Key Takeaways

• Bone mineral density refers to the amount of minerals per volume of bone tissue.

• Reduced bone mineral density significantly increases the risk of experiencing a bone fracture.

• Fractures can permanently impact a person’s physical functioning.

• A DEXA scan is the most common way to test bone mineral density.

• DEXA scans are painless and relatively quick to perform.

• If your bone mineral density is low, then lifestyle factors may help to increase it. In some cases, medications are used.

What is bone mineral density?

Bone tissue is harder than other types of body tissues due to the presence of minerals within the tissue. The main one is a mineral known as hydroxyapatite, which is made up of calcium and phosphate. The minerals make the bone tissue stronger and more resistant to breakage.

Bone mineral density, sometimes referred to simply as bone density, refers to the amount of hydroxyapatite per volume of bone tissue. This varies from person to person, and changes over time based on many factors.

Why should you measure your bone density?

Bone mineral density is important for a person’s health and longevity. If you want to maintain your physical function for as many years as possible, it’s crucial to maintain your bone density. Testing bone density allows you to detect conditions of low bone mineral density – known as osteopenia and osteoporosis.

What are osteopenia and osteoporosis?

Osteopenia refers to bone density that’s somewhat reduced, while osteoporosis refers to more significantly reduced bone mineral density.

People with reduced bone density are significantly more likely to experience a bone fracture. Studies have shown that a 10% decrease in bone mineral density in the hip leads to a 2.5-fold increase in fracture risk. Experiencing a fracture can significantly impact a person’s healthspan. After a hip fracture, two-thirds of patients never return to the same level of function that they had before the fracture.

Osteopenia and osteoporosis often have no clear symptoms, particularly in the early stages. In order to detect these conditions before experiencing a bone fracture, it’s important to have a bone density scan. If your bone mineral density is low, then you can take steps to address the issue before it has a serious impact on your physical functioning.

Various factors increase the risk of osteoporosis, including:

• Aging

• Exercise habits (particularly a lack of resistance exercise)

• Diet (particularly a lack of nutrients like calcium and vitamin D)

• Low levels of hormones like testosterone and estrogen

• Lower body weight

Unfortunately, many people don’t even realize they have osteoporosis until they experience a fracture. This is why it’s known as a “silent disease.” By receiving testing, you’re able to detect low bone mineral density before having a fracture that could impact your physical functioning for the rest of your life. You can then take steps to address the problem, potentially avoiding serious issues in the future.

What is a DEXA scan?

The most commonly used test for bone mineral density is called a dual-energy X-ray absorptiometry scan, or DEXA scan. (This is sometimes abbreviated as DXA scan, although both abbreviations refer to the same test.)

A DEXA scan uses X-rays of two different wavelengths. By comparing the absorption of the two different types of X-rays, the scanner is able to assess the level of minerals in your bone tissue. DEXA scanning can be performed on specific parts of the body, or on the entire body.

DEXA is by far the most common type of bone density test used in Singapore as well as other countries. It’s considered to be the “gold standard” for testing bone mineral density, meaning that medical professionals consider it to be the best test for this purpose.

Are there other types of bone density scans available in Singapore?

There is also another type of bone scan available. This test uses a molecule called a tracer, which is injected into the bloodstream and makes its way to the bone tissue. The tracer emits a small amount of radiation, which can be detected by the scanner. 

This type of bone scan produces very detailed images of the bones. However, this type of bone scan is more expensive, and having the test is more complex as well as painful. Because of these factors, it’s not typically used as a screening test. Rather, it’s used in situations where a doctor suspects that the patient may have a particular medical condition. For example, this type of bone scan is used to check whether cancer has spread to the bones.

What is the process of getting a DEXA scan like?

The process of receiving a DEXA scan is relatively simple. You don’t need to be fasting before the test. The test does not involve any injections and is not painful.

1. To have a DEXA scan, you simply lie on a table. You can usually be wearing your own clothing, but you’ll need to avoid clothing that has any metal on it (such as snaps or zippers), because this can interfere with the results. The technician will ensure that your body is positioned properly, which may involve using pillows or foam blocks for support. A scanning arm will then move over your body to perform the scan. It’s important to stay still during the scan, because movements of the body can blur the images. 2. Most commonly, a DEXA scan specifically tests the hips and spine, so these are the areas that the scanning arm will move over. 

2. In some cases, other bones may also be scanned.

Although a DEXA scan does involve exposure to X-rays, the amount of radiation is very small. This is because an extremely low dose of X-rays is needed to do the scan – just enough to compare the two different X-ray wavelengths to each other. In fact, a DEXA scan of the hip and spine is equivalent to about three hours of the natural background radiation that everyone is constantly exposed to.

What can you do if your bone density is low?

If your DEXA scan shows that you have low bone mineral density, there are a few ways for you to increase this. Some options include:

• Exercise. The most effective type of exercise for increasing bone density is resistance exercise. This may involve lifting weights, pulling on resistance bands, or body weight exercises. Putting force on the bones triggers the body to deposit more minerals in the bone tissue, which strengthens it.

• Nutrition. The most important nutrients for bone health are calcium and vitamin D. In Singapore, more than 40% of adults don’t have adequate vitamin D levels, and more than half of all older adults don’t get enough calcium. There are also other nutrients important for bone health, including magnesium, vitamin K, copper, and zinc. For some people, adjusting their diet allows them to get enough of these nutrients. For others, taking supplements may be recommended.

• Hormone therapy. Both testosterone and estrogen are important in maintaining bone density. These hormones generally decline over time as a result of the aging process. For people whose hormone levels have dropped, taking hormone therapy can help to increase bone density and reduce fracture risk. It’s important to weigh the potential risks and benefits with your doctor before deciding whether to take hormone therapy.

• Bisphosphonates. There are also medications available that are used to increase bone density. The most common type are known as bisphosphonates. Although they can decrease fracture risk, they can also have side effects, and may not be right for everyone. It’s important to carefully weigh the potential benefits and risks for each individual patient. Your doctor will talk with you about whether these medications are recommended for you.

Where to get a DEXA scan in Singapore

A physician’s orders are required to receive a DEXA scan. To get this scan, you will need to visit a doctor.

In some cases, a DEXA scan may be ordered as part of your regular physical exam. However, this is not always the case. If you’d like to receive a DEXA scan, but you’re not yet at the age where a DEXA scan is always recommended, then you will need to visit a doctor to ask about having the scan.

A DEXA scan is one of the add-on options of the NOVI Assessment Max program. NOVI Assessment Max is for those who wish to take a proactive approach to health and longevity. By regularly performing a variety of blood tests and imaging tests, you can track your health status over time. This allows you to adjust your lifestyle as needed to maintain the best possible health, and to address any medical conditions early, while they’re generally easier to treat.

NOVI Assessment Max includes a consultation with your doctor, easy to understand results, and an optional personalized nutrition, fitness and lifestyle plan to improve your health and longevity.