Bone Health Screening: Understanding DEXA Scan Results and Fracture Risk

Most people don’t think about their bones until something breaks. But bone loss doesn’t come with pain, swelling, or warning signs. It’s silent. By the time a fracture happens - often from a simple fall or even a sneeze - the damage is already done. That’s why DEXA scan screening matters. It’s not just another test. It’s your best chance to catch weak bones before they fail.

Every year in the U.S., over 2 million fractures happen because of osteoporosis. Half of women over 50 and a quarter of men will break a bone in their lifetime due to low bone density. And here’s the scary part: 80% of those people never had a bone density test before their fracture. A DEXA scan isn’t about fear. It’s about control. If you know your numbers, you can act. If you don’t, you’re guessing.

What a DEXA Scan Actually Measures

A DEXA scan - short for dual-energy X-ray absorptiometry - is the gold standard for checking bone strength. It uses two very low-dose X-ray beams to measure how much mineral is packed into your bones. The machine doesn’t take pictures like a regular X-ray. It calculates density in grams per square centimeter. That number tells you if your bones are dense enough to handle daily stress or if they’re thinning out.

The scan focuses on the two places most likely to break: the lower spine (lumbar vertebrae) and the hip. Sometimes, if you’ve had wrist fractures or joint replacements, they’ll also scan your forearm. The whole thing takes about 10 minutes. You lie on a table. The machine passes over you like a giant, quiet printer. No needles. No fasting. No discomfort. The radiation you get is less than what you’d absorb from a cross-country flight or two days of natural background radiation.

Understanding Your T-Score

Your DEXA report gives you one number that matters most: the T-score. This isn’t just a number. It’s your bone’s personal report card compared to a healthy 30-year-old adult of your same sex and ethnicity.

• T-score of -1.0 or higher: Normal bone density. Your bones are in good shape.
• T-score between -1.0 and -2.5: Osteopenia. Your bone density is below average but not yet osteoporosis. This is your wake-up call.
• T-score of -2.5 or lower: Osteoporosis. Your bones are fragile. Fracture risk goes up sharply.

Let’s say your T-score is -2.1. That’s osteopenia. It doesn’t mean you’ll break a bone tomorrow. But it does mean your risk is climbing. Studies show people with osteopenia are 2 to 3 times more likely to fracture than those with normal density. And if your T-score is -3.0? Your fracture risk jumps to 5 to 7 times higher.

Don’t confuse T-score with Z-score. Z-score compares you to people your own age. It’s useful for younger adults or those with unusual risk factors. But for most people over 50, the T-score is what doctors use to make decisions.

Fracture Risk Isn’t Just About Bone Density

Here’s the truth: a low T-score doesn’t tell the whole story. Some people with osteopenia break bones. Others with osteoporosis never do. Why? Because bone strength isn’t just about density. It’s about structure, balance, and lifestyle.

The FRAX tool was created by the World Health Organization to fix this gap. It takes your DEXA result and adds in your age, sex, weight, smoking status, alcohol use, family history of hip fracture, and whether you’ve had a prior fracture. It then calculates your 10-year chance of breaking a hip or other major bone.

For example: a 68-year-old woman with a T-score of -2.7 (osteoporosis) who never smoked, drinks one glass of wine a week, and has no family history might have a 12% fracture risk. But another woman with the same T-score who smokes, drinks heavily, and had a wrist fracture at 60? Her risk jumps to 34%. That’s not just a number. That’s a reason to start medication.

Studies in the Journal of Bone and Mineral Research show FRAX improves prediction accuracy by 15-22% over DEXA alone. That’s why doctors now use both.

Who Needs a DEXA Scan?

You don’t need a DEXA scan just because you’re over 50. But if you fit any of these categories, you should get one - and soon.

• Women 65 and older
• Men 70 and older
• Postmenopausal women under 65 with risk factors (low body weight, smoking, steroid use, family history)
• Men 50-69 with risk factors
• Anyone who broke a bone after age 50 from a minor fall
• People on long-term steroid medication (like prednisone for more than 3 months)
• People with rheumatoid arthritis, hyperthyroidism, or malabsorption disorders

Medicare covers DEXA scans every two years for eligible people. Most private insurers follow the same rules. If you’re unsure, ask your doctor. It’s not a luxury. It’s preventive care.

What DEXA Can’t Tell You

DEXA is powerful - but limited. It can’t see how your bone is structured inside. Two people can have the same T-score, but one has a honeycomb-like internal structure that’s strong. The other has thin, brittle rods that snap easily. That’s why some people fracture despite “normal” DEXA results.

New tools are starting to fix this. Trabecular Bone Score (TBS) analyzes the texture of your spine on the DEXA image. It doesn’t need extra radiation. It just uses the data already collected. Studies show TBS improves fracture prediction by 12-18%. It’s not yet standard everywhere, but more clinics are adding it.

Also, DEXA struggles with people who have severe arthritis, spinal fusion, or metal implants. The machine can’t tell if low density is from bone loss or from calcium deposits in nearby arteries. That’s why your technologist needs to be trained - and why you should go to a certified facility.

What Happens After the Scan?

If your scan shows normal bone density? Great. Keep doing what you’re doing. Eat enough protein. Get vitamin D. Walk daily. Avoid falls.

If you have osteopenia? You’re not helpless. Lifestyle changes can slow or even reverse bone loss. Weight-bearing exercise (like walking, dancing, or lifting weights) three times a week. 1,200 mg of calcium daily. 800 IU of vitamin D. Stop smoking. Cut back on alcohol. These steps can improve your T-score by 1-2% per year.

If you have osteoporosis? Medication is often needed. Drugs like alendronate (Fosamax), denosumab (Prolia), or teriparatide (Forteo) can reduce fracture risk by 40-70%. They’re not magic. But they work - if taken as prescribed.

One real case from the National Osteoporosis Foundation: a 68-year-old woman had a T-score of -2.7. She had no symptoms. No pain. No history of fractures. Her doctor recommended medication. She started it. Two years later, her repeat scan showed improvement. She never broke a bone. She didn’t know she was at risk - until the scan told her.

Common Misconceptions

• “I don’t need a scan because I’m not old enough.” Bone loss starts in your 30s. Women lose 1-2% of bone per year after menopause. Waiting until 65 means you’ve already lost 20-30%.
• “I’m not at risk because I’m healthy.” You can be fit, eat well, and still have low bone density. Genetics, hormones, and medications play bigger roles than you think.
• “The radiation is dangerous.” One DEXA scan equals less radiation than a day of sun exposure. You get more from driving to the clinic.
• “My doctor said I’m fine, so I don’t need one.” Many primary care doctors don’t routinely order DEXA scans unless you ask. Don’t wait for them to bring it up.

What to Do Next

Don’t ignore bone health until it’s too late. If you’re over 50 - or under 50 with risk factors - talk to your doctor about a DEXA scan. Ask for your T-score. Ask about FRAX. Don’t settle for vague answers like “you’re fine.”

Take action now. Whether it’s starting calcium, walking more, or getting medication - knowing your numbers gives you power. And power means you can keep living without fear of breaking.