Accuracy of DEXA Scans

Hello! Can someone tell me exactly is the FRAX score? I've seen it but not paid attention. Any info appreciated. Thank you!

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.

May I ask how old you are? I'm 59 and had significant deterioration from my last scan. Am at -3 for femoral neck, -2.5 hip, and -2.7 L1-L4. Am healthy, exercise 3-5 times a week, lift weights, eat well. Am being referred to an endocrinologist, but can't get in until May. Trying to learn and understand. Feeling kinda bummed and confused on what I do until then.

Was first diagnosed when I was 40 and changed diet and got to osteopenia range. Then this surprise. Am on HRT. I declined taking boniva at the time because I didn't want to be on a med that didn't have trials for long periods of time.

Had couple of fractures when kid, but nothing since.

Open to all guidance any of you have on how to navigate and sort through all the info.

May I ask how old you are? I'm 59 and had significant deterioration from my last scan. Am at -3 for femoral neck, -2.5 hip, and -2.7 L1-L4. Am healthy, exercise 3-5 times a week, lift weights, eat well. Am being referred to an endocrinologist, but can't get in until May. Trying to learn and understand. Feeling kinda bummed and confused on what I do until then.

Was first diagnosed when I was 40 and changed diet and got to osteopenia range. Then this surprise. Am on HRT. I declined taking boniva at the time because I didn't want to be on a med that didn't have trials for long periods of time.

Had couple of fractures when kid, but nothing since.

Open to all guidance any of you have on how to navigate and sort through all the info.

I agree with your inference - I can’t quite make out how they came to their conclusion that one score fits all. Did you read the NIH link? - I’m not positive I caught all the info. It seemed they put more focus on whether the standard deviation, based on a 30 yo white female, could be applied to men (with larger bone mass). It also seemed that they recognized that the individual bone mass was different - I can’t help but feel it was implied that the physician would make a clinical decision on what “normal” was and adjust their treatment plan accordingly. Normal meaning an average sized white female - and if the patient is larger, smaller, different race, the score would be expected to be different. But I’m afraid that is not what is happening in a typical PCP or endocrinologist office.

The FRAX score is usually used as part of decision making for BMD treatment.
https://frax.shef.ac.uk/FRAX/tool.aspx?country=9
I find this a rather simple tool. It is also dependent on knowing whether there has been a previous fracture. My mother had undiagnosed spinal compression fractures that did not get diagnosed until the pain increased. Perhaps the tool is meant to capture clinically relevant fractures only.

My FRAX score barely met criteria for treatment. And based on my thinner bone, I may have had only osteopenia not osteoporosis. But, for me, the breast cancer metastasis issue is now a factor. And it pushes me over into taking Reclast infusions- at least until the risk of invasive cancer is lower.

Did your doctor recommend Reclast? And why not Zometa? Are you taking it for bone mets or to prevent it? Thank you.