Back with more bone health info that I hope you find helpful! I wanted to talk about frequent questions I get asked by clients.
A DEXA scan is important—but it doesn’t tell the whole story.
Many people believe that once they’ve had a DEXA scan, they know everything they need to know about their bones. While a DEXA scan is the gold standard for measuring bone density, it’s only one piece of the puzzle. Understanding your fracture risk, bone quality, treatment options, and lifestyle habits can help you make informed decisions with your healthcare provider.
What Is a DEXA Scan?
A DEXA (Dual-Energy X-ray Absorptiometry) scan measures bone mineral density (BMD), most commonly at the hip and spine.
Your results are reported as a T-score:
- Normal: -1.0 or higher
- Osteopenia: Between -1.0 and -2.5
- Osteoporosis: -2.5 or lower
While these numbers are important, they don’t tell us how likely you are to break a bone.
Bone Density Isn’t the Whole Story
Think of your bones like a house.
A DEXA scan tells us how much building material the house contains.
It doesn’t tell us:
- How strong the framework is
- The quality of the materials
- Whether the house could withstand a storm
Bone strength depends on much more than bone density alone.
Other important factors include:
- Age
- Previous fractures
- Family history
- Balance and fall risk
- Muscle strength
- Certain medications
- Medical conditions
- Overall bone quality
Other Tests That May Be Helpful
Depending on your health history, your provider may recommend additional testing.
FRAX Score
The FRAX® score estimates your risk of having a major osteoporotic fracture over the next 10 years by combining your DEXA results (if available) with other risk factors such as age, previous fractures, smoking history, steroid use, and weight.
Blood Work
Blood tests can help identify possible causes of bone loss or determine whether treatment should be adjusted.
Your provider may check:
- Vitamin D
- Calcium
- Parathyroid hormone (PTH)
- Thyroid function
- Kidney function
- Testosterone (for some men)
Not All Osteoporosis Medications Work the Same
Many people are surprised to learn there are two main categories of osteoporosis medications.
Bone-Building (Anabolic) Medications
These medications stimulate your body to build new bone, making them an option for people with severe osteoporosis or those at very high risk of fracture.
Examples include:
- Evenity®
- Forteo®
- Tymlos®
These medications are typically prescribed for 12–24 months and are often followed by another medication to help preserve the new bone that was built.
Anti-Resorptive Medications
These medications slow the breakdown of bone, helping your body maintain more of the bone you already have.
Examples include:
- Fosamax®
- Actonel®
- Boniva®
- Reclast®
- Prolia®
Your healthcare provider will recommend the medication that best matches your fracture risk, overall health, and treatment goals.
Can I Try Exercise and Nutrition Instead of Medication?
One of the questions I hear most often is:
“Can I improve my bones with strength training and nutrition instead of taking medication?”
The answer is sometimes—but it depends on your individual fracture risk.
For some people with osteopenia or a low risk of fracture, their healthcare provider may recommend focusing on:
- Progressive strength training
- Weight-bearing exercise
- Balance training
- Adequate protein
- Calcium-rich foods
- Vitamin D (if recommended)
- Healthy lifestyle habits
They may then repeat a DEXA scan in 1–2 years to monitor for changes.
However, if you have:
- Osteoporosis
- A previous fragility fracture
- A high FRAX score
- Very high fracture risk
Your healthcare provider may recommend medication in addition to exercise and nutrition to help reduce your risk of breaking a bone.
The goal isn’t choosing exercise or medication—it’s finding the combination that gives you the best chance of protecting your bones and maintaining your independence.
Will I Have to Take Osteoporosis Medication Forever?
Another common concern is:
“If I start medication, will I have to stay on it for the rest of my life?”
Fortunately, not necessarily.
Many osteoporosis medications are taken for several years before your doctor reassesses your fracture risk.
Some people taking bisphosphonate medications (such as Fosamax® or Reclast®) may even be candidates for a stoppage, where the medication is temporarily stopped while bone density is monitored.
However, not every medication can be stopped suddenly. For example, Prolia® should never be discontinued without a plan, because stopping abruptly can lead to rapid bone loss and increase the risk of spinal fractures.
The best treatment plan depends on your individual fracture risk, age, medical history, and response to treatment.
How Long Does It Take to Build Stronger Bones?
Another question I hear frequently is:
“How long before my bones get stronger?”
Bone remodeling is a slow process.
Although many people notice improvements in strength, balance, posture, and confidence within 4–8 weeks, measurable improvements in bone density usually take much longer.
Most changes in bone density occur over 12–24 months, which is why DEXA scans are often repeated every 1–2 years.
Think of bone health like saving for retirement. One deposit doesn’t make much difference, but consistent deposits over months and years can have a significant impact.
Every strength workout, every nutritious meal, and every balance exercise is another investment in stronger bones.
Questions to Ask Your Doctor
If you’ve been diagnosed with osteopenia or osteoporosis, consider asking:
- What is my T-score?
- What is my FRAX fracture risk?
- Am I at low, moderate, or high fracture risk?
- Would additional blood work help determine why I’m losing bone?
- Should I see an endocrinologist or osteoporosis specialist?
- Am I a candidate for trying exercise and nutrition before medication?
- Would a bone-building medication or a medication that slows bone loss be more appropriate for me?
- How long do you expect me to stay on this medication?
- If I stop this medication someday, what is the plan afterward?
- How often should I repeat my DEXA scan?
Lifestyle Still Matters
Whether you’re taking medication or not, healthy lifestyle habits remain essential for maintaining bone health.
Strong muscles support strong bones—and better balance helps reduce the falls that often lead to fractures.
