# DEXA scan in Germany: What it costs, when insurance pays and where to get one

_By Maurice Lichtenberg · Published 2026-09-05 · Updated 2026-10-21_

As of October 2026, a self-pay DEXA bone density scan in Germany costs about 40 to 70 euros [4]. A whole-body DEXA scan of fat and lean tissue has no fixed fee, so ask the provider for a written quote. Statutory insurance pays only for bone density scans, follow-ups included, and only when findings like a fracture from a minor fall lead your doctor to plan osteoporosis medication [3, 15]. Both scans use X-rays, so each needs a medical reason from a doctor, and a scan only to check your body fat is not permitted in Germany [5, 22].

Two very different scans run under the same name. One measures your bones and is sometimes paid for by statutory insurance. The other estimates fat and muscle, is always self-pay and, like the first, needs a doctor to see a medical reason for the X-ray.

## On this page

- How much does a DEXA scan cost in Germany without insurance? 2026 prices
- Bone density or body composition: Which two DEXA scans are there?
- Does health insurance pay for a DEXA scan? G-BA rule and DVO guideline
- Where can you get a DEXA scan? Berlin, Munich, Hamburg, Frankfurt, Cologne
- What do T-score, ALMI and visceral fat mean on your DEXA report?
- DEXA or InBody, radiation and how often: What to know before the appointment
- Is a DEXA scan worth it for you?

## How much does a DEXA scan cost in Germany without insurance? 2026 prices

A DEXA bone density measurement costs about 40 to 70 euros without insurance, as of October 2026 [4]. The whole-body scan for body composition estimates your fat, your lean tissue (everything that is neither fat nor bone) and the fat around your abdominal organs. It has no fixed price at all, because each provider sets its own fee, so ask for that price in writing before you book.

The difference comes from how practices bill self-pay patients. Doctors bill both scans under the official fee schedule for private billing (GOÄ), but body composition has no item of its own there. The practice therefore bills it by analogy to a comparable listed service that it chooses itself [26], so the price changes from practice to practice. When you ask for the quote, also ask whether a doctor's results consultation is included. A printout alone and half an hour of discussion are two different services.

Side by side, the two scans differ in what they measure, what they cost and whether statutory insurance ever pays:

| Scan | What is measured | Self-pay (as of October 2026) | Statutory insurance |
|---|---|---|---|
| Bone density (osteodensitometry) | Bone density at lower spine and hip | about 40 to 70 euros [4] | Yes, but only when your doctor plans osteoporosis medication [3, 15] |
| Whole-body composition | Body fat, lean tissue and fat around the abdominal organs | provider sets the price, ask in advance | No, always self-pay [15] |

Sources: Deutsche Rheuma-Liga [4], G-BA [3, 15].

The insurance column covers statutory insurance only. With private insurance, cover depends on your plan, so ask your insurer to confirm it before the scan. If you end up paying yourself, our [self-pay guide](/en/guide/selbstzahler-longevity) weighs the scan against other self-pay tests in Germany, Austria and Switzerland.

## Bone density or body composition: Which two DEXA scans are there?

A DEXA machine can measure two different things: the density of your bones, or the fat and lean tissue across your whole body. Its name, also written DXA, stands for dual-energy X-ray absorptiometry, because the machine sends X-rays at two energies through your body. Bone, fat and lean tissue absorb them to different degrees, so the software can estimate bone mineral, fat mass and lean soft tissue separately [7]. Which of these the practice looks at, and over which part of your body, decides which of the two tests you get.

**Scan 1: bone density measurement.** Practices often call this scan Knochendichtemessung or osteodensitometry, and it takes a few minutes. It usually measures your lower back and both hips, the sites the osteoporosis guideline of the German-speaking bone societies (DVO) specifies [1]. The result is the T-score, which shows how far your bone density sits above or below the average of young healthy adults. That distance is counted in standard deviations, a unit for the usual spread of values in that young group. A low T-score alone is not yet a diagnosis, though. The doctor first has to rule out other causes of low bone density, such as osteomalacia, a softening of the bones [27].

