Why the DEXA Scan Should Be in Everyone’s Annual Physical

The missing half of your annual labs

Blood tests show chemistry (glucose, lipids, hormones), but they can’t show structure: where fat is stored, how much muscle you carry, and whether your bones are quietly weakening.

Those three structural factors (visceral fat, skeletal muscle, and bone density) are independently tied to diabetes, heart disease, cancer, disability, and fractures. DEXA is the fastest, lowest-dose way to measure all three—objectively, in ~10 minutes. IAEA

1) Fat quality matters more than weight — and DEXA sees it

Visceral fat (VAT) around your organs drives metabolic disease and cardiovascular risk far more than BMI or total weight. DEXA directly estimates VAT and central fat patterns validated against CT/MRI and shows stronger correlations with cardiometabolic risk factors than scale metrics. PubMed+1

• Cardiometabolic risk: In adults, DEXA-estimated VAT tracks more tightly with insulin resistance, blood pressure, HDL, and triglycerides than BMI or waist alone. PMC
• Central fat pattern: A higher android-to-gynoid fat ratio (from DEXA) is linked to worse lipid profiles and higher blood pressure, signaling elevated cardiovascular risk even when BMI is “normal.” PMC
• Cancer burden: In a 2024 population study, high visceral fat explained more total cancer than high BMI (population-attributable risk: ~9–12% for VAT vs ~5–8% for BMI), highlighting why “where fat sits” beats “how much you weigh.” PubMed

2) Muscle is a longevity vital sign — and DEXA quantifies it

Low skeletal muscle (sarcopenia) and the combo of low muscle + high fat (sarcopenic obesity) are consistently associated with higher all-cause mortality. DEXA is the clinical standard to quantify appendicular lean mass and diagnose sarcopenia. PMC

• Mortality signal: A 2024 JAMA Network Open study of older adults found sarcopenia and sarcopenic obesity predicted worse survival, reinforcing the need to screen and intervene early. JAMA Network
• Meta-analytic evidence: Systematic reviews link lower lean mass to higher mortality independent of BMI, underscoring that body composition > body weight. PMC+1

Clinical payoff: Muscle mass is trainable. With a DEXA baseline, resistance training, protein optimization, and targeted programs can be measured in weeks, not guessed. PMC

3) Bone density predicts fractures — years before they happen

Bone loss begins silently; one bad fall can change a life. Each standard-deviation drop in bone mineral density (BMD) raises fracture risk substantially; DEXA BMD is the accepted predictor used in tools like FRAX and in treatment decisions. New England Journal of Medicine

• Therapy decisions rely on BMD: Major osteoporosis trials and editorials emphasize that low BMD is a fracture risk factor and a core input to decide on anti-resorptive or anabolic therapy, not vitamin D alone. New England Journal of Medicine+1

Actionability: A single DEXA can identify osteopenia years before a fracture and track the effects of exercise, calcium, vitamin D optimization, and medications. New England Journal of Medicine

Safety, speed, and standardization

DEXA uses very low radiation — typically less than a chest X-ray — and takes ~10 minutes with high test-retest reliability for fat, lean mass, and BMD. IAEA

What this changes in your annual physical

Without DEXA: you can be “normal BMI” with dangerous visceral fat, “normal weight” but low muscle, or losing bone density unnoticed. With DEXA: you and your doctor get three objective risk levers to pull: reduce visceral fat, build/maintain muscle, and protect bone. PMC+2JAMA Network+2

How doctors use DEXA data (in practice)

• Cardiometabolic prevention: If VAT or android:gynoid ratio is high, intensify lifestyle therapy, consider CGM-guided nutrition, prioritize resistance training, and track VAT change on follow-up DEXA (3–6 months). PMC+1
• Sarcopenia screening: Low appendicular lean mass → prescribe progressive resistance training + protein (1.2–1.6 g/kg/day as appropriate), re-scan to confirm muscle gain. PMC
• Bone health: Low BMD or rapid loss → assess secondary causes, optimize calcium/vitamin D, load-bearing exercise; if indicated, initiate pharmacotherapy and monitor BMD. New England Journal of Medicine+1

For consumers: what to do with your numbers

1. Know your VAT and android:gynoid ratio. Aim to bring VAT down with nutrition quality, sleep, and resistance + zone 2 training; confirm change on your follow-up DEXA. PMC+1
2. Protect your muscle. Track lean mass and aim for progressive strength gains; muscle is your metabolic and mobility insurance. PMC
3. Guard your bones. If you’re 40+ (earlier with risk factors), get a baseline; if post-menopausal or on risk-raising meds, discuss cadence with your clinician. New England Journal of Medicine

Why Fitnescity Health

We make hospital-grade DEXA accessible nationwide with clear reports and guidance your physician can use.

Fitnescity Health is the world’s largest platform for health and wellness tests like the DEXA Scan, the VO2 Max, the Calcium Score Test, and more. Fitnescity Health partners with the nation’s leading hospitals, diagnostic centers, and academic institutions to make testing more accessible and provide personalized insights.

If you already do annual bloodwork, add a DEXA once a year. Know your structure. Change your trajectory.

Sources

• DEXA-VAT vs cardiometabolic risk; DEXA VAT validation vs CT. PMC+1
• Android:gynoid fat ratio and risk markers. PMC
• Visceral fat and total cancer burden (higher than BMI). PubMed
• Lean mass and mortality; sarcopenic obesity. JAMA Network+2PMC+2
• BMD and fracture risk; role of BMD in decisions. New England Journal of Medicine+2New England Journal of Medicine+2
• Dose & safety (DEXA < chest X-ray).IAEA