In reading the article and doing more research on this topic it appears that, Biomechanical CT (BCT) is not typically ordered as a standalone, primary screening test—nor is it a complete replacement for a DXA scan. Instead, it functions as a highly accurate supplementary tool or when standard testing is unavailable, inconclusive, or already captured via other CT imaging. BCT uses computational engineering (finite element analysis) to calculate bone strength and structural load-bearing capacity. It uses software to analyze an already existing clinical CT scan (such as one of your hip or spine) to generate a "virtual stress test" of the bone, measuring both density and structural breaking strength. Other factors to consider are higher radiation exposure, the distorting effects of contrast dyes if used, potential over diagnosis in the spine, and limited widespread standardization.

DXA scan remains the gold standard for OP screening. Recommended to discuss the pros and cons with your provider.