**Scan 2: the whole-body scan for body composition.** For this scan you lie completely under the scanner for about five to ten minutes. The printout usually shows:

- fat mass in kilograms and percent
- lean mass, often split into arms, legs and trunk
- an estimate of visceral fat (the fat around your abdominal organs)
- ALMI, a measure of arm and leg lean mass adjusted for height and used as a stand-in for muscle mass [7]

Visceral fat and ALMI appear only if the practice's software calculates them, so ask when you book. This whole-body scan is the one that strength athletes, people on weight-loss injections and longevity-minded people usually mean when they search for a DEXA scan.

That difference matters at the reception desk, because a radiology practice asked for a DEXA scan will do scan 1 by default. If you want to see fat and muscle, ask explicitly for body composition (Körperzusammensetzung), since not every practice that measures bone density has the whole-body software enabled. And if your doctor sees a reason for both scans, ask whether they can be done in one appointment, since they run on the same machine. The two scans do part ways with your health insurer, which pays for one of them in defined cases and never for the other.

## Does health insurance pay for a DEXA scan? G-BA rule and DVO guideline

Statutory health insurance pays for a bone density measurement only when there is a concrete medical reason, and it never pays for body composition. The rule comes from the G-BA, the Federal Joint Committee that decides what statutory insurance pays for. Its decision of February 2013 is still in force as of October 2026. Under it, insurance pays when findings from your medical history and examination lead your doctor to plan specific osteoporosis medication [3, 15]. The classic example is a spine or hip fracture from something as minor as a fall from standing height or lifting a shopping bag [3, 15].

A fracture is no longer a requirement, though, and long-term cortisone tablets, for example, can count as such a finding [3]. Risk factors alone are still not enough, because the findings must lead your doctor to plan osteoporosis medication [15].

Once that treatment is running, the same rule can also cover follow-up measurements [3]. The German osteoporosis guideline (DVO) recommends one within five years of starting or changing treatment [1]. For payment, though, the G-BA rule allows a repeat five years after the last scan at the earliest, unless findings that matter for treatment require one sooner [15].

Being advised to have a scan is therefore not the same as having it paid for. Who should be measured is a medical question, which the current DVO guideline answers [1]. At any age, it recommends a full osteoporosis check-up with DXA before planned cortisone therapy of 7.5 mg or more per day for over three months [1]. That dose refers to prednisolone, so for other cortisone medicines it is converted to the amount with the same effect.

Beyond cortisone, the guideline sorts its advice by age. The list shows whom it would measure, but payment still follows the G-BA rule:

- Under 50: after a fracture, the guideline recommends a scan for postmenopausal women and for men. Without a fracture, doctors should offer one when specific risk factors are present and the result would change treatment [1]
- From 50: promptly after every fracture, especially after a fragility fracture (a break from very little force) [1]
- Between 50 and 70: depending on your mix of risks, such as cortisone therapy, rheumatoid arthritis, diabetes, falls or a parent's hip fracture [1]
- From 70: offered to everyone, provided a treatment would follow from the result [1]

European guidance for postmenopausal women argues the same way: measure when the fracture risk would change the decision, not as screening for everyone [2].

That leaves the healthy 45-year-old who simply wants to know how their bones are doing. The DVO guideline does not count a routine check for healthy people among its reasons to measure [1]. Statutory insurance does not pay either, so the measurement becomes an IGeL, a self-pay service. Paying does not replace the medical reason, though. Under the Radiation Protection Act, a doctor still has to judge that the benefit outweighs the radiation risk [5]. If you do pay, the practice has to tell you the expected costs in text form, on paper or by email, before the scan [24].

