The standard test is a bone density scan called a DEXA scan

A DEXA scan (dual-energy x-ray absorptiometry) is the test your doctor will order to measure bone density and diagnose osteoporosis. It takes about 10 to 30 minutes, uses a small amount of radiation (less than a chest x-ray), and you stay fully clothed. The machine scans your hip, spine, and sometimes your forearm, then produces a score that tells you whether your bones are normal, show early bone loss (osteopenia), or have osteoporosis.

Your doctor sends the order to an imaging center—usually a hospital radiology department or an outpatient imaging clinic. You schedule an appointment, show up, and the technician positions you on a table while the scanner arm moves over you. Results come back in a few days to a week, and your doctor explains what the numbers mean and whether treatment is needed.

DEXA is the only test that can diagnose osteoporosis before a fracture happens. Other imaging (like regular x-rays) can show a fracture but cannot measure bone density accurately enough to catch the disease early.

Key Takeaways

  • DEXA scans measure bone density and are the standard way to diagnose osteoporosis; your doctor orders the test and sends you to an imaging center.
  • The scan takes 10 to 30 minutes, uses minimal radiation, and requires no special preparation or fasting.
  • Medicare covers DEXA scans for women 65 and older and for younger women and men with risk factors; many private insurance plans cover them too, though you may have a copay.
  • Your doctor may order a DEXA scan if you are over 50, have risk factors like family history or long-term steroid use, or have had a fracture from a minor fall.
  • Results come back within days, and your doctor will discuss the findings and next steps, which may include medication, calcium and vitamin D, or lifestyle changes.

Who should get tested and when

The U.S. Preventive Services Task Force recommends DEXA screening for all women 65 and older and for men 70 and older. If you are younger but have risk factors, your doctor may order a test sooner. Risk factors include a family history of osteoporosis, long-term use of corticosteroids (like prednisone), rheumatoid arthritis, a previous fracture from a minor fall, low body weight, or early menopause.

If you have already had a fracture—even from a fall that would not normally break a healthy bone—your doctor will likely order a DEXA scan to assess your bone strength and guide treatment decisions. Some doctors also screen people with certain medical conditions that affect bone health, such as chronic kidney disease or celiac disease.

There is no single age at which everyone needs testing. Your doctor decides based on your age, sex, medical history, and personal risk. If you are unsure whether you should be tested, ask your primary care doctor at your next visit.

What happens before and during the test

You do not need to fast or prepare in any special way. Wear comfortable, loose clothing without metal buttons, zippers, or buckles—the technician may ask you to change into a hospital gown to avoid metal artifacts on the scan. Remove jewelry, glasses, and any metal objects from your pockets.

During the scan, you lie flat on your back on a padded table. The technician positions your legs and arms in a specific way to keep them still. A large scanning arm moves slowly over your body while you remain motionless. You will hear a quiet humming sound. The technician stays in the room or nearby and can hear you if you need to speak. The whole process is painless.

If you are pregnant or think you might be, tell the imaging center before your appointment—DEXA scans are not done during pregnancy. If you have had a recent CT scan or nuclear medicine scan with contrast dye, tell the technician, as this can affect timing of your DEXA.

Insurance coverage and costs

Medicare covers one DEXA scan every two years for women 65 and older and for younger women and men with certain risk factors. You typically pay 20 percent of the Medicare-approved amount after you meet your deductible. If your doctor orders the scan as medically necessary, Medicare usually covers it; if it is screening only, coverage depends on your age and risk factors.

Private insurance plans vary widely. Many cover DEXA scans for people over 50 or those with risk factors, but some require prior authorization from your doctor. Call your insurance company or check your plan documents to find out whether the scan is covered and what your copay or coinsurance will be. Ask whether you need a referral from your primary care doctor.

If you do not have insurance, imaging centers often offer cash-pay rates that are lower than the standard billed amount. Call ahead and ask what the cost is for an uninsured patient. Some community health centers or hospital financial assistance programs may also help cover the cost.

