If newly diagnosed with osteopenia or osteoporosis of spine

You can see discussions of REMS scans as adjunct to DEXA elsewhere in this forum.

Here is just one reference.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11988531/
EXCERPT: ". Conclusions
In conclusion, REMS technology effectively identifies cases of osteoporosis and osteopenia, representing a significant advance in detecting and monitoring osteoporosis. This technology ... does not use ionising radiation ..."

New research reported today by @j1976 has changed my perspective on REMS. You can see that person's comments and my response here:
https://connect.mayoclinic.org/discussion/what-decision-to-make-regarding-osteoporosis/

My cynical self after dealing with the system with my Loved one's Osteoporosis, a fall, L5 fracture, nerve pain, and unsuccessful treatment since. Gives me the impression that the reason for no Xray is insurance doesn't allow it, and most Providers won't buck them.
If you find one that will. Hold onto them.

@cman55 I'm so sorry to hear all that your loved one's gone through. From what I've read, it sounds as if many people are living with compression fractures without knowing they have them. If they are that common and silent, it would seem, to me, to point to a need for better imaging than the standard DXA. The vertebral fracture assessment (VFA), which some DXA machines/centers provide, seems a good minimum, if the VFA can be depended on to provide reliable info. (But I'd still want xrays.)

@karyn23 Thanks, she has had many MRI's, 2 CT scans, and 2 EMG's in the 2 1/2 yrs of her ordeal. She has been treated including Kyphoplasty, and Spinal Cord Stimulator, many various injections, and epidural/ablations. Relief from nerve pain is brief, and fleeting. Mostly non-existent lately.
It all started with Osteoporosis, and a fall. I am for people getting whatever they need from our Medical System to avoid all that my Loved one has experienced.

"The nature of a compression fracture is to make the bone appear denser. So the t-score will appear better than the one previously taken, before the fracture." If that's the case, and your DEXA shows osteoporosis, then your "true" bone density is actually *worse* than what appears on the report. Also... DEXA gives you bone density in your hips, which is obviously important.

An X-ray basically shows you what happened, not necessarily why it happened. Let's say you had an X-ray years ago and it showed a history of compression fractures. OK, what next? Maybe you need an MRI to diagnose any disc problems. if you have aches. Maybe you need a DEXA to check bone density. An X-ray alone isn't going to cut it.

I totally agree with you that any one test is not sufficient! The more information we have, the better. If you go to the orthopedist complaining of back issues, then an X-ray is often one of the first things they do, followed by an MRI if necessary.

The doctor also matters. I am male. I had a compression fracture not from a fall. The orthopedist did an X-ray and MRI. He did not once mention osteoporosis, probably because I'm not female. My PCP suggested a DEXA which showed a T-score of -3.4. Otherwise, I would not have known.

So tired of bones... 🙂 🙂

@njx58
This all so frightening. I was in an accident 2 years ago. Fractured my spine T12,L1. The nightmare began. after a few months of recovery,my other doctor sent me for a DEXA scan. I was 63 and female. Hadn't been told prior to have one. I'm health, exercise and eat correctly.. I had -4 osteoporosis. Started me on Tymlos once my insurance stopped playing the cost game. Tymlos was horrific. I had every symptom possible. After about 4 months, the heart palpitations started so then she had to get the insurance to switch to another medication. That took 6 months. Now I am on Prolia. First injection was February, so far so good, but back pain is still with me. My insurance is Fed. Blue Cross/Blue Shield.. My doctors since the accident have stated I need via Disc procedure because my disk is compressed and fragmented. But insurance is making me go through lame procedures. Steroid injections. Latest one was Lumbar Medial Branch Block Bilateral. Now I will be turning 65 and making the choice for Medicare. I hope the procedure gets approved. As far as getting the -4 score lowered seems like an impossibility. I hate being negative, but there really doesn't seem to be anyone getting better from Osteoporosis.

@njx58
This all so frightening. I was in an accident 2 years ago. Fractured my spine T12,L1. The nightmare began. after a few months of recovery,my other doctor sent me for a DEXA scan. I was 63 and female. Hadn't been told prior to have one. I'm health, exercise and eat correctly.. I had -4 osteoporosis. Started me on Tymlos once my insurance stopped playing the cost game. Tymlos was horrific. I had every symptom possible. After about 4 months, the heart palpitations started so then she had to get the insurance to switch to another medication. That took 6 months. Now I am on Prolia. First injection was February, so far so good, but back pain is still with me. My insurance is Fed. Blue Cross/Blue Shield.. My doctors since the accident have stated I need via Disc procedure because my disk is compressed and fragmented. But insurance is making me go through lame procedures. Steroid injections. Latest one was Lumbar Medial Branch Block Bilateral. Now I will be turning 65 and making the choice for Medicare. I hope the procedure gets approved. As far as getting the -4 score lowered seems like an impossibility. I hate being negative, but there really doesn't seem to be anyone getting better from Osteoporosis.

@cmbaczenski Oh my goodness, you've been through so much. I'm so sorry. I hope you get relief from the back pain soon. I am pretty new to all of this - diagnosed with osteoporosis last December - so I don't a lot about the road ahead, but I'm holding hope, and feeling buoyed by the support and guidance here - it means the world to have each other.