most important pieces of self-advocacy in midlife.

What a DEXA actually measures

Bone mineral density at the hip and lumbar spine (and sometimes forearm), compared to a young adult reference (T-score) and to your age-matched peers (Z-score).
The T-score is the number that drives diagnosis and treatment decisions in postmenopausal women.
Total body composition (fat mass, lean mass, visceral fat) is available on many scanners as a bonus — useful data if included.

Understanding your T-score

T-score above -1: normal bone density.
Between -1 and -2.5: osteopenia (thinning) — lifestyle interventions, HRT if in perimenopause, and monitoring.
-2.5 or below: osteoporosis — usually indicates medical treatment (HRT, bisphosphonates, denosumab depending on situation).
Below -3.5: severe osteoporosis — specialist input, often anabolic agents like teriparatide.
The FRAX tool combines your T-score with age, smoking, family history and other factors to estimate 10-year fracture risk.

Woman lying calmly on a DEXA scanner during a bone density scan — A DEXA scan takes 10–15 minutes and delivers less radiation than a flight to Spain — the diagnostic value is enormous.

Who typically qualifies for an NHS DEXA

Any fragility fracture (a bone broken from a fall from standing height or less) — automatic referral in most areas.
Premature ovarian insufficiency (POI) or early menopause (before 45).
Long-term oral corticosteroid use (≥7.5 mg prednisolone daily for 3+ months).
Strong family history of hip fracture, particularly maternal.
Body weight below 58 kg or BMI below 19.
Chronic conditions: rheumatoid arthritis, coeliac disease, hyperthyroidism, hyperparathyroidism, malabsorption, chronic liver or kidney disease.
High FRAX score above the NOGG treatment threshold.
Medications: aromatase inhibitors, androgen deprivation therapy, some anti-epileptic drugs, PPIs long-term.

Getting a DEXA if the NHS declines

Private DEXA typically costs £100–£200 in the UK — significantly less than most other bone assessments.
Widely available at private hospitals (Spire, BMI, Nuffield, HCA) and specialist osteoporosis centres.
Some pharmacies now offer peripheral DEXA (wrist or heel) as a screening test — useful but not a substitute for full hip and spine DEXA.
Ask for the full report, not just the summary — the numbers matter for future comparison.

How often to rescan

Every 2–5 years for most women, depending on baseline result and treatment.
Sooner (1–2 years) if starting a bone medication or if T-score is close to a treatment threshold.
Longer intervals (5+ years) if bone density is stable and normal.
Same machine, same centre where possible — different scanners can give slightly different readings.

Illustration of trabecular bone microstructure — Density is only part of the story — bone quality, muscle strength and fall prevention matter for fracture risk too.

What to do while waiting for a scan — or after a good result

Strength training 2–3 times a week — the strongest known stimulus for bone.
Weight-bearing cardio (walking, running, dancing) most days.
Protein 1.2–1.6 g/kg body weight daily, spread across meals.
Calcium 1,000–1,200 mg from food, vitamin D 800–1,000 IU year-round.
Address alcohol, smoking, and low body weight if relevant.
In perimenopause, HRT is the most effective single intervention for bone density — well-evidenced in the WHI and subsequent trials.

What a DEXA can't tell you

Bone quality (microarchitecture) — density and quality aren't identical. Some women fracture at 'normal' T-scores.
Falls risk — muscle strength, balance and vision matter as much as bone density for fracture prevention.
Vertebral fractures — separate imaging (VFA on some DEXAs, or spine X-rays) is needed if height loss or back pain suggests one.

Key takeaway

A DEXA scan changes what you know — and what you can do about it. If you're in a risk group and the NHS declines, £100–£200 privately is one of the highest-value tests you can buy in midlife.

How Dr Awal approaches this in clinic

Every consultation starts with your full story — symptoms, cycle, medical history, family history and what you've already tried. From there we look at whether hormonal treatment, non-hormonal options, lifestyle changes or a combination will give you the best result, and we tailor the plan to your age, risk factors and preferences.

A detailed 60 minute first appointment — no rushed 10-minute slots.
Evidence-based recommendations aligned with NICE NG23 and BMS guidance.
Body-identical HRT considered first-line where appropriate.
Shared-care letters sent to your NHS GP so treatment can continue affordably.
Follow-up at 3 months to fine-tune your regimen and address side effects.
Ongoing annual reviews so your plan evolves with you.

Common questions we hear about this

Do I need to be at a certain age to be seen?

No. We see women in early perimenopause (often late 30s and 40s), through post-menopause and beyond. Age alone doesn't decide whether treatment is right — symptoms, health history and goals do.

Will my GP continue the prescription?

In most cases yes. After your consultation we send a detailed shared-care letter with the diagnosis, treatment plan and rationale so your NHS GP can prescribe on the NHS. Not every practice accepts shared care — we'll discuss this in your appointment.

What if I've tried HRT before and it didn't suit me?

Very common — often the type, dose or route wasn't right rather than HRT itself. We review what you've tried, why it didn't work, and adjust accordingly. Many women who thought HRT wasn't for them do well on a different preparation.

How long will I need to stay on treatment?

There is no set upper time limit for HRT. Current BMS and NICE guidance supports continuing HRT for as long as the benefits outweigh the risks for you personally. We review this together every year so you stay in control of the decision.

Where do you see patients?

All consultations at Pause and Co Healthcare are conducted securely via video, allowing us to support patients anywhere in the UK. Prescriptions and shared care arrangements are managed in the same way, regardless of your location.

About the author

Dr Nadira Awal is a British Menopause Society Advanced Menopause Specialist with 15+ years' NHS and private experience. She holds the BMS Advanced Certificate in Menopause Care, sits on the BMS Programme Planning Group, and advises the UK Government Menopause Strategy Group. Read her full profile.

Sources & further reading

General information only — not a substitute for personalised medical advice. Always speak to your GP or a menopause specialist about your own situation.

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