DEXA scans in Philadelphia measure bone mineral density (the standard medical use) or whole-body composition (the longevity use). Fishtown Medicine orders both as part of primary care rather than selling scans on their own, so a body composition DEXA is not something you can buy from us by itself. For patients in our care the scan takes about 15 minutes, the imaging center bills $150 self-pay at their price with nothing added by us, and the result comes back to Dr. Ash to read with you rather than waiting in a portal. Bone density DEXA is widely covered by insurance for women over 65 and select younger patients. If a body composition number on its own is what you want, any Philadelphia imaging center will sell you one directly. If you want it to lead somewhere, start the intake and Dr. Ash takes it from there.
DEXA (dual-energy X-ray absorptiometry) is the standard imaging method for measuring bone mineral density. The same machine, set to a different protocol, also measures whole-body composition with high accuracy. Most patients in Philadelphia have heard of the bone-density use; many have not realized the body-composition use exists at the same imaging centers.
This page covers both: what each is, when to get one, where to get one in Philadelphia, and how Fishtown Medicine integrates DEXA into ongoing primary care.
Bone density DEXA: who needs one
Standard indications for bone density DEXA:
- All women age 65 and older.
- Postmenopausal women under 65 with risk factors: prior fragility fracture, family history of hip fracture, body weight under 127 lb, current smoker, chronic glucocorticoid use, hyperthyroidism, hyperparathyroidism, certain medications.
- Men age 70 and older.
- Men 50-70 with risk factors.
- Anyone with a prior low-trauma fracture in adulthood.
- Patients on long-term glucocorticoids or anti-androgen therapies.
We often recommend a baseline bone density DEXA for women in or after the perimenopausal transition (typically late 40s to early 50s) even if not yet at the standard cutoff. The fastest bone loss happens in the years around menopause, and a baseline before that window is informative for the long-arc plan.
Standard sites measured: lumbar spine, hip (femoral neck and total hip), sometimes forearm.
Results are reported as T-score (compared to young healthy adult population) and Z-score (compared to age-matched population). T-score above -1.0 is normal; -1.0 to -2.5 is osteopenia; below -2.5 is osteoporosis.
What your Z-score is telling you when the report says normal
This is the part of a bone density report most people are never walked through, and it is where the useful information usually hides.
The T-score compares you against a healthy young adult, and it is what the osteopenia and osteoporosis labels are built from. The Z-score compares you against people your own age and sex. Because the labels come off the T-score, and because prescription treatment does not usually enter the conversation until things are considerably further along, a report can come back saying no treatment is needed and repeat in 2 years while the Z-score is telling you something worth acting on that nobody reads aloud.
Consider a report showing a lumbar spine Z-score of -1.0 and a left femoral neck of -1.4. Nothing on that page will alarm anyone. The interpretation will likely read normal, no prescription therapy indicated. What those numbers say is that your spine is a full standard deviation below your own peer group and your hip is nearly 1.5 below, and a full standard deviation is a wide gap rather than a rounding error. Your peers are not an aspirational target. They are people the same age living in the same environment, and being meaningfully below them means the trajectory started earlier than it should have.
We read that as an opportunity rather than a diagnosis, and the difference matters because of what you can still do about it. Bone responds to load, and it responds most where the load is applied. A hip number that trails the spine points the work at the hip: lateral movement, glute work, and loading through the lower back and pelvis, rather than another few months of walking, which is weight-bearing but does not challenge the hip in the planes that build it. Finding this at a Z of -1.4 and acting on it is a far better position than finding it at -2.5 and starting a medication conversation.
One practical note on reading your own report. Many centers scan only one hip, so a report may carry a left femoral neck and nothing on the right. That is normal and it does not mean anything was missed, though it matters when you compare a future scan, since the follow-up should measure the same side at the same facility for the comparison to mean anything.
Body composition DEXA: what it measures
Whole-body DEXA measures three things with high accuracy:
- Lean mass. Total and regional (arms, legs, trunk).
- Fat mass. Total, regional, and percentage.
- Visceral fat (in modern scanners). Specifically the fat around your internal organs, which is the metabolically dangerous fraction.
