Osteoporosis and bone density tests: does the Hong Kong Government offer screening, how DXA differs from ultrasound, and who is at higher risk
Dual-energy X-ray absorptiometry (DXA) is currently regarded as the gold standard for diagnosing osteoporosis (Primary Healthcare Commission reference framework, December 2022); there is insufficient scientific evidence to support routine screening for people at average risk, and the Government then had no plan to provide osteoporosis screening services (Government reply to the Legislative Council, February 2025).
Does the Hong Kong Government offer osteoporosis screening?
Because there is currently insufficient scientific evidence that routine osteoporosis screening for people at average risk is effective or cost-effective, the Government then had no plan to provide osteoporosis screening services to the public; District Health Centres will continue to organise educational activities on preventing osteoporosis and osteoporotic fractures, and provide information or make referrals for people who are interested or in need (Secretary for Health's written reply to the Legislative Council, February 2025).
The appendix of the reference framework lists the recommendation of the Osteoporosis Society of Hong Kong and the Hong Kong Osteoporosis Foundation (2020): screening of the hip and spine by DXA, for women aged 65 or above and men aged 70 or above (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022). Individual cases are decided by the treating doctor.
People at risk of osteoporosis, for example those who are underweight, have had a fracture, had premature menopause, smoke or drink heavily, or have a family history of osteoporosis or fracture, should actively control their risk factors and discuss a suitable management plan with a doctor, for example whether a bone density assessment or treatment is needed (Government reply to the Legislative Council, May 2022).
Hospital Authority doctors refer patients for follow-up tests as needed, including dual-energy X-ray bone density scans to measure bone mineral density; doctors in different Hospital Authority specialties, including endocrinology, geriatrics, family medicine and orthopaedics and traumatology, can prescribe drug treatment for patients who need it (Government reply to the Legislative Council, May 2022, describing Hospital Authority services). Eligible elders aged 65 or above can use Elderly Health Care Vouchers to choose private primary healthcare services, including services for managing osteoporosis and other chronic diseases (Government reply to the Legislative Council, May 2022); for how to use them, see Elderly Health Care Vouchers.
What kinds of bone density test are there? How does DXA differ from ultrasound?
The Module on Osteoporosis (December 2022) of the Primary Healthcare Commission's Hong Kong Reference Framework for Common Musculoskeletal Problems in Primary Care Settings is written for primary care professionals; the table below sets out how it and the Department of Health Elderly Health Service's ‘Osteoporosis’ information (accessed 5 October 2026) describe three tests.
T-scores measured on different machines may differ, and health care professionals are advised to monitor changes in bone density at the same institution and on the same DXA machine wherever possible (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022). For a comparison of private hospital charges for bone density tests, see Bone density test fees compared; for the English name, see Bone density in English.
| Test | Description |
|---|---|
| Dual-energy X-ray absorptiometry (DXA) | DXA is currently regarded as the gold standard for diagnosing osteoporosis, can also be used to assess fracture risk and monitor changes in bone density, and the hip and spine are the recommended measurement sites (reference framework, December 2022); DEXA is used for diagnosis and for monitoring the effect of treatment (Elderly Health Service, accessed October 2026) |
| Quantitative ultrasound (QUS) | QUS is non-invasive, portable and radiation-free, measures peripheral skeletal sites, and may be considered as a pre-screening tool before DXA, but its correlation with DXA measurements is poorer, it should not be used interchangeably with DXA to diagnose osteoporosis under the World Health Organization classification, and it should not be used to monitor bone loss or response to treatment (reference framework, December 2022); DXA is widely available in Hong Kong and indiscriminate use of QUS for osteoporosis is discouraged (reference framework, December 2022); QUS can only be used as a preliminary screening method for bone density and cannot be used as a diagnostic tool (Elderly Health Service, accessed October 2026) |
| Quantitative computed tomography (QCT) | QCT may be suitable for people with spinal deformity or previous spinal surgery, or with vertebral compression fractures or osteoarthritis that make DXA measurement of the spine unsatisfactory; QCT has a higher precision error, a high radiation dose, a relatively high cost and limited evidence (reference framework, December 2022) |
What is a T-score? What counts as osteoporosis?
Postmenopausal women and men over 50 are classified as normal, osteopenia or osteoporosis according to the bone density T-score measured at the lumbar spine or proximal femur: a T-score of -1.0 or above is normal, -1.0 to -2.5 is osteopenia, and -2.5 or below is osteoporosis, following the World Health Organization definition (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022).