For body composition, paying yourself is the only route. The G-BA rule covers DXA only as a bone density measurement, and the fee schedule that statutory practices bill by (EBM) has no code for body composition [15]. So no statutory insurer pays for it, not even with obesity or suspected sarcopenia, the age-related loss of muscle mass and strength. Ask your insurer before you book, but count on paying the full price.

### Outside Germany: Austria and Switzerland

The G-BA rule applies only to German statutory insurance. In Austria the insurer pays for a bone density measurement when a doctor refers you and the scan is done at a contracted institute (Vertragsinstitut) [20]. In Switzerland, ask your basic insurer before you book whether it covers the planned scan and which documents it needs from your doctor.

## Where can you get a DEXA scan? Berlin, Munich, Hamburg, Frankfurt, Cologne

Radiology practices are the most common place for a DEXA scan in Germany, followed by bone specialists, sports medicine institutes and a few commercial studios:

- **Radiology practices.** Almost every larger practice has a DEXA machine for bone density. Whether the whole-body software is enabled is usually stated on the website under Körperfettmessung (body fat measurement) or Körperzusammensetzung (body composition).
- **Osteology centres and endocrinologists.** Osteology is bone medicine and endocrinologists treat hormone disorders, so both are the first choice if osteoporosis is your concern.
- **Sports medicine institutes and university sports science.** Some universities and Olympic training centres measure body composition for external clients too, sometimes at research rates, so a call can be worth it.
- **Commercial body composition and longevity studios.** These usually work with a medical partner and offer a detailed evaluation.

Wherever you book, the scan is an X-ray exam, and that changes how you get one. Under section 83 of the German Radiation Protection Act, a doctor trained in radiation protection must confirm a medical reason for the scan. That doctor also has to judge that the benefit outweighs the radiation risk [5]. A pure lifestyle measurement along the lines of "I want to know my body fat percentage" does not count as such a reason. In 2015 the German Commission on Radiological Protection (SSK) stated that DXA scans without a medical reason are not permitted. That includes scans only to motivate people or to accompany lifestyle activities [5, 22].

In practice a doctor decides case by case whether there is a medical question. Examples are suspected sarcopenia, the age-related loss of muscle mass and strength, or follow-up during obesity treatment or on a weight-loss injection. Each repeat scan needs its own justification [5]. Before booking, check which doctor will assess the medical reason for your scan, and be wary of a provider that sells it without any medical contact at all.

For local experience, ask in our chapter groups in [Berlin](/en/city/berlin), [Munich](/en/city/munich), [Hamburg](/en/city/hamburg), [Frankfurt](/en/city/frankfurt) and [Cologne](/en/city/cologne). Members there share who got measured where and whether the results consultation was worth the money. Whichever place you pick, three questions are worth asking when you book:

- **Which machine?** The big makers are Hologic and GE Lunar. Different brands do not give consistent results, so stay with the same machine for follow-up scans [6, 7, 12].
- **Full report?** You want regional values and visceral fat, not just a percentage.
- **Doctor's interpretation included?** A doctor can tell you whether your numbers call for any action, which the printout cannot.

## What do T-score, ALMI and visceral fat mean on your DEXA report?

A DEXA report gives different results for bone density and for body composition. The bone scan scores your bones against reference groups, while the whole-body scan shows how much fat and lean tissue you carry. A handful of key numbers carry the meaning, and the rest of the multi-page printout, colour graphics included, mostly breaks them down by body region.

**T-score (bone density only).** The T-score compares your bone density with young healthy adults. These categories apply to postmenopausal women and men from 50 [13]:

- minus 1.0 or higher: normal
- between minus 1.0 and minus 2.5: osteopenia, a pre-stage with below-normal bone density
- minus 2.5 or lower: osteoporosis [2]

The treatment decision does not hang on the T-score alone. The DVO guideline bases it on the absolute fracture risk, your personal chance of breaking a bone, which is calculated from age, sex, T-score and risk factors [1]. A T-score of minus 2.0 can therefore call for treatment in a 75-year-old with a previous fracture and not in a 52-year-old without risk factors.

