What Do The Results Of Your DEXA Scan Mean For Your Bone Health?

Finding out your DEXA scan has revealed some abnormal, unusual or reduced results – or that you have osteoporosis or osteopenia, is one thing. But understanding what this means for your bone health and overall health, including what you should be doing to best take care of your health going forwards, is another.

We understand the nature of DEXA scans can be confusing, and this can be confounded with complicated medical terminology from physicians. To help, in this article we have broken down how to interpret your DEXA results, what having a diagnosis of osteoporosis or osteopenia means, and the best steps you can start taking today to prevent future damage and protect your overall bone health.

DEXA Scan: What Does It Measure?

DEXA stands for a dual-energy x-ray absorptiometry scan. It uses low intensity x-rays (less than the radiation dose you receive from a chest x-ray)¹ to take measurements of your bone density, which determines the strength and thickness of your bones. A DEXA scan is considered the most accurate and gold standard way to diagnose your risk of osteoporosis and osteopenia, as well as to track changes in your bone density over time.

• Osteoporosis translates to “bones with holes” and is a condition that is diagnosed when your bone mineral density, meaning how much calcium and other types of minerals are present within a bone, is significantly reduced. In other words, when your normally dense and mineral-filled bones lose enough of this mineral ‘filling’, it can leave them brittle, significantly weaker and more prone to breaks and fractures. The value needed to diagnose osteoporosis from a DEXA scan is a finding of approximately 2.5 standard deviations or more below the average bone density value for your age and gender.²

• Osteopenia is often nicknamed ‘pre-osteoporosis’ and means that your bone mineral density has decreased below the normal range but is not yet low enough for you to be formally diagnosed with osteoporosis.³ However, it is a clear red flag that osteoporosis may be a real risk if your current daily activities and attention to bone health do not improve.

A DEXA scan is superior to a standard x-ray as it can detect decreasing bone density and strength at a much earlier point when prompt intervention and treatment can be most beneficial, compared to a regular x-ray which can only pick up on weakened bones when they are at a more advanced stage. The scan time is also shorter, and it uses a lower dose of radiation, making it safer. Your DEXA scan may also include a full body composition analysis which will also show you your fat mass (in grams),

^[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948153/
^[2]  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02772-0
^[3]  https://www.ncbi.nlm.nih.gov/books/NBK499878/

muscle mass (in grams), total body fat and muscle percentages, bone mass (in grams) and more across all the areas of your body, identifying additional risk factors to your health.

Understanding Your DEXA Scan Results

Your bone-related DEXA scan results will generally consist of two key measures that compare your bone mineral density to two norms – healthy young adults, giving you a T-score, and age-matched adults, giving you a Z-score

DEXA T-Score

Firstly, your the DEXA scan compares your bone mineral density to that DEXA results from healthy 30-year-old adults that match your sex and ethnicity. The standard deviation is the difference between your bone mineral density and that of the younger adults, and the result is your T-score. A positive T-score indicates that your bones are stronger than normal, and negative T-scores indicate that your bone is weaker than normal.

According to the World Health Organisation, osteoporosis is diagnosed based on the following bone density results:

● A T-score between +1 and -1 indicates that your bone density is in the normal range

● A T-score of -1 to -2.5 indicates that you have low bone mass, and that your bone density is slightly below the normal range, signifying osteopenia

● A T-score of -2.5 or below indicates that your bone density is in the osteoporosis range.

Interestingly, a person who has a T-score of -1 with weakened bone density has approximately twice the risk for a bone fracture as someone with a T-score within the normal range⁵ . Therefore, knowing this information is valuable in helping you prioritise your bone health now to help reduce the risk of fractures in the future. You may also be diagnosed with osteoporosis even when your T-score is better than -2.5, if you’ve already had a broken bone or other analysis that shows that your risk of a fracture is high.

DEXA Z-Score

Your Z-score compares your bone mineral to the average of people that match your age, sex, race, height, and weight. For example, if you are a 25-year-old female, a Z-score compares your bone density to the average bone density of other 25-year-old females of a similar build to you.

The Z-score can be particularly useful for detecting bone mass in children, young adults, women who are pre-menopausal, and men under age 50,⁶ and it can be helpful in diagnosing secondary osteoporosis, which means that rather than resulting from ageing, your osteoporosis may be caused

^[4] https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02772-0

^[5] https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.3722

^[6] https://americanbonehealth.org/bone-density/understanding-the-bone-density-t-score-and-z-score//span>

by other underlying medical conditions, such as rheumatoid arthritis, diabetes, celiac or kidney disease, among others, or medications such as corticosteroids, chemotherapy, or anticoagulants:⁷

● A Z-score between +1 and +2 indicates that your bone density is higher than others of your age, sex and body size

● A Z-score of 0 means that your bone density is the same as others your age

● A Z-score between -1 and -2 indicates bone density is lower than others your age

● A Z-score of -2.5 or lower indicates that you have significantly less bone mass or may be losing bone more rapidly than expected for someone your age, which can be a warning sign for secondary osteoporosis⁸

What Do The Other DEXA Scan Results Mean?

