Why is it that some people with very high scores on the DEXA never break anything yet those on low scores sometimes do. Isn’t there more than bone density we should be testing?
Hi, Warrior,
Welcome to the community - I’ve only recently joined too!
I’m interested in your question because this is exactly what’s happened with me. I have had 4 Dexa scans, the first in 2019 and the most recent in December 2025. Throughout, my diagnosis has remained as Osteopenia although I’m being treated as if I have Osteoporosis.
However, vertebral osteoporosis was confirmed in 2019 in T5 & T7 following fractures . An Xray report in February 2026 confirmed a compression fracture at T10.
So Dexa shows Osteopenia but I’m being treated with Alendronic Acid and Colecalciferol for Osteoporosis.
At one stage, my case was forwarded to a rheumatologist who commented '‘this shows the limitations of Dexa scans”!
SO why can’t we move on from them? Bone has many qualities.
That’s why they do a FRAX fracture risk score too, which takes into account other factors that affect bone health (for example specific medications and illnesses). But I find it very frustrating that the NHS won’t recognise the newer REMS technology, which also gives a measure of bone strength, not just bone density. REMS scans have been shown to be comparable to DEXA scans when both are done properly, with the added advantage that REMS is more fully automated so less open to error.
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Hi, just joined. I have t scores which put me in osteopenia but have a frax score which means I am being treated as osteoporosis. I am going to get a REMs scan on Thursday to get an accurate fragility score. I had a wrist fracture in August.
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After 20 years since a first DEXA scan identified ‘advanced spinal osteoporosis’, at the age of 58, I have arrived at theories of my own, which might well be dismissed by medical opinion.
That DEXA scan was part of a thorough health check up when I was having a lot of pain in one ankle. I am not ‘sporty’ but have always enjoyed regular yoga, pilates and, later, tai chi classes. I believe those have kept my body flexible and the muscles, etc. surrounding any bones strong. From being a small child I have had weak ankles and can fall on a pavement variation of a fraction of an inch! Therefore, I get very annoyed at any ‘falls’ I have in recent years being put down to old age decrepitude!
Just to say that, following that upsetting and damning diagnosis, I had 15 years with quite a few high impact ‘falls’ but no fractures! I did try some treatments (wanting a ‘cure’). The first was parathyroid hormone injections which were to be for a year, followed by bisphosphonates after that (which my osteoporosis diagnosed dentist was not happy with). After a bit more than 6 months on the injections (together with calcium tablets) I got an urgent telephone call from my GP that a routine blood test had identified hypercalcemia. This is dangerous and I was angry with the hospital for not monitoring my health whilst taking the injections (which were fairly new at the time). Then, it was suggested I should take Strontium Ranelate. This I did but started to get a lot of itching in lower legs and torso. Unfortunately I didn’t identify this as the ‘possible rash’ (as there was nothing resembling a rash to look at) and probably carried on taking it for longer than advisable. I did stop and, around that time considerable research had been done into the effects of Vit D3 and K2 on bone health. I therefore (treading carefully) asked the specialist if I could take this combination. He was amenable so that is what I have been doing for a long time now.
I was identified with low thyroid around 6 years ago and took thyroxine for 2 years (without being monitored!) I then paid for a consultation and it was thought that, as I was borderline, I should come off thyroxine and ‘see how things go’. It was only at that point that I noticed that Thyroxine can weaken bones! This was followed by Covid and cessation of all exercise classes so my exercise levels dropped a lot and in 2022 I slipped on a second to last stair and gained a compression fracture in the spine at T12. I was in such a lot of pain for many months (but was following physio exercises) so, again, my activity levels dropped. 9 months after that fracture, I fell forward on paving and received a triple shoulder fracture - so again extreme pain and reduced exercise. There followed 3 years fracture free until 2025 when I slipped on a garage forecourt and fractured L1 and 18 months later I am still battling the pain, not helped by a complicated risk fracture a year after the L1.
During Covid there was an absence of any contact with the hospital or any monitoring so I have carried on with D3 and K2 but have since been contacted with an eagerness to ‘get me started on a treatment’.
I will try and sum up by saying that I do tend to have adverse reactions to medicines in general so have to always consider whether I am better to stick with a ‘medical condition’ or risk creating an or more other medical conditions caused by a medicine designed to help the initial one.
I also feel I am proof that strength and flexibility of all the bone supporting tissues is as, or more, important that the density of the bone. (On that point it is thought that some treatments, by stopping bone renewal, actually make the bones more brittle and less flexible.)
Some of this may relate to readers and some may seem a waste of space but, hopefully, a few relatable experiences may help. It seems we all need to self-monitor and read up on any medications which are prescribed and, to me, it seems that specialists do not look beyond their own field for any possible harm when prescribing.
Some people with high DEXA scores never break anything while some with low scores do, because DEXA measures only how much bone you have — not how well it’s built inside, and not whether you’ll fall. Its single flat number is dominated by the dense outer shell (cortical bone), so the spongy inner scaffolding (trabecular bone, also called cancellous bone) — the part that thins first and actually fails first — barely shows up. That’s why the score and the fracture don’t always line up: a high number can sit on top of quietly weakening structure, and a modest number can go with a lattice that’s lost its strength.
DEXA gives a solid first read on bone strength for most people. In the minority where the number and the real risk don’t match, it’s usually because the trabecular structure has changed in a way density alone doesn’t capture — and that’s what TBS or QCT are there to check. The tools to catch the gap already exist and are in routine use.
So it isn’t that DEXA is failing — it’s a good, standardised first pass that works well for most people. It just can’t see everything, and when someone’s real risk doesn’t match their score, that’s the signal to look closer with the tests designed to read the bone that’s actually at issue
I had a 3d trabecular bone scan QCT scan and my dexa scores were very different. I went private at Kims hospital Kent
Yes you do need to get a referral from a specialist.
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