A DEXA scan produces a number. Most women leave the office knowing they have osteopenia or osteoporosis but with little understanding of what those categories actually mean for their fracture risk – or what they can do about them.
What the T-Score Means
A DEXA scan measures the mineral density of bone, typically at the lumbar spine and hip. The T-score compares your bone density to the average peak bone density of a healthy 30-year-old.
Normal: T-score above -1.0. Osteopenia: T-score between -1.0 and -2.5. Osteoporosis: T-score below -2.5.
Osteopenia means your bone density is below the young-adult average but not yet in the range associated with significantly increased fracture risk. Osteoporosis means density has fallen to a level where fracture risk – particularly at the hip, spine, and wrist – is meaningfully elevated.
What the Scan Doesn’t Tell You
A T-score is a snapshot at a single point in time. It reflects bone mineral density at the measurement sites. It says nothing about bone quality, bone geometry, the rate at which you’re currently losing bone, or the strength of the muscles that protect your skeleton from fracture.
The Z-score, which compares your bone density to women of your age rather than to a 30-year-old, appears on the same report. A low T-score with a normal Z-score means your density is consistent with what’s typical for your age group – which provides useful context that the T-score alone doesn’t give you.
Neither score captures everything relevant to actual fracture risk. Muscle strength, balance, fall history, and functional capacity all contribute. A woman with a T-score of -2.6 who strength trains regularly and has strong hip musculature may carry lower real-world fracture risk than a woman with a T-score of -2.0 who is sedentary and has poor balance. The scan doesn’t show that.
The Fracture Risk Question
The practical concern with low bone density is fracture – most critically at the hip. Hip fractures in women over 70 carry serious functional consequences and are among the most significant injury events in this age group.
Reducing fracture risk requires addressing both the bone and the circumstances that lead to fracture. Bone density matters. So does muscle strength, balance, and gait stability. Interventions that address only bone density without addressing neuromuscular factors miss half the problem.
What Changes After the Diagnosis
For women with osteopenia, the evidence-supported approach is the same as bone-protective training in general: progressive resistance training, weight-bearing activity, adequate calcium and vitamin D, and assessment of any factors accelerating bone loss.
For women with osteoporosis, the same principles apply with some modifications to exercise selection. High-impact jumping and exercises involving significant spinal flexion under load are typically avoided. Progressive resistance training is not contraindicated – it’s one of the most effective interventions available for osteoporosis – but starting loads and progressions should account for the increased tissue fragility.
A diagnosis of osteopenia or osteoporosis is not a reason to stop loading. For most women, it’s the strongest reason to start.
→ Bone Loss After Menopause: What’s Happening and What Reverses It
→ Can You Reverse Bone Loss After Menopause?
– Stephen Holt, CSCS
29 Again Custom Fitness | Timonium, MD
Nerd Note: T-score thresholds for osteopenia and osteoporosis are established by the WHO. Fracture risk is multi-factorial and includes muscle strength, balance, and fall history in addition to bone mineral density. WHO Study Group, Assessment of Fracture Risk (1994); Kanis JA et al., Osteoporosis International (2008); Cauley JA, Journal of Bone and Mineral Research (2011).
