I received so much interest in the article I did on bone density and DEXA, that I want to come back to women's bone health.
In this article, I will go over a DEXA report with a case example (all identifying information removed).
- Risk factors for low bone density
- How to read a DEXA report
If you are over 50 and female, you are probably aware of what a DEXA scan is. Having a DEXA scan can be daunting, with worry waiting to be told if your bones are dust, skinny, or robust. Not to mention, the report can be confusing and complicated to read. Plus, we all know someone who has osteoporosis, which makes women's bone health extremely important and kinda scary.
So let's break it down so we can understand what factors influence your bone density, and what your DEXA means.
And you will get to meet Diana, and see how she not only maintained, but improved her bone density from 2021 to 2025 (we will look at all 3 DEXA reports for her and what she did for her bone health).
DEXA: How to read your bone density report with some cases:
There are four parts to your DEXA scan:
- Bone Mineral Density (BMD) measures how much overall mineral content is in your bones.
- T-score: Measures your bones compared to a healthy 30-year-old female.
- Z-score: Measures your bones compared to those of your peers or those of the same age and sex.
- FRAX Assessment: Gives you a 10-year probability of a fracture of the hip, spine, forearm, or shoulder
For this article, I want to focus on the T-score and FRAX assessment. This is really where you need to focus on with your DEXA.
T-SCORE: This is the value you really want to sink your teeth into. A T-score measures your bone density to that of a healthy 30-year-old female. Now, a 30-year-old female will not have any bone density loss. A zero T-score is no bone loss. The more negative you get from zero, the more bone loss there is.
The breakdown of a T-score:
Normal Bone: 0 to -.9 is considered normal bone. If you are female and over 50 years old, and your T-score is between 0 and 0.9, that is amazing; your bone density is perfect.
Osteopenia: -1.0 to -2.4 is considered to be osteopenia. Our goal in osteopenia is not to lose any more bone. Now -1.0 is quite different from -2.4. So, depending on where you are on the spectrum of osteopenia, our goals for your bone density may vary. Ultimately, the goal here is to maintain and work on developing your bone density.
Osteoporosis: -2.5 and beyond (more negative):
Osteoporosis land is where we must address bone density.
In your report, there are also Z-scores and bone mineral density (BMD).
- The Z-score compares your bone density to that of your peers. It helps determine whether a secondary cause beyond normal aging contributes to bone loss, such as hormonal, nutritional, or metabolic factors.
- BMD calculates the mineral density in your bones, and it is used for the FRAX assessment.
Let's Go Back to the T-Score:
Your T-score is what you really want to focus on. It compares your bone density to the bone density of a healthy 30-year-old female. Mainly, it is a great way to monitor your bone density over time. As our goal is not to lose any more bone and to maintain what we have.
I will be honest with you: it can be a challenge to increase bone density after menopause, as our hormones have a significant influence on bone density. But it certainly can be done with lifestyle changes, supplements, exercise, HRT, and nutrition. I believe it's much better to be proactive and preventative and start working on bone density well before menopause.
FRAX Assessment: This is a clinical tool to estimate your fracture risk. It will give you two scores as percentages:
-The 10-year risk of a hip, shoulder, and wrist fracture in a broad sense.
-The 10-year risk of fracture specific to your hip.
A hip fracture in a female over 65 years old is a serious concern. A hip break can increase your risk for mortality and create a cascade of conditions from surgery to recovery and complications.
The scores will determine how aggressive the treatment for bone density needs to be.
When to get serious:
- The score of Major fracture risk ≥ 20%
- The hip fracture risk score is ≥ 3%
The FRAX assessment is an equation that can be an accurate tool to predict fracture risk. If there is not a complete assessment, the FRAX can be inaccurate.
What the full assessment should include:
- Age
- Sex
- Weight
- Height
- Femoral Neck BMD (Bone Mineral Density).
