Osteoporosis test: which one is right and when it’s free

October 20, 2026approx. 14 minutesby mybody®x Editorial & Expert Team

In this article

Which osteoporosis test is right?

The right osteoporosis test is a bone density test using DXA, because according to the guideline, an osteoporosis diagnosis is based on low bone density (DVO, 2023). The other methods in this overview complement this measurement but do not replace it (DVO, 2023).

Osteoporosis tests at a glance

Osteoporosis refers to reduced bone density, which according to IQWiG (2022) is not a disease but a risk factor for fractures. According to IQWiG (2022), reduced bone density can be detected with a bone density test, known to specialists as osteodensitometry.

You cannot feel osteoporosis, says IQWiG (2022). According to IQWiG (2022), it often only becomes noticeable when a bone breaks. So if you want to know how your bones are doing, you cannot rely on how you feel; you need a measurement.

When looking for an osteoporosis test, the question of whether a blood test is enough comes up quickly. The answer is no: osteoporosis is diagnosed not from a blood test result, but from measured bone density (DVO, 2023). Blood tests still play an established role in the evaluation, but they serve a different purpose. You can find out what that is in the section on blood tests.

Why is DXA the standard for osteoporosis testing?

Only DXA can determine whether osteoporosis is present according to the WHO definition, because that definition is based on the DXA measurement (DVO, 2023).

DXA stands for dual X-ray absorptiometry, an X-ray procedure. The guideline identifies it as the recommended standard procedure and calls for measurements of the lumbar spine and both hips (DVO, 2023). According to DVO (2023), its first purpose is to check whether osteoporosis is present according to the WHO definition. An overview of the updated guideline confirms that DXA remains the preferred procedure (Pfeil & Lange, 2024).

Two other methods also provide bone measurements: quantitative ultrasound, or QUS, and computed tomography, or QCT. According to DVO (2023), their values cannot be converted into DXA values. In addition to DXA, QCT can also be used, with some limitations, to assess treatment effects; according to DVO (2023), ultrasound has not been studied for this purpose, or has not been studied adequately.

Ultrasound is therefore not an equivalent alternative to DXA, but a preliminary test for exceptional cases. The guideline considers it a suitable first step only for certain high-risk groups for whom a DXA scan is difficult to perform (DVO, 2023). According to DVO (2023), there are no newer studies on ultrasound.

What does an osteoporosis risk calculator like FRAX show?

A risk calculator estimates fracture risk based on risk factors; it does not measure bone density (DVO, 2023).

FRAX is a calculation tool developed by a WHO working group, according to DVO (2023). It estimates the risk of fractures based on clinical risk factors, optionally supplemented by DXA bone density at the femoral neck (DVO, 2023). The 2023 guideline shortened the time period: instead of looking at fracture risk over ten years, it considers the risk over three years for fractures of the femoral neck and vertebrae (Pfeil & Lange, 2024). The calculator does not provide a diagnosis; that is based on measured bone density (DVO, 2023).

Bone density measurement is a medical examination. The doctor interprets the result together with your risk factors.

How does bone density measurement work for osteoporosis?

Bone density measurement determines how much mineral salt the bone contains and reports the result as a T-score (IQWiG, 2022). The body is exposed to a low dose of X-rays during the procedure (IQWiG, 2022).

The T-value, or T-score, is a comparison figure: a T-score of 0 corresponds to the bone density of a young, healthy adult aged 20 to 30 (IQWiG, 2022). According to the WHO definition as cited by IQWiG (2022), these thresholds are used for classification:

• T-score up to −1: normal (IQWiG, 2022)
• T-score between −1 and −2.5: reduced, known as osteopenia (IQWiG, 2022)
• T-score equal to or below −2.5: osteoporosis (IQWiG, 2022)

The guideline uses the same threshold of −2.5 and states that the WHO definition is based on the DXA measurement value (DVO, 2023). According to DVO (2023), a T-score from another measurement method therefore cannot be applied to this scale.

The measurement site also matters. According to IQWiG (2022), bone density is best measured at the femoral neck. Lumbar spine values are less informative because the vertebrae can also change with age for other reasons (IQWiG, 2022).