The accuracy is substantially better than BMI, calipers, or bioelectrical impedance (BIA) methods.
Body composition DEXA is useful for:
- Tracking lean mass during weight loss (particularly on GLP-1 medications).
- Tracking training response and muscle gain.
- Measuring visceral fat as a metabolic risk marker.
- Setting baseline for longevity planning.
- Verifying that a weight-loss plan is preserving lean mass.
Can a body composition scan tell me if I have osteoporosis?
No, and this is worth knowing before you pay for one, because many of them hand you a T-score anyway.
Fishtown Medicine
A 90-minute conversation with Dr. Ash. A written plan you can follow.
A body composition scan measures your whole body at once, so the T-score it prints is a whole-body number. The osteopenia and osteoporosis definitions were never built on that. They are built on the density at three specific places, your lumbar spine, your total hip, and your femoral neck, measured one at a time, because those are the sites where a fracture changes your life and those are the sites the treatment research was done on. A whole-body number averages your arms, your ribs and your skull in with all of that, and the averaging can hide a hip that is well below where it should be.
So if what you want is body composition, a body composition scan is the right scan and the T-score on it is a curiosity rather than a finding. If what you want is to know about your bones, ask for the bone density scan of the spine and hip, and read the Z-score alongside the T-score. They are the same machine and often the same building, but they are not the same test and one does not substitute for the other.
Where to get a DEXA scan in Philadelphia
Most major Philadelphia hospital systems (Penn, Jefferson, Temple, Cooper, Main Line Health) offer bone density DEXA at their radiology centers. Most also offer whole-body composition DEXA on a self-pay basis. Standalone imaging centers in Philadelphia also offer both.
What it costs through our imaging partners:
- Bone density DEXA: usually covered by insurance when the standard indications apply.
- Whole-body composition DEXA: $150 self-pay, with no markup from the practice.
We maintain a current list of preferred imaging partners, send the order electronically, and the results come back to Dr. Ash rather than waiting unread in a portal.
How DEXA fits into Fishtown Medicine's preventive workup
We typically order:
- Baseline bone density DEXA for women in or after the perimenopausal transition (late 40s-early 50s) and for men over 60 with risk factors.
- Serial bone density DEXA every 2-3 years for patients in the osteopenia range or on osteoporosis treatment, every 5 years for patients with normal bone density.
- Body composition DEXA at baseline for patients starting a serious longevity plan, weight-loss plan, or training program. Serial scans every 6-12 months when useful.
We integrate DEXA results into the broader prevention plan: bone density informs hormone therapy and bisphosphonate decisions; body composition informs training, nutrition, and weight-management plans.
How do I get a DEXA scan through Fishtown Medicine?
It starts with the intake rather than a phone call: tell Dr. Ash what you are tracking and where you want to end up. He reads every intake himself, and the scan follows from that conversation rather than the other way around, because whether a DEXA is the right test at all depends on what you are trying to find out.
Once you are in his care, there are two rhythms it tends to fall into. Patients on an annual care package get the deep-dive visit, where Dr. Ash reads a body composition baseline alongside advanced labs in one unhurried session and hands you the plan. Patients in membership tend to repeat it, with a scan every 6 to 12 months, the training and nutrition plan adjusted as the numbers move, and Dr. Ash a text away in between.
In both, the scan itself is billed by the imaging center (insurance-covered for bone density when indicated, $150 self-pay for body composition), the order and any insurance paperwork come from us, and the interpretation is part of your visit rather than something added on. Neither path is a way to buy a scan, and if a standalone number is what you want, an imaging center will sell you one without going through a physician at all.
Key Takeaways
- DEXA measures bone density (standard medical use) or whole-body composition (longevity use) depending on protocol.
- Bone density DEXA is often insurance-covered for standard indications; body composition DEXA runs $150 self-pay at the imaging center, at their price with nothing added by us.
- We order DEXA inside primary care rather than selling scans on their own, so the result comes with someone who reads it against the rest of your picture.
- DEXA is substantially more accurate than BIA or calipers for body composition.
- Fishtown Medicine integrates DEXA results into ongoing primary care.
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