- Previous Fracture
- Parent Fractured Hip
- Smoking current
- Alcohol 3 or more daily
- Glucocorticoids/Steroids
- Rheumatoid arthritis
Secondary osteoporosis: underlying medical conditions or external factors that can cause osteoporosis, such as type 1 diabetes, hyperparathyroidism, celiac disease, liver disease, kidney disease, and organ transplants.
If your practitioner or the imaging center did not have the full intake, your FRAX % scores will not be accurate.
- If the assessment was not based on a full intake, it could make your FRAX% look better or even worse than it truly is.
I always feel that stories, cases, and examples are a great way of explaining a DEXA report/scan.
Here is (identifying info removed), a currently 60-year-old female, Diane.
Meet Diana:
Diana is a petite female at 5'1, 115lbs. She eats very clean, no processed foods or soda. She exercises regularly and has been taking HRT since she was 48 years old. She went through menopause earlier than most, in her mid-40s. She is not entirely certain of her family history of bone density because she does not know her father's side of the family. Her mother did have osteoporosis. While her mother was petite like Diana, her mom was a smoker.
DEXA report: 2021:
- Lumbar Spine: L1 through L4: T-score is -2.2
- Left Femur: T-score is -3.0
- Right Femur: T-score is -3.1
10-year probability of Fracture: FRAX Score:
- Major osteoporotic Fracture: 11%
- Hip Fracture: 3.5%
You can see here in 2021, Diana's lumbar spine is in osteopenia but getting close to osteoporosis. And Diana's hips would be considered osteoporosis.
This really scared Diana, and she didn't want to take medication for osteoporosis, so she decided to get serious about lifestyle and nutrition.
This is what Diana did:
- Increased her working out. She wore a weighted vest and walked every day. She made sure to hit at least 3 miles a day, and on some days up to 5. She also started weight training to build muscle. Because her hips were affected by osteoporosis, she really wanted to work on her lower body by walking and strengthening her core.
-
She started taking
- Vitamin D3 with K2
- Calcium citrate 500mg
- Magnesium (combo mag glycinate/aspartate/citrate)
- Collagen
- Mineral mix
-
She continued and altered her static dosing HRT:
- Biest increased based on blood work.
- Progesterone
- Increased her protein intake. She was not a fan of red meat, which is just fine. Diana was fine with dairy, so she increased her yogurt, added cottage cheese, started eating eggs, and added protein powder. She made protein a focus.
DEXA report: 2023: Two years later
- Lumbar Spine: L1 through L4: T-score is -1.8
- Left Femur: T-score is -2.8
- Right Femur: T-score is -2.8
10-year probability of Fracture: FRAX Score:
- Major osteoporotic Fracture: 10.8%
- Hip Fracture: 2.8%
While this 2023 DEXA report still shows osteoporosis in her hips, she has definitely improved. Remember, I mentioned that building bone can be a challenge. This shows you can build bone when you put your mind, energy, and effort into it. Her risk of fracture decreased, and she improved her bone density.
Next, let's look at Diana's DEXA in 2025. Let me preface this by saying, life gets in the way. Diana was so diligent, and we were so happy and proud that she built bone; she was ready to keep the momentum going.
But she got very stressed, and there were some family issues, so Diana put herself on the back burner. Like I said, life can get in the way. She stopped the weights and did yoga a couple of times a week. She still took her HRT, magnesium, and vitamin D3/K2. But stopped the calcium and protein shakes. She did keep walking every day, because walking helped her relieve stress.
So let's look at 2025.
DEXA report: 2025: Two years later
- Lumbar Spine: L1 through L4: T-score is -1.5
- Left Femur: T-score is -2.8
- Right Femur: T-score is -2.8
10-year probability of Fracture: FRAX Score: (this % will change with increasing age as a factor)
- Major osteoporotic Fracture: 11%
- Hip Fracture: 3.0%
This is still really good given Diana’s original 2021 results. She was still able to improve her lumbar spine. Given her life stressors and not being so diligent in her bone health plan, she didn't lose bone in her hips. She was still adamant that she didn't want to take the bone density pharmaceutical medications. Her mom took those meds and had terrible reactions to them, so Diana really did not want to go there.
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