According to the guideline, there is a strong link between bone density and fracture risk (DVO, 2023). Nevertheless, fewer than half of fractures in older women are associated with reduced bone density, because most fractures occur at measurement values above the threshold of −2.5 (DVO, 2023).

For you, this means that a normal result is no guarantee against a fracture, and an abnormal result is not a sure sign of one. In addition to the scan, the guideline considers other risk factors, including previous fractures and a fall in the past year (Pfeil & Lange, 2024).

When is an osteoporosis test free?

If a bone density scan is medically indicated, statutory health insurers cover the costs, according to IQWiG (2022). IQWiG (2022) gives these situations as examples:

• A bone fracture raises suspicion of osteoporosis.
• There is an increased risk of osteoporosis, for example after taking corticosteroid medication for a long time.
• Treatment with osteoporosis medication is being considered.

According to IQWiG (2022), some practices offer the measurement without a medical reason as a self-pay service, known as an individual health service (IGeL).

Is osteoporosis screening worthwhile?

For women under 65 with no risk factors, the examination may have more disadvantages than advantages, according to IQWiG (2022). Here, early detection means a measurement when there are no symptoms and no specific reason for suspicion.

IQWiG (2022) identifies two disadvantages. The body is exposed to a small amount of X-ray radiation during the measurement. And if the measurement shows low bone density, this can be worrying and may lead someone to move less for fear of a fracture; in that case, early detection may even be harmful, according to IQWiG (2022).

Overall, according to IQWiG (2022), the benefits of early detection have not been adequately studied and remain controversial. For younger women and men, the advantages and disadvantages have not yet been investigated in meaningful studies, according to IQWiG (2022). A measurement without a specific reason is therefore not automatically the more cautious choice.

Which blood values are part of an osteoporosis assessment?

According to the guideline, the assessment includes a basic laboratory panel of eleven blood values (DVO, 2023). None of these values measures bone density, but according to IQWiG (2022), a blood test can help rule out other diseases as the cause of bone loss.

Why test blood when the concern is bones? According to the guideline, reduced bone density alone is not specific to osteoporosis; various clinical conditions can cause it (DVO, 2023). One of these is osteomalacia, another bone disease that is also associated with low bone density measurements. According to DVO (2023), the basic laboratory panel is intended, among other things, to help distinguish it in individual cases.

The guideline refers to the laboratory tests that should be performed during the assessment as the basic laboratory panel (DVO, 2023). According to DVO (2023), it comprises these eleven values:

• Serum calcium
• Serum phosphate
• Alkaline phosphatase (AP)
• Gamma-GT
• Creatinine clearance (GFR)
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• Complete blood count
• TSH
• Serum sodium
• Serum protein electrophoresis

The guideline explicitly recommends measuring both CRP and ESR (DVO, 2023). The entire compilation is an expert consensus, meaning an agreement among specialists, because comparative studies on the significance of individual values are largely lacking (DVO, 2023). The values help distinguish other causes; the diagnosis of osteoporosis itself is based on low bone density (DVO, 2023).

The article Calcium in the blood and bones explains what blood calcium levels can tell you about your bones. This article focuses on the path to diagnosis.

Is vitamin D included in osteoporosis blood tests?

No, according to the guideline, 25-hydroxyvitamin D, or 25-OH vitamin D for short, is not part of the basic lab panel (DVO, 2023). It should be measured only in selected cases, such as when osteomalacia is suspected (DVO, 2023).

The guideline also cites the measurement methods as a reason: they are not standardized enough and have a margin of variation of up to 30 percent (DVO, 2023). If your result has already been measured, read about what the 25-OH-D3 result means in the related article.

No test from mybody®x (MYBODY Lab GmbH) measures bone density. The VitalCheck from mybody®x measures calcium, phosphate, and 25-OH vitamin D3 in capillary blood for €169.00 (as of 20.10.2026; subject to change). It does not replace a bone density measurement; the results can help you prepare for your doctor’s appointment.

Who should get an osteoporosis test?

The guideline recommends an assessment for women after menopause and for men aged 50 and over if the doctor considers their fracture risk factors relevant (DVO, 2023). Osteoporosis testing should be offered from age 70 (DVO, 2023).

