A bone density test — called a DEXA scan (Dual-Energy X-ray Absorptiometry) or DXA — is the gold-standard method for diagnosing osteoporosis and osteopenia in Canada. It's a quick, painless, low-radiation procedure that gives your doctor the data needed to assess fracture risk and guide treatment decisions. Here's everything you need to know about getting one in Canada.
DEXA stands for Dual-Energy X-ray Absorptiometry. The machine uses two low-dose X-ray beams at different energy levels to measure how much of the beam is absorbed by bone versus soft tissue. The difference tells the machine — and the radiologist — how dense your bones are. The scan focuses primarily on the lumbar spine (L1–L4) and the proximal femur (hip), the two sites most predictive of fracture risk.
The radiation dose is extremely low — equivalent to about 1–10 microsieverts, roughly the same as a few hours of background radiation or a short flight. By comparison, a chest X-ray delivers about 100 microsieverts. DEXA is considered very safe, even for repeat measurements over time.
Most Canadian hospitals and bone density clinics use DEXA machines from Hologic or GE Lunar — the two main manufacturers. Results between machines from different manufacturers are not directly comparable, which is one reason follow-up scans should ideally be done on the same machine at the same facility.
Osteoporosis Canada's clinical guidelines and most provincial health programs cover DEXA scans under specific criteria. Generally, a bone density test is recommended if you:
In most Canadian provinces, DEXA scans are covered under provincial health insurance when ordered by a physician and meeting clinical criteria. However, coverage specifics vary:
| Province | Coverage | Notes |
|---|---|---|
| Ontario | OHIP covered | Physician order required; specific indications listed in OHIP schedule |
| British Columbia | MSP covered | Covered with physician referral; BC Guidelines specify eligible populations |
| Alberta | AHCIP covered | Age and risk factor criteria apply; free for qualifying patients |
| Quebec | RAMQ covered | Must meet age or risk criteria; physician order required |
| Manitoba | MB Health covered | Covered with qualifying indications |
| Saskatchewan | SK Health covered | Available at major centres |
| Nova Scotia | MSI covered | Covered for qualifying patients |
If you do not meet provincial coverage criteria but want a bone density test, private DEXA scans are available at many clinics across Canada, typically for $80–$150. Some osteoporosis specialty clinics offer bundled assessments that include DEXA, FRAX calculation, and a consultation.
A DEXA scan is one of the easiest medical tests you'll have. Here's what to expect step by step:
Your DEXA report will include several numbers. The most important are T-scores and Z-scores.
The T-score compares your bone mineral density (BMD) to that of a healthy young adult (typically a woman in her late 20s to early 30s at peak bone mass). A T-score of 0 means your BMD is exactly average for a young healthy adult. Each unit represents one standard deviation.
Bone density is within the normal range for a healthy young adult.
Bone density is lower than normal but not low enough to be classified as osteoporosis. Increased attention to nutrition, exercise, and fall prevention is important. Medication is usually not indicated unless fracture risk is elevated by other factors.
Bone density meets the World Health Organization (WHO) definition of osteoporosis. This is the threshold commonly used in Canadian clinical practice to consider pharmacological treatment, in combination with fracture risk assessment tools like FRAX.
The Z-score compares your bone density to others of your age, sex, and ethnicity. A Z-score of −2.0 or lower suggests your bone loss is greater than expected for your age and prompts investigation for secondary causes of osteoporosis — underlying medical conditions or medications causing accelerated bone loss. Z-scores are particularly important for premenopausal women and men under 50.
T-scores measure how dense bone is, but density alone doesn't capture everything about bone strength. Trabecular Bone Score (TBS) is a software analysis applied to the lumbar spine DEXA image that assesses bone microarchitecture — how well the internal lattice structure of bone is organized. TBS can identify bone quality problems that the T-score misses, particularly in people with diabetes, obesity, or glucocorticoid use.
Not all Canadian DEXA centres offer TBS. Ask whether your facility has TBS software when booking your appointment. For a deeper dive, see our article on interpreting your DEXA results including TBS and FRAX.
A T-score alone doesn't determine whether you need treatment. The FRAX tool — developed by the World Health Organization and calibrated with Canadian population data by Osteoporosis Canada — calculates your 10-year probability of a major osteoporotic fracture (spine, hip, wrist, or shoulder) and hip fracture specifically. It incorporates your BMD alongside clinical risk factors including age, sex, weight, prior fractures, parental hip fracture history, smoking, alcohol use, and glucocorticoid use.
Osteoporosis Canada uses FRAX results to place patients into low, moderate, or high fracture risk categories, with treatment recommendations tied to those categories. You can use the FRAX calculator online at sheffield.ac.uk/FRAX — be sure to select Canada as your country for appropriately calibrated estimates.
The appropriate interval for repeat DEXA scans depends on your initial results and whether you are on treatment:
Provincial health programs generally cover follow-up scans at clinically appropriate intervals when on treatment. Ask your ordering physician how to ensure coverage for your follow-up scan.
DEXA scans are available at most hospitals, many osteoporosis specialty clinics, and some radiology clinics in larger cities. In rural and remote areas, access can be limited — patients may need to travel to a regional centre. Osteoporosis Canada maintains a clinic finder at osteoporosis.ca where you can locate services by province. Some provincial health authorities also offer mobile DEXA services for remote communities.