Osteoporosis and bone health assessment
An assessment of how strong your bones are and your risk of breaking a bone, so that fracture-prevention treatment can be offered to those most likely to benefit.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It estimates your risk of breaking a bone and measures bone strength, to prevent fractures in those most at risk.
- Bone density alone does not give the full picture — age, previous fractures, steroids and falls all count, so a risk calculator (FRAX or QFracture) is used alongside the scan.
- A DEXA scan is quick and uses a low dose of X-rays; results guide whether treatment is likely to help you.
- A normal result lowers but does not remove fracture risk, especially if you are prone to falls.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Identifies people at high risk of fracture who are likely to benefit from treatment.
A DEXA scan adds little if a clear high-risk decision (such as treatment after a hip fracture) can already be made on history alone.
Your history and risk factors are reviewed, fracture risk is calculated, and the DEXA scan is performed if arranged.
A clear explanation of your fracture risk and a matched, written plan.
Your history and risk factors are reviewed, fracture risk is calculated, and the DEXA scan is performed if...
The scan is reported and combined with your risk calculation. Many services discuss the results with you shortly...
If treatment is recommended, it is started and explained, including how it is taken and what side effects to watch...
Falls-prevention measures, lifestyle advice and any treatment continue, with review at an interval the specialist...
What is an osteoporosis and bone health assessment?
Osteoporosis means the bones have become thinner and more fragile, so they break more easily — sometimes after a minor bump or fall that would not normally cause harm. These are called fragility fractures, and the hip, spine and wrist are common sites.
This assessment estimates your risk of breaking a bone and measures your bone strength. It usually combines a fracture-risk calculator (FRAX or QFracture), which uses your age, history and risk factors, with a bone density scan (DEXA, also written DXA), a quick, low-dose X-ray that measures bone density at the hip and spine.
The whole point is fracture prevention. Bone density is only part of the picture — your age, a previous fragility fracture, steroid use, falls and other factors matter too. That is why the risk calculator and the scan are used together rather than relying on the scan alone.
The assessment guides whether bone-protecting treatment is likely to help you. It cannot guarantee you will never break a bone, and a 'normal' scan does not remove all risk, especially if you fall.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Fracture-risk calculation (FRAX or QFracture)
A questionnaire-based tool that estimates your 10-year risk of a major fragility fracture from your age, history and risk factors. It can be used with or without a bone...
DEXA (DXA) bone density scan
A quick, low-dose X-ray scan, usually of the hip and spine, that measures bone density and gives a 'T-score' comparing your bones with a healthy young adult.
Combined assessment
The risk calculator and the scan are interpreted together, and risk is often recalculated using the bone density result to decide whether treatment is worthwhile.
Cause and contributor review
Checking for causes of weaker bones (such as steroid use, low vitamin D, thyroid or hormone problems) and for falls risk, which strongly affects whether you break a bone.
Preparing for your test
- Bring a full list of your medicines and supplements, including steroids, vitamin D and calcium, and any previous bone treatments.
- Note any previous broken bones, especially those from a minor fall, and any loss of height or new back pain.
- Bring details of family history, particularly a parent who broke a hip.
- Mention any history of falls, as falls risk is a major part of fracture prevention.
- Tell the team if you might be pregnant, as the scan uses X-rays (this mainly applies to younger patients).
- Wear loose clothing without metal zips or buttons where possible, as metal can affect the scan.
- Bring details of conditions that affect bones, such as thyroid, hormone, kidney or bowel problems.
What happens
At the clinic review, the specialist or nurse goes through your history and risk factors and calculates your fracture risk. They look for causes of weaker bones and assess your risk of falling.
For the DEXA scan, you lie on a padded table while a scanning arm passes over you, usually measuring your hip and lower spine. It is usually not painful, takes about 10 to 20 minutes, and uses a low dose of radiation — much less than a standard X-ray of the same area.
The results are combined: your bone density T-score is read alongside your calculated risk, and the risk may be recalculated with the bone density value included. The specialist then explains whether your risk is low, raised or high, and whether bone-protecting treatment, vitamin D and calcium, or simply lifestyle and falls advice is the right plan.
You should leave understanding your fracture risk, the recommended plan, and how it will be reviewed.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A DEXA scan adds little if a clear high-risk decision (such as treatment after a hip fracture) can already be made on history alone.
- It is the wrong focus if the urgent problem is an acute, painful possible fracture, which needs prompt imaging and assessment first.
- It is not a falls assessment — if recurrent falls are the main issue, a falls work-up is also needed.
- Bone density readings can be unreliable where there is significant spinal arthritis or previous spinal surgery.
Delay or rearrange if…
- You might be pregnant (the scan uses X-rays) — mainly relevant to younger patients.
- You have had a recent scan using contrast or radioactive tracer, which can interfere with the DEXA reading.
- You are acutely unwell; treat the acute illness first.