**Z-score (if you are under 50).** Your report also shows a Z-score, which compares your value with people of your own age and sex. For women before menopause and men under 50, this is the number to read, not the T-score [13]. A Z-score of minus 2.0 or lower means below the expected range for your age [13]. That is worth a talk with your doctor, but it is not an osteoporosis diagnosis on its own.

**Body fat percentage.** The usual yardstick for a DEXA body fat percentage comes from NHANES, a US national health survey that scanned people on Hologic machines. In it, fat made up about 24 percent of body weight in 25-year-old men and about 38 percent in women, and the values rise with age [11]. These are population reference values, not targets, and no longevity threshold for DEXA body fat has been established.

A fairer yardstick is your own scan from last year on the same machine, which beats anything on Instagram. Numbers from callipers or bioimpedance scales do not fit into that comparison, because each method uses its own model. In one hospital study, a clinical bioimpedance device put fat mass several kilos below DEXA [8].

**Visceral fat (VAT, visceral adipose tissue).** Visceral fat is the fat between the abdominal organs. DEXA estimates it from the belly region of the scan, and your report usually gives it in grams or square centimetres. When a study compared that estimate with CT, the cross-sectional X-ray scan used as the reference method, the two tracked closely across the group. For a single person, though, the DEXA value could be well off [10]. Because visceral fat is linked to diabetes and cardiovascular risk more than fat under the skin [10], it is worth following on the same machine.

**ALMI (appendicular lean mass index).** ALMI is the lean mass of your arms and legs in kilograms divided by your height in metres squared. Doctors use it to confirm sarcopenia, the age-related loss of muscle mass and strength. The European sarcopenia consensus group EWGSOP2 sets the cut-off at below 7.0 kg/m² for men and below 5.5 kg/m² for women [6]. The order matters, though: doctors check muscle strength first, and a low ALMI confirms the diagnosis only when strength is also low [6]. EWGSOP2 counts strength as low when one of these applies:

- grip strength below 27 kg in men or 16 kg in women
- more than 15 seconds for five chair rises without using your arms

Little muscle mass with good strength is therefore not yet sarcopenia, which makes your grip the cheaper first check. Our [grip strength calculator](/en/tools/grip-strength) places your result against German reference values. If your grip is weak or getting up from a chair is hard, ask your doctor about strength testing before you book a scan [6].

## DEXA or InBody, radiation and how often: What to know before the appointment

DEXA is the usual reference method for body composition, while bioimpedance devices can be several kilos off [8]. Beyond total fat and lean mass, DEXA also gives results for each body region and estimates the fat around your abdominal organs [7].

### DEXA versus InBody and body fat scales

InBody, Tanita and bathroom scales estimate body composition with bioelectrical impedance analysis (BIA). They run a weak current through your body and estimate your body water from the resistance. A built-in formula then turns that estimate into fat and muscle. The result shifts with how much you have drunk, whether you have just trained and which formula the manufacturer chose.

A French hospital study, which compared one clinical device with DEXA in patients treated at a nutrition unit, shows how far such estimates can drift. In patients with a body mass index (BMI, weight relative to height) between 18.5 and 40, the device put fat-free mass about 3 to 8 kilos higher than DEXA did [8]. Fat-free mass is everything in the body that is not fat, so the device made these patients look leaner. For any single person, the two numbers also often disagreed widely [8]. InBody, Tanita and home scales were not tested, but the lesson carries over: the error depends on the device and its formula.

A scale is enough for a rough direction, but not to tell whether you lost two kilos of lean mass in six months on a weight-loss injection. DEXA is an estimate too, since it works out fat, lean tissue and bone from how X-rays are absorbed [7]. Still, it is the usual reference method [8], and its repeatability is well documented.