How to order a DEXA scan through your doctor

Start by scheduling an appointment with your primary care doctor or a specialist (such as a rheumatologist or endocrinologist). Bring up your concerns about bone health or mention any risk factors you have. Your doctor will decide whether a DEXA scan is appropriate and write an order if it is.

Your doctor's office will either give you a paper order to take to an imaging center or send the order electronically to a facility they work with. Ask which imaging center they recommend or whether you have a choice. If your insurance requires prior authorization, the doctor's office usually handles this before you schedule.

Call the imaging center to schedule your appointment. Tell them you have a DEXA order from your doctor and ask how soon they can see you. Most centers can fit you in within one to four weeks. Confirm the location, time, and what to bring (usually just your insurance card and photo ID).

Understanding your DEXA results

DEXA results are reported as a T-score, which compares your bone density to that of a healthy 30-year-old adult. A T-score of -1.0 or higher is considered normal. A score between -1.0 and -2.5 means you have low bone mass (osteopenia). A score of -2.5 or lower means you have osteoporosis. The lower the score, the weaker your bones are and the higher your fracture risk.

Your doctor will explain your score and what it means for you. If your score is normal, you may not need treatment beyond calcium, vitamin D, and weight-bearing exercise. If you have osteopenia, your doctor may recommend lifestyle changes and monitoring with another scan in one to two years. If you have osteoporosis, your doctor will likely discuss medication options, calcium and vitamin D intake, and exercise.

Results also include a Z-score, which compares your bone density to others your age and sex. This can help your doctor determine whether your bone loss is typical for your age or faster than expected, which might point to an underlying condition.

Other tests that may go along with DEXA

Your doctor may order blood tests to check your calcium, vitamin D, and kidney function before or after a DEXA scan. Low vitamin D is common and easy to treat, and it affects how well your body absorbs calcium. A blood test can show whether you need supplementation.

If your doctor suspects an underlying condition is causing bone loss (such as thyroid disease or celiac disease), they may order additional tests. If you have osteoporosis and your doctor is considering medication, they may also check your kidney function to make sure certain drugs are safe for you.

In rare cases, your doctor may order a different imaging test—such as a CT scan or ultrasound—if DEXA results are unclear or if you cannot have a standard DEXA for medical reasons. Your doctor will explain if any additional testing is needed.

Frequently Asked Questions

How often do I need a DEXA scan?

If your first scan is normal, most doctors recommend repeating it every 10 years. If you have low bone mass or osteoporosis, or if you are taking bone-strengthening medication, your doctor may order scans every one to two years to track changes. Your doctor will tell you when to schedule your next scan based on your results and risk factors.

Is a DEXA scan safe?

Yes. The radiation dose from a DEXA scan is very small—about one-tenth the radiation of a chest x-ray. There are no side effects, and the test is not invasive. The only reason to avoid it is if you are pregnant.

Can I get a DEXA scan without a doctor's order?

Most imaging centers require a doctor's order to perform a DEXA scan. Some private imaging centers or wellness clinics may offer scans without an order, but these are usually not covered by insurance and cost more. It is better to go through your doctor so results are part of your medical record and your doctor can interpret them and recommend next steps.

What if my DEXA results show osteoporosis?

Osteoporosis is treatable. Your doctor will discuss options, which may include medication (such as bisphosphonates), calcium and vitamin D supplements, weight-bearing exercise, and fall prevention. Having osteoporosis does not mean you will break a bone—it means your risk is higher, and there are steps you can take to slow bone loss and reduce fracture risk.

Does insurance cover DEXA if I have no symptoms?

Yes, if you meet age or risk factor criteria. Medicare covers screening DEXA for women 65 and older regardless of symptoms. Many private plans also cover screening for people over 50 or those with risk factors. Check with your insurance to confirm coverage for your situation.