Some DEXA facilities are able to evaluate your bone health in more ways beyond the T- and Z-Scores:

● Vertebral fracture assessment (VFA): This can detect fractures or crushed bones in the spine, which many people don’t realise are there. Identifying a previously unrecognised spine fracture is helpful for understanding your bone health and evaluating your fracture risk.

● Trabecular bone score (TBS): This is a number representing the internal structure of your bones at a microscopic level from within your spine, and the higher the number, the healthier these bones are. This can also be used to evaluate your risk of fractures.

● Full-length femur imaging (FFI): This is a technique whereby the DEXA scan analyses your entire thigh bone, known as your femur, instead of just the area around your hip that is seen with a standard DEXA. This can make it possible to detect abnormalities in the bone that can lead to fractures.

● Hip structural analysis (HSA): DEXA can use this to look at the size, shape, and configuration of your hip bones, which can influence the strength of your hip and the likelihood of it breaking in the future.

Now What? Evidence-Based Ways To Improve Bone Health And Reduce Osteoporosis Risk

Now that you understand your results a little better, what are the best ways to target your bone health and help prevent or slow the development of osteoporosis in the future, as well as your risk of fractures? It all comes down to adjusting your modifiable risk factors while proactively taking further actions that support your bone health. This might look like:

● Exercising regularly: while being told to exercise regularly is a common piece of advice that is often not heeded, weight-bearing exercise is proven to be a treatment and prevention

^[7] https://www.medicalnewstoday.com/articles/z-scores-for-bone-density-chart-meaning-and-more#osteoporosis

^[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919174/

method for both postmenopausal and age-associated osteoporosis.⁹ Incorporating various forms of physical activity into our daily lives is shown to improve muscle function and offset age-related muscle morphology changes.¹⁰ To best benefit from the results, the National Osteoporosis Foundation recommends skeletal loading with high and low-impact weight-bearing exercises for at least 30 minutes per day, 5–7 days a week.¹¹

● Improving your diet: while calcium and vitamin D intake are well-know to be necessary for good bone health, research from the Framingham Osteoporosis Study on over 5,000 adult men and women have shown that various other foods and nutrients play an important role in bone health too,¹² including vitamin C, carotenoids, folate and B12, vitamin K, potassium, magnesium, fish (three or more servings per week), omega-3 fatty acids, dairy products (whose nutritional benefits go above calcium and vitamin D to include magnesium, zinc, riboflavin and protein), protein, and more. You can read more about this here.

● Avoiding smoking: smoking can decrease estrogen levels in women (directly linked to bone health) and inhibit new bone development.¹³

● Stopping unprescribed steroid use: research has found that taking 5mg or more of corticosteroids every day for three months or more is enough to significantly increase your risk of fractures and poor bone mineral density.¹⁴ While some people may need this for medical purposes, it’s a strong warning sign as to why you should avoid steroids for exercise or sports performance, if they’re not prescribed.

● Limiting alcohol intake: alcohol interferes with the absorption of Vitamin D and calcium in the stomach, which can contribute to lowered bone density and an increased risk of osteoporosis.¹⁵

● Maintaining a healthy BMI: a BMI of 23.0 to 24.9 kg/m2 is the optimal range for minimising the risk of osteoporosis, and a lower BMI than this is strongly correlated with an increased rate of osteoporosis.¹⁶

● Managing stress levels: chronic stress has a strong impact on a range of biological systems within your body on a cellular level, including your hormones, insulin, growth factors, inflammatory responses, mineral absorption and more, and as such, stress has been strongly linked to osteoporosis across many different studies.¹⁷

⁹ https://pubmed.ncbi.nlm.nih.gov/30814687/

¹⁰ Rogers, M. A. & Evans, W. J. Changes in skeletal muscle with aging: effects of exercise training. Exerc. Sport Sci. Rev. 21, 65–102 (1993).