### How often a repeat scan makes sense

That repeatability was measured in a study of 30 people on one Hologic scanner. Their repeat scans varied by less than 3 percent for total fat and lean mass [23]. That scatter is called the precision error, and a difference between two scans has to be clearly larger than it to count as real change. For visceral fat, this study set the bar at a change of about 7 percent [23]. Smaller differences may therefore be measurement noise, unless your body is changing fast.

These figures come from one small study on one scanner [23], so your provider's machine may need a different bar. The International Society for Clinical Densitometry (ISCD) asks every facility to work out its own threshold, called the least significant change [13, 19]. When you book, ask how much two of your results must differ before the practice counts the difference as real change.

When a doctor uses DEXA to follow obesity treatment or a weight-loss injection, 6 to 12 months is a common interval for body composition. That is a rule of thumb, not an ISCD rule, and not a fixed minimum either. With fast weight loss, real changes can pass the threshold sooner. The right gap therefore depends on how fast your body changes and how precise your provider's machine is [13, 23]. For bone density, the interval depends on how far your T-score is from the treatment threshold [1]. Statutory insurance pays for a routine repeat after five years at the earliest [15]. Each repeat needs its own medical justification, just like the first scan [5].

### The radiation dose

Every one of those scans uses X-rays, but the dose is very low. A review of X-ray doses in osteoporosis imaging puts a whole-body scan at about 4 to 8 µSv (microsieverts), depending on the machine. A spine plus hip bone density measurement comes to roughly 20 µSv [9]. Natural background radiation in Germany averages 2.1 millisieverts per year, about 6 µSv per day [14]. Measured against that, a body composition scan equals about one day of normal life, and a bone density measurement a few days [9, 14].

Low is still not zero, which is why the law ties every scan to a medical indication [5]. The dose is no reason to fear the scan, with one exception: no scanning during pregnancy [21].

## Is a DEXA scan worth it for you?

A DEXA scan is clearly worth it when its result would guide care for a fracture risk or suspected sarcopenia, the age-related loss of muscle mass and strength. During weight-loss treatment or serious strength training it may help too, but only when a doctor sees a specific medical question behind it. Most other people can save the money for now.

**Yes, if you are over 50 and have a fracture risk.** The DVO guideline recommends an osteoporosis check-up with DXA after a fracture from 50 and for everyone from 70. Between 50 and 70 it applies when your risk factors add up to a relevant fracture risk [1]. What counts is the combined risk: in an example from the guideline, a 50-year-old man without other risk factors needs no scan for his mother's hip fracture alone [1]. For this group bone density is standard medicine rather than a longevity extra, and insurance pays when your doctor then plans osteoporosis medication [3, 15]. Raise it with your GP.

**Possibly, if you are on a weight-loss injection.** On GLP-1 medication, the drug class behind these injections, part of the weight you lose is lean mass, which includes muscle. The STEP 1 semaglutide trial scanned a subgroup of 140 participants with DXA. They lost lean mass in kilograms despite diet and exercise counselling, although the share of lean mass in their body weight rose [18].

That lean-mass loss is where the International Society for Clinical Densitometry (ISCD) sees a possible use for DEXA. It lists large weight loss, above roughly 10 percent, as a reason to use a body composition scan, but calls the effect on clinical outcomes uncertain [13]. So it is a case for your doctor's individual decision, not a routine check for everyone on the injection.

If your doctor tracks the treatment this way, scans at the start and after six to twelve months show whether you lost mostly fat or lean mass too. Lean mass is not the same as muscle, though, because DEXA counts everything that is neither fat nor bone as lean soft tissue [7]. Its values also shift with hydration, so scan under the same conditions each time [6]. Whatever the scans show, training and enough protein may help limit the loss, and our [GLP-1 muscle guide](/en/guide/glp1-muskelerhalt) goes into how.