- Key information is missing, such as recent steroid use or previous fractures, which changes the interpretation.
Alternatives to discuss
- Fracture-risk calculation (FRAX or QFracture) without a scan, where that alone answers the treatment question.
- The NHS pathway, often via a Fracture Liaison Service after a broken bone.
- A focused falls-prevention programme if falls are the dominant risk.
- Lifestyle measures alone (exercise, vitamin D, stopping smoking) for people at low risk.
- Treating a specific underlying cause, such as vitamin D deficiency or a thyroid problem.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Identifies people at high risk of fracture who are likely to benefit from treatment.
- Helps avoid unnecessary treatment in people at genuinely low risk.
- Finds treatable causes of weaker bones, such as low vitamin D or steroid effects.
- Highlights falls risk, which is often as important as bone density in preventing fractures.
- Gives a clear, personalised plan and a baseline to measure future change against.
Risks & complications
- A very low dose of radiation from the DEXA scan.
- Anxiety while waiting for results or on hearing you have osteoporosis.
- Being started on long-term medicine you had not expected.
- Needing further tests if a cause for weaker bones is suspected.
- A result that is hard to interpret, for example if spinal arthritis falsely raises the reading.
- Incidental findings, such as a previously unknown spinal fracture, that need further assessment.
- False reassurance if a near-normal scan leads someone to ignore a high falls risk.
- Side effects from bone-protecting medicines, which should be discussed before starting.
- Repeat or additional imaging needed because the first scan was technically inadequate.
- Rare side effects of long-term bone medicines (discussed and monitored by your clinician).
- Over-treatment driven by the scan number alone rather than overall risk.
The biggest pitfalls are treating the scan number in isolation and forgetting falls. A DEXA result should always be read alongside your overall fracture risk and your risk of falling, because preventing falls can matter as much as the bone density itself. In people over 80, the 10-year risk figure can understate short-term risk, so ask how your age has been taken into account.
Published figures to discuss
Fracture risk is usually expressed as a 10-year predicted risk from tools such as FRAX or QFracture, but the exact figure depends heavily on your individual factors and should come from your own assessment rather than a generic number. NICE advises that the 10-year figure can understate short-term risk in people over 80. Because a meaningful percentage is personal and tool-derived, exact rates are not quoted here; ask your clinician for your own calculated risk.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Further fracture after a fragility fracture | High, especially in the first 1 to 2 years | A wrist, vertebral or hip fragility fracture should trigger bone protection and falls prevention. | Guide sourcesClinical context |
| One-year mortality after hip fracture | Often quoted around 20 to 30% in older adults | Hip fracture is a major health event; prevention and rehabilitation both matter. | NICE NG259 — Osteoporosis: fragility fracture risk assessmentnice.org.ukPublished figure |
| Atypical femoral fracture with long-term bisphosphonates | Rare, but risk rises with prolonged use beyond about 5 years | Thigh or groin pain on long-term therapy should be reported; treatment duration should be reviewed. | NICE NG259 — Osteoporosis: fragility fracture risk assessmentnice.org.ukSource-linked context |
| Osteonecrosis of the jaw with osteoporosis-dose bisphosphonates | Very rare, much lower than with cancer-dose bone medicines | Good dental care is sensible, but fear of this rare event should not automatically block fracture prevention. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment or scan. Afterwards, what matters is understanding your fracture risk and acting on the plan, whether that is treatment, supplements, falls prevention, or simply a future review.
- No physical after-effects from the scan.
- Taking time to absorb a diagnosis of osteoporosis or raised risk.
- Getting used to a new medicine and its instructions.
- Making practical changes at home to reduce falls.
Aftercare
- Take any bone-protecting medicine exactly as instructed, including timing rules for tablets.
- Take vitamin D and calcium if advised, and discuss diet.
- Reduce falls risk: review eyesight, footwear, lighting, and trip hazards at home.
- Stay active with weight-bearing and strength exercises suited to you.
- Stop smoking and keep alcohol within sensible limits.
- Report new back pain or sudden height loss, which can signal a spinal fracture.
- Keep the review appointment and ask when, or whether, a repeat scan is needed.
- Full medicine and supplement list, including steroids
- Record of any previous fractures and height loss
- Family history of hip fracture noted
- List of falls in the past year
- Loose, metal-free clothing for the scan
- Questions about treatment and falls prevention written down
- Note of who to contact and when results are due
⚠ Get urgent help if…
- Sudden, severe back pain, especially after a minor strain or fall — this can be a spinal fracture.
- Noticeable loss of height or a new stooped posture.
- Pain and inability to bear weight after a fall, suggesting a possible fracture.
- Hip, wrist or other bone pain after a minor injury.
- Side effects from bone medicines, such as severe heartburn, mouth or jaw problems, or new thigh or groin pain.
