I think we would all want the DXA test to be very accurate with no complicating factors, at least before we've had the test. Once we've had the test and if we have a bad score we want complicating factors to explain away that bad score so that we can have some hope that we really don't have that bone loss or that maybe it isn't as bad as it seems. At least it was that way for myself.
I paid to have Lani Simpson review my scans because I had lost so much bone between 2 of the scans. Unfortunately she said the scans were good and my bone density was dropping rapidly. At least I knew for sure or as close to sure as I was going to get that I was declining in bone density and that my efforts so far have not stopped that. Note: I have had 5 scans over the past 4 years and the last 4 were on the same machine and with the same technician so I've got a pretty clear view of how I'm doing DXA wise.

My bone density has declined to a worst of -4.1 t-score in the spine at my most recent scan. I have not fractured unless there are silent thoracic fractures. I wish DXA scans were better with no inconsistencies or worries about accuracy. I wish all the factors were known about how bone density and bone quality and bone strength and bone mass and yet unknown factors effected the risk of fracturing. BTW my TBS score is also bad. Not sure which TBS numbers are most relevant but I ranged from L1 0.984 to L4 at 1.305. My TBS scores did actually improve slightly. Still no fractures and plenty of opportunity for them. It is all frustratingly imperfect.
Still so glad I haven't fractured.

I think we have to be aware of the imperfections in all this and analyze the tests value and accuracy as best we can. And of course get the best help we can to help us sort this out. Despite the issues surrounding DXA scans I see them as very useful and not to be ignored. It's a test that provides useful information. Unfortunately many, maybe most docs do not know how to make best use of that information. It is up to each of us to try to do that. No matter what all the other factors are rapidly decreasing bone density or a very low steady state bone density are not good.

Despite doing the full set of blood tests that Lani recommended I/we could find no underlying explanation for my high rate of decline in density. A decline I could not stop despite dietary changes and following good resistance training and other exercise protocols. I chose to take Evenity and have had 5 shots so far. Fingers crossed. I'm still working on the dietary and exercise angles more than ever but I'm hoping this med makes a big difference.