**Yes, with suspected sarcopenia.** Trouble getting up from a chair is a reason to have your strength tested first. The European sarcopenia consensus group (EWGSOP2) counts strength as low in either of these cases:

- a grip below 27 kg for men or 16 kg for women
- more than 15 seconds for five chair rises without using your arms

When strength is low, a low ALMI, the lean mass of your arms and legs relative to your height, confirms the diagnosis [6]. That medical question can justify the scan [5, 6].

**Only with a medical reason, if you train for strength.** In Germany a scan only to track training progress is not a medical reason. Germany's radiation protection commission (SSK) files tracking muscle gain in sport and bodybuilding under lifestyle diagnostics and calls DXA scans without a medical indication not permitted [22]. If a doctor sees a medical question alongside your training, for example unexplained weight or strength loss, the scan can be justified. Once a year on the same machine under the same conditions is then enough. Without that, a training log, the tape measure and photos show the trend.

**When you can save the money.** If you are under 50, have no risk factors and are simply curious, three free checks give you a good first picture:

- the [grip strength test](/en/tools/grip-strength) for muscle function, since in the PURE study a weaker grip was linked to a higher risk of death [16]
- a tape measure around your waist, midway between your lowest rib and the top of your hip bone, for belly fat (waist divided by height should be below 0.5) [17]. This ratio beats BMI as a screen for heart and metabolic risk [17]
- a photo every three months in the same light, which shows you the trend over months

Unlike a scan, these checks need no X-ray and no medical reason, so you can repeat them as often as you like. If one of them worries you, ask your doctor whether it needs investigating and whether either scan would help.


## FAQ

### How much does a DEXA scan cost in Germany without insurance?

Without insurance, a DEXA bone density measurement in Germany costs about 40 to 70 euros, as of October 2026 [4]. For the whole-body scan of body fat, lean mass and visceral fat there is no fixed fee item, so each provider sets its own price. Ask for the price in writing before you book, and ask whether a doctor's results consultation is included.

### Does health insurance pay for a DEXA scan?

Statutory insurance pays only for the bone density measurement, and only when concrete findings mean your doctor intends to treat osteoporosis with medication. A typical example is a fracture of the spine or hip after a minor fall [3, 15]. The rule comes from the G-BA, the body that sets what statutory insurance pays for, in a 2013 decision still in force as of October 2026. As pure prevention without findings the scan is an IGeL, a self-pay service, and statutory insurance never pays for body composition (body fat, muscle) [15].

### Does health insurance pay for a bone density scan from age 70?

Not automatically, because a recommendation and payment follow different rules. The German osteoporosis guideline (DVO) says everyone from 70 should be offered an osteoporosis check-up with DXA if a treatment would follow from the result [1]. Statutory insurance, though, pays only when concrete findings such as a fracture or long-term cortisone lead your doctor to plan osteoporosis medication [3, 15]. Ask your GP whether that applies to you, because without such a reason the scan stays self-pay at about 40 to 70 euros [4].

### Do AOK, TK, Barmer, DAK or HKK pay for a DEXA scan?

All statutory insurers follow the same rule, because the G-BA, the body that decides what statutory insurance pays for, sets it for all of them. So AOK, TK, Barmer, DAK and HKK all pay for a bone density measurement when your doctor plans osteoporosis medication based on concrete findings [3, 15]. None of them pays for a body composition scan of fat and muscle [15]. For a body composition scan, check with your insurer before booking, but expect to pay the full price.

### Where can I get a DEXA scan (Berlin, Munich, Hamburg, Frankfurt, Cologne)?

In all five cities you will find DEXA at radiology practices, osteology centres, sports medicine institutes, university sports science departments and a few commercial body composition studios. Radiology practices offer bone density almost everywhere, but body composition only at some. Because DEXA uses X-rays, every scan needs a medical reason under the Radiation Protection Act, and a scan purely out of lifestyle interest is not permitted [5, 22]. Our chapter groups in Berlin, Munich, Hamburg, Frankfurt and Cologne share local experience.

