DEXA checklist.
Who to refer for a bone density (DXA) scan in India, and how to read T-scores and Z-scores by patient group.
Dr Aditya Aggarwal, MS (Ortho), PMC 45581, Aggarwal Clinic, Patiala
For clinicians and healthcare professionals. Nothing you enter is stored or sent.
Use the section that matches the person. For women, use “Who to scan: women”. For men, use “Who to scan: men”. Then use “Read a result” for the scan report.
Who to scan: women (Indian Menopause Society 2026)
Paraphrased from the guideline's indications for DXA. Tick any that apply.
No criterion ticked.
- The guideline states that screening everyone with DXA is not cost-effective in India and advises targeted case-finding, with DXA where available.
- Its pathway for postmenopausal osteoporosis is risk-first from age 40: OSTA (age and weight) for first triage, then FRAX, then FRAX with DXA.
Who to scan: men (ISCD, international)
No Indian rule with a specific age for men has been verified. Tick any that apply.
No criterion ticked.
- These are international (ISCD) positions. The Indian Society for Bone and Mineral Research (ISBMR 2021) advises that screening should begin at an earlier age in Indians, because fractures occur earlier; its published summary gives no specific age for men.
For comparison (not Indian guidance)
- USPSTF 2025 (United States): Screen women aged 65 and over, and younger postmenopausal women at increased risk on clinical assessment. Evidence for screening men is insufficient.
- ISCD (international society): Women aged 65 and over and men aged 70 and over; younger adults with risk factors; anyone with a fragility fracture, being considered for treatment, or on treatment.
Read a result
T-scores and the WHO bands apply to postmenopausal women and men aged 50 and over. For premenopausal women and men under 50, Z-scores are preferred, and osteoporosis is not diagnosed on bone density alone. T-scores use the NHANES III young white women reference (not an Indian population; it may overestimate osteoporosis in Indian women).
Result
Choose a patient group.
T-score bands (WHO, adults)
Postmenopausal women and men aged 50 and over only. Use the lowest valid score of lumbar spine, total hip and femoral neck.
| Band | T-score | Meaning |
|---|---|---|
| Normal | −1.0 or higher | Within the young-adult reference range. |
| Low bone mass (osteopenia) | Between −1.0 and −2.5 | Below the young-adult reference, not in the osteoporosis range. |
| Osteoporosis | −2.5 or lower | In the WHO osteoporosis range. |
| Severe osteoporosis | −2.5 or lower with a fragility fracture | Osteoporosis range plus a fragility fracture. |
Z-score bands (ISCD, younger adults)
Premenopausal women and men under 50.
| Band | Z-score | Meaning |
|---|---|---|
| Below the expected range for age | −2.0 or lower | Not an osteoporosis diagnosis on its own. |
| Within the expected range for age | Above −2.0 | Compared with people of the same age. |
Children and adolescents: not calculated here. Paediatric osteoporosis is not diagnosed on DXA alone; ISCD paediatric criteria are fracture-based and differ from the adult bands.
Source
Citation: Meeta et al. Clinical Practice Guidelines for Menopause: Executive Summary, Indian Menopause Society 2026. J Midlife Health 17(Suppl 1):S12-S116. PMID 41767293; doi:10.4103/jmh.jmh_302_25. A 2026 corrigendum (PMID 42124822; doi:10.4103/jmh.jmh_115_26) corrects references in Sections 1, 4 and 6 only; the guideline is not retracted. Z-score use: ISCD Adult and Pediatric Official Positions (iscd.org, 2023 web edition); Shuhart CR et al. J Clin Densitom 2019. PMID 31400968; doi:10.1016/j.jocd.2019.07.001. Men: ISCD positions above; Bhadada SK et al. ISBMR position statement on osteoporosis in adults. Arch Osteoporos 2021. PMID 34176015; doi:10.1007/s11657-021-00954-1 (abstract). For comparison only: USPSTF. JAMA 2025. PMID 39808425; doi:10.1001/jama.2024.27154.
Licence: IMS 2026 is open access under CC BY-NC-ND: cited and paraphrased here, not reproduced (the OSTA chart is not shown). WHO bands and ISCD positions are stated as facts with citation.