¹¹ https://cdn.nof.org/wp-content/uploads/2016/02/Exercise-for-Your-Bone-Health.pdf

¹² https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928581/

¹³ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304634/

¹⁴ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919174/

¹⁵ https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htm

¹⁶ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652649/

¹⁷ https://pubs.niaaa.nih.gov/publications/arh26-4/292-298.htm

Taking Further Actions To Support And Improve Your Bone Health

Beyond the modifiable risk factors, you can also take proactive steps to support your bone health. There are two primary ways to achieve this:

1. Medications for osteoporosis
There are a range of different medications available for osteoporosis based on your unique circumstances and other medical conditions, and they have varying mechanisms of action. Common brand names include Fosamax, Actonel, Boniva, and Reclast. You may be prescribed an antiresorptive drug that slows the rate that your body breaks down bone, or an anabolic drug that increases bone formation.

Poor adherence rates
The use of medications for osteoporosis shows promising results in helping reduce the prevalence of fractures, though they pose some notable barriers. Aside from the risk of adverse effects^18,19  meaning they require very carefully prescription, research has found osteoporosis medication to be associated with poor patient adherence^20,21 , leading to poor outcomes. A study examining the attitudes and treatment patterns of Australian GP’s in treating osteoporosis found that in over 80% of cases where patients ceased their medication, prescriptions were not being followed up or continued, placing these people at risk of further fractures and suggesting that osteoporosis was undertreated and underdiagnosed.²²

2. Low intensity vibration for osteoporosis
Low intensity vibration (LiV) has been found to promote the construction of healthy bone and muscle, and inhibit the formation of fat, improving bone outcomes in patients.²³ Whole body vibration (WBV) between 20-90Hz has been found to promote the generation of bone and muscle, preventing and reversing osteoporosis²⁴. Moreover, 30Hz vibrations have been shown to build bone and muscle in the hip and spine of young women with osteoporosis²⁵ , promote volumetric bone density in the proximal tibia of children with conditions such as cerebral palsy²⁶ , enhance bone quality in

¹⁸ https://pubmed.ncbi.nlm.nih.gov/30814687/

¹⁹ Rossouw, J. E. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288, 321–333 (2002).

²⁰ Siris, E. S. et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin. Proc. 81, 1013–1022 (2006).

²¹ Cramer, J. A., Gold, D. T., Silverman, S. L. & Lewiecki, E. M. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos. Int. 18, 1023–1031 (2007).

²² https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01103-2

²³ https://pubmed.ncbi.nlm.nih.gov/30814687/

²⁴ https://pubmed.ncbi.nlm.nih.gov/15597385/

²⁵ https://pubmed.ncbi.nlm.nih.gov/16939405/

²⁶ https://pubmed.ncbi.nlm.nih.gov/15040823/

adolescents with idiopathic scoliosis²⁷ , and help protect balance control in those subject to chronic best rest.²⁸

The best LiV tool currently available on the market is the Marodyne LiV. Marodyne is a modern device that has been recognised by the Royal Osteoporosis Society as a safe and effective tool for the prevention of osteoporosis and the improvement of bone health. Its mechanism of action is grounded in the principles of exercise, where the musculoskeletal system responds to ground reaction forces, loading a person’s bone tissue with high and low frequency mechanical signals. The ability of these mechanical signals to increase musculoskeletal mass and quality is multifactorial, simultaneously repressing the systems involved in the formation of adipose tissue (fat), while also promoting the construction of bone.²⁹ By increasing both muscle and bone mass and strength, exercise is able to reduce the incidence of bone fractures.

Marodyne does not require a prescription, is safe to use at home, and is suitable for both prevention in healthy individuals and for treatment for those with weaker bones. Doctor Clinton Rubin Ph.D. is a distinguished State University of New York professor and a global authority on vibration therapy, whole body vibration platforms and their impact. He recommends a minimum of 10 minutes per day, citing that the most important component for success is not duration, but consistency. Using the Marodyne LiV every single day is a more important factor than the time for which it is used. A growing body of evidence suggests that the incorporation of multiple cycles of mechanical signals within a given day, separated by periods of rest, can increase the beneficial bone-building effects.³⁰

How To Start Improving Bone Health Today
You can start improving your health, managing your osteoporosis or osteopenia, and reducing the risks of these conditions by addressing your modifiable risk factors today together with the use of the Marodyne LiV at home. Marodyne is a simple, easy and effective solution for osteoporosis. It can be utilised by all age ranges, all physical abilities, without the need for repeat prescriptions or GP visits, and without strenuous or unmanageable exercise.

Marodyne LiV is available exclusively from Rehacare. To purchase the device, or for any questions, please contact Marodyne.com.au on 1300 653 522.

²⁷ https://pubmed.ncbi.nlm.nih.gov/23011683/

²⁸ https://pubmed.ncbi.nlm.nih.gov/21273076/

²⁹ Wallace, B. A. & Cumming, R. G. Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif. Tissue Int. 67, 10–18 (2000).

³⁰ https://pubmed.ncbi.nlm.nih.gov/30814687/