### Is the radiation from a DEXA scan dangerous?

No, the dose is very low. Depending on the machine, a whole-body scan delivers about 4 to 8 microsieverts (µSv) and a spine plus hip bone density measurement roughly 20 µSv [9]. Natural background radiation in Germany gives you on average about 6 µSv a day [14], so a DEXA scan equals one to a few days of normal life. Even so, there is no scanning during pregnancy [21], and the law requires a medical justification for every X-ray [5].

### DEXA or InBody: Which is more accurate?

DXA is the usual reference method for body composition and estimates fat and lean tissue (everything other than fat and bone) for the whole body and each region [7]. InBody and other bioimpedance (BIA) devices work from electrical resistance instead, and their accuracy depends on the device, its formula and the person [8]. In one French hospital study, a clinical BIA device put fat-free mass about 3 to 8 kilos above DXA in patients with a body mass index (BMI) of 18.5 to 40 [8]. InBody itself was not tested there, so for tracking change stay with one method and one machine.

### How often should I get a DEXA scan?

For bone density, scan timing depends on your result and how close it is to the point where treatment would be considered [1]. Statutory insurance pays for a repeat after five years at the earliest, unless special findings require one sooner [15]. For body composition during a doctor-led obesity treatment or weight-loss injection, 6 to 12 months is a common rule of thumb, and each repeat needs its own justification [5]. Unless your body is changing quickly, closely spaced scans mostly show noise, and because the noise threshold varies by scanner and measure, compare results from the same machine [13, 23].

### What is a good body fat percentage on DEXA?

No longevity threshold for DEXA body fat has been established, so treat the published figures as reference values rather than targets. In the US reference data from NHANES, fat made up about 24 percent of body weight in 25-year-old men and 38 percent in women, rising with age [11]. The more useful comparison is your own earlier DEXA scan on the same machine, because other methods such as bioimpedance give different numbers [8]. Visceral fat, the fat around your abdominal organs, usually tells you more than total body fat, because it is linked to metabolic risk [10].

### What is the difference between DEXA and DXA?

There is no difference: both abbreviations stand for dual-energy X-ray absorptiometry and mean the same measurement. DXA is the spelling healthcare providers and guidelines use today, while DEXA is the older name that has stuck in everyday use and with many providers [21]. Osteodensitometry (Osteodensitometrie) just means bone density measurement in general, and statutory insurance covers it only as central DXA [15].

### How do I prepare for a DEXA scan?

Wear clothes without metal (no zips, buttons or buckles) and skip calcium supplements for 24 hours beforehand [21]. Tell the practice if you might be pregnant [21] or have had an imaging test in the last two weeks, especially a barium exam, a contrast scan or a nuclear medicine test. These can distort the measurement, so the practice decides how long to wait [21, 25]. For body composition, keep conditions the same each time (same machine and time of day, ideally mornings before breakfast and training) so follow-up numbers stay comparable.

### Do I need a referral for a DEXA scan in Germany?

Every DXA scan in Germany needs a doctor trained in radiation protection to confirm a medical reason for it, whether insurance pays or you do [5]. For a bone density scan at your insurer's expense, your doctor also has to see the findings that statutory insurance requires under the G-BA rule, such as a planned osteoporosis treatment [15]. A scan purely for lifestyle reasons, such as checking your body fat out of curiosity, is not permitted [22].

### Can I get a DEXA scan under 50?

Yes, if a doctor sees a medical reason for it, which the Radiation Protection Act requires for every X-ray [5]. Under 50, the German osteoporosis guideline (DVO) recommends the check-up after a fracture in postmenopausal women and in men, and with specific risk factors when the result would change treatment. It also recommends it before more than three months of cortisone at a daily dose equal to 7.5 mg of prednisolone or more [1]. Women before menopause and men under 50 should read the Z-score, a comparison with their own age and sex, while after menopause the T-score, a comparison with young healthy adults, is preferred [13].

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