When I was first diagnosed with severe OP, it was with a DXA only. I had trouble believing it because I am healthy and active. TBS was not offered and the technician had never heard of it.
I found a different place where I could have another DXA ( about 14 months later) and they also had the TBS add-on.
I desperately wanted the TBS to show that my bone quality was good, but alas, the second DXA showed even worse numbers and the TBS showed degraded bone.
After that, I made the decision to start Tymlos.