The guideline calls this assessment basic diagnostics (DVO, 2023). It generally does not recommend it before menopause or for men under 50, because the risk of fractures is low at that age (Pfeil & Lange, 2024). The guideline also does not recommend basic diagnostics outside the specified risk profiles, except for rare conditions (DVO, 2023). However, according to DVO (2023), low results from an ultrasound or QCT measurement may be a reason to investigate further.

At age 70, women’s fracture risk in the guideline’s model is high enough to warrant a bone density measurement if the results are intended to inform treatment (DVO, 2023). At this age, the model estimates an average three-year risk of 3 percent for fractures of the vertebrae and femoral neck (DVO, 2023). From age 70 onward, the DVO (2023) also recommends asking regularly about falls to assess fall risk.

According to IQWiG (2022), osteoporosis usually develops after age 50 and becomes more common with age (IQWiG, 2022). In women, bone loss accelerates around age 50, when levels of the sex hormone estrogen decline with menopause (IQWiG, 2022). If you experience back pain at this stage of life, the article on Back Pain During Menopause provides more context.

Osteoporosis and age

Sources: IQWiG (2022), DVO (2023)

Which risk factors indicate that an osteoporosis test may be appropriate?

According to the guideline, whether further assessment is advisable depends on your personal risk profile (DVO, 2023). IQWiG (2022) identifies these as the main modifiable risk factors:

• Low body weight relative to height
• Calcium deficiency
• Vitamin D deficiency
• Lack of physical activity
• Smoking
• Heavy alcohol consumption
• Long-term use of corticosteroid medications, for example over several months

The article Vitamin D Deficiency in Women describes how a vitamin D deficiency can manifest. An overview of the guideline lists other risk factors, including these (Pfeil & Lange, 2024):

• Previous fractures of the vertebrae or hip
• A fall in the past year
• Underweight, with a body mass index (BMI) below 20 kg/m² (Pfeil & Lange, 2024)
• Type 1 or type 2 diabetes mellitus (Pfeil & Lange, 2024)

If any of these points apply to you, this is not a diagnosis but a reason to discuss it with your doctor. According to the guideline, your doctor will assess whether this amounts to a relevant risk profile (DVO, 2023).

What are the limitations of osteoporosis tests?

The standard test also has limitations: according to IQWiG (2022), bone density measurement cannot reliably predict how likely a bone fracture is.

For screening without a specific reason, IQWiG (2022) also says that its benefits have not been adequately studied and are disputed. The basic blood tests are based on expert consensus, not comparative studies (DVO, 2023). According to DVO (2023), there are no recent studies on ultrasound.

The sources also have a publication date. The guideline information in this guide comes from its full version published in 2023; the updated guideline was published in October 2023 (Pfeil & Lange, 2024). The IQWiG health information is dated October 2022, with an update announced for 2026 (IQWiG, 2022). The figures for people aged 70 are based on self-reports in a large study (IQWiG, 2022).

No mybody®x test measures bone density. A blood test shows your current status, and an abnormal result does not automatically mean you have a disease. Bone density is measured at a doctor’s office.

Osteoporosis test: What you can do now

The right test for osteoporosis is a DXA bone density scan, which is done at a doctor’s office. Before your appointment, go through the risk factors in this guide and write down which ones apply to you and whether you have ever had a fracture after a minor fall. This note can help your doctor assess whether you should be evaluated. A blood test can supplement the scan, but it cannot replace it.

Frequently asked questions

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Sources

1. Dachverband Osteologie (DVO): S3 Guideline on Osteoporosis, full version (as of 2023) – cdn.lmu-klinikum.de
2. IQWiG, gesundheitsinformation.de: Osteoporosis and bone fractures (as of 2022) – gesundheitsinformation.de
3. Pfeil A., Lange U.: Update to the 2023 DVO guideline, Journal of Rheumatology (as of 2024) – europepmc.org

The statements on DXA and ultrasound are based on guideline [1], as are the basic laboratory tests and age limits for assessment. The T-score and measurement site are from IQWiG’s health information [2], along with information on early detection and modifiable risk factors. The other risk factors in the guideline and the switch to three-year risk are from overview [3]. The VitalCheck price and measurements are as of 20.10.2026.