The World Health Organization criteria should not be applied to men under 50, children or premenopausal women, for whom the International Society for Clinical Densitometry recommends referring to the Z-score, and osteoporosis cannot be diagnosed in men under 50 from a bone density test alone; in addition, a fragility fracture (a fracture after a fall from standing height or less, or without trauma) can also be a clinical diagnosis of osteoporosis (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022). Individual test results are interpreted by a doctor, and individual cases are decided by the treating doctor.
Who is at higher risk?
The clinical risk factors for osteoporosis include: being female, increasing age, low body weight (below 45 kg), a family history of osteoporosis or fragility fracture, a previous fragility fracture, premature menopause (before age 40) or early menopause (age 40 to 45), low calcium intake, a sedentary lifestyle or lack of exercise, smoking, excessive alcohol intake (3 standard drinks or more per day), lack of sun exposure and prolonged immobilisation (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022).
Osteoporosis usually has no obvious symptoms until a fracture occurs, and common fracture sites include the spine, forearm and thigh bone (Centre for Health Protection, December 2025).
How can osteoporosis be prevented?
The most important measures for preventing osteoporosis are a healthy diet (especially calcium and vitamin D), regular exercise and avoiding smoking; quitting or avoiding smoking is strongly recommended to protect the bones, because smoking is known to accelerate bone loss (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022). For quit-smoking services in Hong Kong, see Quit smoking services in Hong Kong.
The prevention methods include a balanced diet, moderate weight-bearing exercise (for example walking or tai chi, at least 3 times a week for 30 to 60 minutes each time), outdoor activities to get sunlight (the information warns against overexposure to avoid sunburn), and not smoking or drinking excessively (Department of Health Elderly Health Service, accessed October 2026).
Which specialty treats osteoporosis?
Doctors in different Hospital Authority specialties, including endocrinology, geriatrics, family medicine and orthopaedics and traumatology, can prescribe drug treatment for osteoporosis for patients who need it (Government reply to the Legislative Council, May 2022). Which specialty follows up an individual patient is decided by the treating doctor.
For choosing a specialist, see How to choose an endocrinologist, How to choose a geriatrician, How to choose an orthopaedic surgeon and How to choose a family doctor.
Frequently asked questions
Does the Hong Kong Government offer osteoporosis screening?
There is insufficient scientific evidence that routine osteoporosis screening for people at average risk is effective or cost-effective, and the Government then had no plan to provide osteoporosis screening services to the public (Secretary for Health's written reply to the Legislative Council, February 2025).
What is a DXA bone density test?
DXA is currently regarded as the gold standard for diagnosing osteoporosis, can also be used to assess fracture risk and monitor changes in bone density, and the hip and spine are the recommended measurement sites (Primary Healthcare Commission Hong Kong Reference Framework for Common Musculoskeletal Problems in Primary Care Settings, Module on Osteoporosis, December 2022).
Can an ultrasound bone density test confirm osteoporosis?
Ultrasound can only be used as a preliminary screening method for bone density and cannot be used as a diagnostic tool (Department of Health Elderly Health Service, accessed October 2026); QUS correlates poorly with DXA measurements and should not be used interchangeably with DXA to diagnose osteoporosis under the World Health Organization classification (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022).
At what age should I have a bone density test?
Osteoporosis screening recommendations differ between organisations; the recommendation of the Osteoporosis Society of Hong Kong and the Hong Kong Osteoporosis Foundation (2020) listed in the appendix is screening of the hip and spine by DXA, for women aged 65 or above and men aged 70 or above (Primary Healthcare Commission reference framework Module on Osteoporosis, December 2022). There is insufficient scientific evidence to support routine screening for people at average risk (Government reply to the Legislative Council, February 2025); people at risk of osteoporosis should discuss with a doctor whether a bone density assessment is needed (Government reply to the Legislative Council, May 2022). Individual cases are decided by the treating doctor.
Which specialty treats osteoporosis?
Doctors in different Hospital Authority specialties, including endocrinology, geriatrics, family medicine and orthopaedics and traumatology, can prescribe drug treatment for osteoporosis for patients who need it (Government reply to the Legislative Council, May 2022); which specialty follows up an individual patient is decided by the treating doctor.