Most people over 40 have heard they should “watch their bone density,” but far fewer understand what the actual tests involve or what the resulting numbers mean. A DEXA scan and a FRAX score are the two main tools doctors use to move the conversation from a vague worry about osteoporosis to an actual, individualised estimate of your fracture risk, and understanding the difference between them can make a routine screening conversation with your doctor much more useful.
This article explains what a DEXA scan measures, what a T-score and a Z-score actually mean, what FRAX adds on top of that, who in India should realistically consider getting tested, and roughly what it costs.
Quick Answer
A DEXA scan measures bone mineral density and produces a T-score comparing you to a healthy young adult, while a FRAX score combines that density reading with your personal risk factors to estimate your actual chance of a fracture over the next 10 years. Together they give a much clearer picture than bone density alone, and are generally recommended starting around menopause for women and from the mid-sixties for men, or earlier if specific risk factors are present.
- A DEXA scan gives a T-score, which compares your bone density to that of a healthy young adult
- A FRAX calculation adds your age, weight, fracture history, and other factors to estimate real fracture probability
- Bone density alone does not predict fracture risk as well as density combined with these other factors
- In India, DEXA scans typically cost somewhere between roughly ₹1,500 and ₹3,500 at diagnostic centres, varying by city and facility
- Earlier testing makes sense with risk factors like early menopause, long-term steroid use, a parent's hip fracture, or a previous fragility fracture
What does a DEXA scan actually measure?
DEXA stands for dual-energy X-ray absorptiometry, a low-radiation scan that measures how dense your bones are, usually at the hip and spine, the two sites most predictive of serious fracture risk. The result is reported as a T-score, which compares your bone density to the average peak bone density of a healthy 30-year-old of the same sex, since that is roughly the age at which bone density peaks before the slow, natural decline that follows for everyone.
Reading a T-score
A T-score of -1.0 or above is considered normal. A score between -1.0 and -2.5 indicates osteopenia, a lower-than-ideal but not yet osteoporotic bone density. A score of -2.5 or below meets the clinical definition of osteoporosis. This single number is useful, but on its own it does not tell your doctor how likely you actually are to break a bone in the real world, which is where FRAX comes in.
What does FRAX add that a T-score alone doesn’t?
FRAX, the Fracture Risk Assessment Tool, is a calculation developed by the World Health Organization that combines your bone density T-score with other independently important risk factors, including age, sex, weight and height, whether you have had a previous fracture, whether a parent had a hip fracture, smoking status, long-term steroid use, certain other conditions, and alcohol intake, to produce an estimated percentage risk of a major fracture over the next 10 years. The key insight behind FRAX is that two people can have identical T-scores and very different real-world fracture risk once their other factors are accounted for, which is why many doctors now use FRAX output, not the T-score alone, to decide whether treatment is actually warranted.
Who should actually consider getting tested?
Current international guidance generally points to screening women from around the time of menopause, especially with additional risk factors, and men from around 65 to 70, or earlier for either sex if specific risk factors are present. In the Indian context, there is an added wrinkle worth knowing: vitamin D deficiency is widespread across the country despite abundant sunshine, largely due to limited sun exposure from clothing and indoor lifestyles, and this can compound age-related bone density decline in ways that make earlier awareness genuinely useful, even if routine testing age recommendations stay similar to global guidance.
| Risk factor | Why it matters | Who it applies to |
|---|---|---|
| Early menopause (before 45) or surgical removal of ovaries | Oestrogen drop accelerates bone loss earlier than usual | Women |
| Long-term corticosteroid use (for asthma, autoimmune conditions, and similar) | Steroids directly reduce bone formation over time | Both sexes |
| A parent who had a hip fracture | Reflects a genetic component to bone strength | Both sexes |
| Previous fracture from a minor fall after 40 | A fragility fracture is itself a strong predictor of future ones | Both sexes |
| Low body weight or a small frame | Less peak bone mass built up earlier in life | Both sexes, more pronounced in women |
| Smoking and heavy alcohol use | Both independently reduce bone density over time | Both sexes |
What does a DEXA scan actually cost and involve in India?
A standard DEXA scan at a diagnostic centre or hospital in India typically costs somewhere in the range of ₹1,500 to ₹3,500, though this varies by city, facility, and whether both hip and spine are scanned, making it considerably more affordable than many assume. The scan itself takes about 10 to 20 minutes, involves lying still on a table while a scanning arm passes over you, uses a very low radiation dose (far lower than a standard chest X-ray), and requires no special preparation beyond avoiding calcium supplements on the day of the test, which some centres recommend.
What happens after you get your results?
A normal T-score with no major risk factors usually just means continuing the basics: adequate calcium and vitamin D, regular weight-bearing and resistance exercise, and a repeat scan on whatever interval your doctor suggests, often two years later. An osteopenic or osteoporotic result combined with a meaningfully elevated FRAX score is when your doctor will typically discuss whether medication is appropriate, alongside the same lifestyle measures, since the test’s real purpose is guiding that treatment decision, not creating anxiety about a number on a page.
Frequently Asked Questions
At what age should I actually get my first DEXA scan? General guidance suggests around the time of menopause for women, or earlier with risk factors like early menopause or steroid use, and around 65 to 70 for men, again earlier with specific risk factors like a previous fragility fracture or a parent’s hip fracture. Your doctor can personalise this based on your history.
Is a DEXA scan painful or does it involve a lot of radiation? No to both. It involves lying still while a scanning arm passes over the hip and spine, takes about 10 to 20 minutes, and uses a radiation dose considerably lower than a standard chest X-ray.
My T-score shows osteopenia. Does that mean I will definitely get a fracture? No. Osteopenia means lower-than-ideal bone density, not osteoporosis, and your actual fracture risk depends heavily on your other factors, which is exactly what a FRAX calculation is designed to estimate more precisely than the T-score alone.
Can I calculate my own FRAX score without a scan? A basic FRAX estimate can be calculated using risk factors alone, without a bone density input, though adding an actual DEXA T-score makes the estimate considerably more accurate. This is best discussed with your doctor rather than self-calculated online, since interpreting the result properly matters as much as the number itself.
Bone density decline is quiet and gradual, which is exactly why a specific number, rather than a vague sense that “bones get weaker with age,” is so useful. If you are in a higher-risk group or simply at an age where screening is generally recommended, ask your doctor whether a DEXA scan and FRAX assessment make sense for you.
Life Begins After 40 is an information resource, not a medical provider. For personal advice, speak with your doctor. Write to us at thesecondspringofficial@gmail.com