Regarding your comment, “There is less bone for the xrays to penetrate which could be interpreted as the bone being less dense,” bone density tests don’t truly measure bone density.

“The DEXA technique analyzes the attenuation of xrays as they pass through an area of the body. The method cannot detect the depth of the bone which is being measured, and thus is actually an "areal" density in g/cm2 rather than a "volumetric" or Archimedean density in g/cm3.” Source: https://courses.washington.edu/bonephys/opBMAD.html. That is also the link to Dr. Susan Ott’s BMAD calculator, which you might find interesting.

You might also want to look up Dr. Lani Simpson, https://lanisimpson.com/ She talks a lot about inaccuracies with DEXA scans.

It’s good that you are trying to gather more info and not letting a doctor push you on to osteoporosis meds.

Here are a few more informative links
https://www.betterbones.com/fractures-and-healing/bone-quality-thinner-women/
And the link below lists tests you should have before going on osteo-meds https://www.betterbones.com/testing/whats-the-cause-of-your-osteoporosis/

BTM (bone turnover marker) tests can tell you if you are losing a lot of bone right now. One DEXA scan is just a snapshot in time. It doesn’t tell you if you are actively losing a lot of bone. BTM tests can.

And this website can help you find an imaging center in your state that has DEXA with TBS capabilities. https://www.medimapsgroup.com/

TBS (trabecular bone score) is a much better indication of bone health/strength than T scores are. According to BetterBones.com “various studies document that well over half of those who suffer a low-trauma “osteoporotic” fracture do not have an osteoporotic bone density. Rather they have “osteopenia,” or even normal bone density.”