- Repeated falls, which sharply increase fracture risk and need their own assessment.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good assessment gives you a clear picture of your fracture risk and a plan matched to it: treatment and falls prevention if your risk is high, or reassurance and lifestyle advice if it is low. The DEXA result also provides a baseline to compare against in future.
Results need careful interpretation. A 'normal' or near-normal bone density does not remove fracture risk, particularly if you fall often, and spinal arthritis can sometimes make the spine reading look better than it is. The number is one part of an overall judgement, not the whole answer.
Bone strength and fracture risk change over time, so the assessment is a snapshot rather than a permanent verdict. If you are on treatment, your clinician will review whether and when to repeat the scan, often after a few years. Risk can rise with new steroid use, illness, or more falls, so reassessment may be needed if your situation changes.
Related tests, treatments or support
Bone health assessment is often combined with a falls assessment, a medicines review, and checks for causes of weaker bones such as vitamin D deficiency or thyroid problems. After a fragility fracture, it may be coordinated through a Fracture Liaison Service, which links the fracture, the bone assessment and prevention together.
Follow-up & long-term care
You should be told your fracture risk, the recommended plan, and how it will be reviewed. Follow-up may include checking that treatment suits you and is being tolerated, reviewing vitamin D and calcium, falls-prevention progress, and deciding whether a repeat scan is needed. Make sure you know who is responsible for the plan and how to ask questions.
- Continuing bone-protecting medicine as prescribed, with review of how long to take it.
- Maintaining vitamin D and calcium intake as advised.
- Ongoing falls-prevention measures at home and with exercise.
- Periodic review of fracture risk, sometimes with a repeat DEXA scan.
- Re-checking bone health if you start steroids or have a new fracture.
Repeat, follow-on and what comes next
- Fracture risk is reassessed over time, and a repeat scan after a few years is common when on treatment.
- A reading affected by spinal arthritis or technical issues may need to be repeated or interpreted with caution.
- Treatment plans are reviewed and may change, including planned breaks from certain medicines.
- Risk can be revised upward after a new fracture, new steroid use, or more falls.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of your fracture risk and a matched, written plan.
- A named contact and a defined process for results and treatment questions.
- Falls-prevention advice alongside any bone treatment.
- Monitoring and review of any medicine, including how long to continue it.
- Coordination through a Fracture Liaison Service after a fragility fracture where available.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The clinic assessment and risk-calculation time.
- The DEXA scan and which sites are scanned.
- Any additional spine imaging for suspected fractures.
- Blood tests to look for causes of weaker bones.
- Whether results are discussed in a follow-up appointment.
- Any bone-protecting treatment and its monitoring, which is a separate ongoing cost.
- The assessment fee and who interprets the results.
- The DEXA scan fee and which body sites are included.
- Any blood tests or extra imaging.
- A follow-up appointment to discuss results and a plan.
- Whether a repeat scan in future is included or charged separately.
- Cancellation policy and what happens if the scan is technically inadequate or inconclusive.
On the NHS? Bone health assessment and DEXA scanning are available on the NHS when fracture risk meets assessment criteria, including after a fragility fracture; private routes are mainly used for speed or choice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Treating the scan number alone rather than overall fracture risk.
- Not discussing falls prevention, which strongly affects whether a fracture happens.
- Starting long-term medicine without explaining benefits, side effects and how long to take it.
- Giving false reassurance from a near-normal scan in someone who falls often.
- Not explaining that the over-80 risk figure may understate short-term risk.
Marketing red flags
- Selling DEXA scans as a routine 'MOT' without linking them to fracture-risk decisions.
- Promising that a scan or supplement will prevent all fractures.
- Pushing treatment based on the bone density number alone.
- Ignoring falls risk while focusing only on bone density.
- Offering whole-body composition scans as if they assess fracture risk.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What is my overall fracture risk, and how was my age and falls risk taken into account?
- Does my bone density result change the plan, and was my risk recalculated with it?
- Is there a treatable cause for weaker bones, such as low vitamin D or steroid use?
- If treatment is advised, what is the expected benefit and what side effects should I watch for?
- What can I do to reduce my risk of falling?
- When, if ever, should this be reassessed or the scan repeated?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does a DEXA scan hurt or involve much radiation?
Who should think about a bone health assessment?
If my scan is normal, am I safe from fractures?
Why is a risk calculator used as well as the scan?
Will I definitely need medicine if I have osteoporosis?
Can I get this on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG259 — Osteoporosis: fragility fracture risk assessment NICE QS149 — Assessment of fragility fracture risk Royal Osteoporosis Society — Bone density scan (DXA/DEXA) NHS — Bone density scan (DEXA scan) Royal Osteoporosis Society — What is a Fracture Liaison Service? British Geriatrics Society — CGA: patients at risk of falls and fractures NICE NG259 — Identifying vertebral fragility fractures NICE NG259 — Deciding whether pharmacological treatment is appropriate
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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