Do petite women get over-diagnosed with osteoporosis?

Posted by mmilich @mmilich, May 12 4:42pm

I came across some articles about petite women getting overdiagnosed with osteoporosis due to limitations on DEXA scans. The same article mentioned that taller women with larger bones also get underdiagnosed because the machine thinks they have more bone mass. Has anyone else heard about this, and do your doctors address this discrepancy?

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Profile picture for lindamaegirl @lindamaegirl

@kfhoz Rems in Massachusetts only does one hip. NOTE: take a look at who the major shareholders of Dexa scare are.....surprise surprise the pharmaceutical companies that sell some of the drugs for osteoporosis!!!!

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@lindamaegirl REMS in Vancouver usually does 1 hip, but you can pay us$50 more to get the other one done.

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Profile picture for lindamaegirl @lindamaegirl

@gently One thing that dexa does that REMS does not is gets skewed by arthritis which makes the scores worse.

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@lindamaegirl, I'd rather rely on bone markers.
You are right about Dexa numbers getting skewed by arthritis. But the skew often raises the scores of arthritic patients because it includes the calcium of osteophytes. Scores are lower in patients with RA because inflammatory arthritis does destroy bone.
REMS may turn out to be a better instrument, but I wish the company would pay out for the clinical trials and get recovery from insurance coverage rather than financing at the expense of osteoporosis patients.

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Profile picture for lindamaegirl @lindamaegirl

@gigi4 Just so you know there is also a DEXA scan with TBS Why doctors don'tsuggest this...the TBS is the fragility score!!!! There is no more radiation but needs to be done on a newer machine. I guess they want to pay for all the older machines!!! (so they do not suggest the newer machines)...NOTE: I live in Boston Ma. You would think with all these great hospitals and universities here there would be several of these newer machines. NOPE.
there is ONE at the Brigham on longwood ave and the WL is about 6 months...I guess there are a few people in the know. I talked my endocranologist in getting me to do this dexa after 6 months of my last dexa and my 2 compression fractures because I want to start and stay on this new machine for all my dexa scans.

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@lindamaegirl

I see you mentioned Boston. There is a great bone group that started there. OsteoBoston. Great info there also.

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Profile picture for gravity3 @gravity3

@lindamaegirl

I see you mentioned Boston. There is a great bone group that started there. OsteoBoston. Great info there also.

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@gravity3 I like Osteo Boston too, Shelly, the lady running it is great! She gets good presenters too.

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Profile picture for kfhoz @kfhoz

@amyt123 I also had REMS scans, and I have posted in the past suggesting REMS to people on this site. But I no longer trust REMS results based on 2 new research papers and my own results. I am trying to now balance out for my former advocating of REMS. Below is an overview from MelioGuide that also indicates where to look to see the original research which I have also read.
https://melioguide.com/osteoporosis-prevention/rems-bone-scan/
EXCERPT 1: "A 2026 study in Osteoporosis International (Chan et al.) found that age and weight alone explain the vast majority of REMS output variance."

EXCERPT 2: "The Bobelyak et al. Study (2025)
An earlier study by Bobelyak and colleagues found similar concerns. Their model using only age, sex, and BMI accounted for approximately 90% of the variability in femoral neck REMS-BMD. Perhaps most provocatively, they reported that REMS showed only minimal change in hip BMD values after a patient had a metallic hip prosthesis inserted, a scenario in which any device truly measuring bone should show a dramatic change."

The second excerpt describes my situation. The local DEXA scan people would not do both of my hips, despite the fact that I have more heavily used one leg over the other for 12+ years due to knee arthritis in my other leg. I was very surprised when REMS reported my hips to be the same T-score! Other studies show that when one limb is stressed more than the other then that leg or arm develops more bone density. But the research above explains that REMS is 90% estimating your values based on things like age & weight, not the actual bone density difference in my hips.

I was planning on relying on REMS, which only cost me about US$170 in Vancouver Canada, to monitor my bones more often than DEXA. So I am very sorry to see this sad outcome.

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@kfhoz
Thanks so much for the Melioguide invaluable artcle!

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My consultant is urging me to go on to Teriparatide (Forteo) because of -3.6 T score with DXA and I had an adverse reaction to Prolia (denosumab) which has caused necrosis of the jaw. I'm reluctant to go on to Teriparatide partly because it seems I'll be taking another drug to resolve the issues with the first one, so I had a REMS scan last week. It is just another machine and all results need to be read cautiously, but the results suggest that my bone quality is quite good. I have the wrist strength of an above average man ( am female). My spine is 20% better than the average person of my age (70) and hips 17% better. Less than 5% risk of bone fracture. What to make of it all? I'll take all the results to another bone doctor, this one female who doesn't have posters promoting Prolia on all walls of the office, and get a second opinion.

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Would you happen to have links to the info you are sharing? Would love to learn more!

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Profile picture for kfhoz @kfhoz

@amyt123 I also had REMS scans, and I have posted in the past suggesting REMS to people on this site. But I no longer trust REMS results based on 2 new research papers and my own results. I am trying to now balance out for my former advocating of REMS. Below is an overview from MelioGuide that also indicates where to look to see the original research which I have also read.
https://melioguide.com/osteoporosis-prevention/rems-bone-scan/
EXCERPT 1: "A 2026 study in Osteoporosis International (Chan et al.) found that age and weight alone explain the vast majority of REMS output variance."

EXCERPT 2: "The Bobelyak et al. Study (2025)
An earlier study by Bobelyak and colleagues found similar concerns. Their model using only age, sex, and BMI accounted for approximately 90% of the variability in femoral neck REMS-BMD. Perhaps most provocatively, they reported that REMS showed only minimal change in hip BMD values after a patient had a metallic hip prosthesis inserted, a scenario in which any device truly measuring bone should show a dramatic change."

The second excerpt describes my situation. The local DEXA scan people would not do both of my hips, despite the fact that I have more heavily used one leg over the other for 12+ years due to knee arthritis in my other leg. I was very surprised when REMS reported my hips to be the same T-score! Other studies show that when one limb is stressed more than the other then that leg or arm develops more bone density. But the research above explains that REMS is 90% estimating your values based on things like age & weight, not the actual bone density difference in my hips.

I was planning on relying on REMS, which only cost me about US$170 in Vancouver Canada, to monitor my bones more often than DEXA. So I am very sorry to see this sad outcome.

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@kfhoz How disappointing!!

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Profile picture for franmg @franmg

My consultant is urging me to go on to Teriparatide (Forteo) because of -3.6 T score with DXA and I had an adverse reaction to Prolia (denosumab) which has caused necrosis of the jaw. I'm reluctant to go on to Teriparatide partly because it seems I'll be taking another drug to resolve the issues with the first one, so I had a REMS scan last week. It is just another machine and all results need to be read cautiously, but the results suggest that my bone quality is quite good. I have the wrist strength of an above average man ( am female). My spine is 20% better than the average person of my age (70) and hips 17% better. Less than 5% risk of bone fracture. What to make of it all? I'll take all the results to another bone doctor, this one female who doesn't have posters promoting Prolia on all walls of the office, and get a second opinion.

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@franmg
During your REMS exam, did they do just femur/hip or spine as well?
Thank you.

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Femur/hip and spine. It felt a thorough test and I had 40 min with the Doctor afterwards to go through it, so felt worthwhile.

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