What Is a Bone Health Assessment and Who Needs One?

What is a bone health assessment — and is it the same as a bone density scan?

A bone health assessment is an evaluation of how strong your bones are and how likely you are to fracture. A bone density scan is one part of that assessment — the measurement — not the whole thing. The assessment brings together your personal risk factors, your history and a bone density result, then interprets them together to tell you where you stand.

People often use "bone health assessment", "bone density scan" and "DEXA scan" as if they mean the same thing. They are related but distinct. The scan produces a number — your bone mineral density (BMD). The assessment is the clinical picture around that number: your age, menopause status, family history, medications and previous fractures, all read alongside the scan. A high-quality assessment is what turns a raw measurement into something you can act on.

This matters because osteoporosis is usually silent. There is no ache or warning that bone is thinning — the first sign is often a fracture from a minor fall. An assessment is the only way to know your bone status before that happens.

Who should have a bone health assessment in the UK?

You should consider a bone health assessment if you are post-menopausal, over 50, or carry recognised risk factors for weak bones — because fragility fractures are far more common than most people realise. The Royal Osteoporosis Society notes that one in two women and one in five men over the age of 50 will break a bone due to osteoporosis, and highlights oestrogen loss around the menopause and a parent breaking a hip as important risk factors.

The scale of the problem in the UK is significant. Current UK clinical guidance reports that around 549,000 new fragility fractures occur each year, including 105,000 hip fractures, and that one in two women and one in five men will sustain one or more fragility fractures in their lifetime.

You are more likely to benefit from an assessment if you:

• are post-menopausal or have had an early menopause;
• are over 50, particularly with other risk factors;
• have a parent who broke a hip;
• take long-term oral steroids or certain other medications;
• have lost height or had a fracture from a minor fall;
• have a medical condition known to affect bone.

The Royal Osteoporosis Society's online self-check tool is offered to people in the UK aged 18 and over — but that age threshold reflects who can use a screening questionnaire, not a recommendation that every young adult needs a bone-density scan. A scan is targeted at people whose risk profile warrants it.

What does a bone health assessment actually involve?

A bone health assessment typically has two halves: a structured review of your risk factors, and a bone density measurement. Neither alone gives the full answer; together they tell you both your current bone strength and the context that shapes your future risk.

The risk-factor review covers your age, sex, menopause status, family history of fractures, medications, lifestyle and any previous breaks. Many services pair this with a validated risk tool. The measurement is a bone density scan — most often a DEXA scan or a radiation-free REMS scan — which gives a number for the density of bone at key sites such as the spine and hip.

At Screen My Bones, the bone health assessment is delivered through a radiation-free REMS scan at our pop-up assessment days. You get your reading and a clear explanation of what it means, rather than just a printout. The whole point is to make the result understandable and actionable.

What are the main risk factors that put you in line for a bone check?

The strongest signals are age and menopause, a family history of hip fracture, long-term steroid use, and any fracture from a fall that shouldn't normally break a bone. These are the factors that most often tip someone from "general population" into "worth assessing".

Two of the most important are hormonal and hereditary. The Royal Osteoporosis Society specifically flags the drop in oestrogen around the menopause and a parent breaking a hip as key risks. Bone is living tissue that is constantly remodelled, and the menopause accelerates the rate at which it is broken down.

The cost of missing these signals is real. The Royal Osteoporosis Society reports that around 90,000 people every year are missing treatment because of the absence of Fracture Liaison Services, with two-thirds of people with osteoporosis missing treatment and such services absent in half of NHS Trusts. Internationally, the picture is similar: one 2021 review described treatment-gap proportions of 25 to 85% of patients estimated to be eligible for treatment but not receiving it across (mostly non-UK European) countries, and a fall in post-hip-fracture osteoporosis medication use from 40.2% in 2002 to 20.5% in 2011 in the US. Those last figures are international, not UK data — but they illustrate a global pattern of under-treatment that an early assessment helps you avoid.

What is a DEXA scan and how does the NHS decide who gets one?

A DEXA scan (dual-energy X-ray absorptiometry) is the long-standing reference method for measuring bone density. It uses a very small dose of X-ray radiation and is the technology UK guidance names for diagnosing osteoporosis. Current UK clinical guidance confirms that DXA measured at the femoral neck is the reference technology for bone mineral density.

How does the NHS decide who is referred for one? In general terms, a GP weighs up your risk factors — age, menopause status, family history, steroid use, previous fractures — and may use a fracture-risk calculator to decide whether a DEXA scan is warranted. Because NHS DEXA capacity is finite and referral is risk-based, many people who would value knowing their bone status don't meet the threshold for a scan, or face a wait — which is part of why private and community screening exists.

What is a radiation-free REMS scan and where does it fit in the UK?

REMS (Radiofrequency Echographic Multi Spectrometry) is an ultrasound-based way of measuring bone density that uses no ionising radiation. It is best understood as a radiation-free option for access and repeat monitoring — not a replacement for DEXA in diagnosis. Getting this distinction right matters, so here is the honest evidence picture.

On the supportive side, a 2023 review reports that a multicentre study of 1,914 postmenopausal women found lumbar-spine agreement between REMS and DXA of 88.8%, and that a European validation on 4,307 women reported both methods exceeding 90% sensitivity and specificity, with REMS able to overcome osteoarthritis-related artefacts that can distort DXA readings. A 2025 primary-care study also found that REMS performed by a radiographer was significantly associated with a doctor-confirmed diagnosis at the femur, supporting its value for improving access where DXA is limited.

One clear advantage of being radiation-free is repeatability. Because it uses no ionising radiation, REMS can also be used during pregnancy, when bone-density scanning with DEXA is normally avoided. A 2024 cohort of 65 low-risk pregnant women used REMS to track bone over pregnancy and found a mean femoral-neck bone density reduction of about 1.9% from the first to the third trimester — a measurement made possible precisely because the method carries no radiation dose. You can read more about how the technology works in our guide to REMS technology and the science behind it.

What happens after a bone health assessment — and what can you do about the results?

After an assessment you get your bone density result, an explanation of what it means for your fracture risk, and a clear set of next steps. Those steps depend on what the scan shows — and importantly, an assessment result is a guide to action, not a diagnosis. As the Royal Osteoporosis Society puts it, only a healthcare professional can diagnose osteoporosis.

If your bones are healthy, the value is reassurance plus a baseline — a number to measure future change against, which is exactly where radiation-free repeat scanning shines. If your density is low, the assessment points you towards the right conversation: lifestyle and nutrition changes (weight-bearing and resistance exercise, adequate protein, calcium and vitamin D), closer monitoring, or a discussion with your GP about further investigation or treatment. Acting early, while change is gradual, is when prevention is most effective.

Wherever you land, the assessment replaces uncertainty with a number you can act on. You can book a screening at one of our UK assessment days, learn more about Screen My Bones and our team, or explore our services.

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This article is part of our screening technology series. If you take weight-loss medication, see our guide to Ozempic and bone loss; and for hormone-related risk, our menopause and bone health guides.