How to Analyze Your DEXA Results for Bone Quality

Updated: August 26, 2022

Lara Cover Photo

Lara Pizzorno is the author of “Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life – Naturally” and a member of the American Medical Writers Association with 29 years of experience specializing in bone health.

Recently we asked Lara if she would help us provide a series of short, ongoing videos to help you (our customers and readers) stay up to date on the latest facts and science related to bone health.

In this latest video, Lara discusses how you can analyze your DEXA results to discover what your bone quality is. Watch the video below (or read the transcript provided) and let us know what you think in the comments. 🙂

Hello, my name is Lara Pizzorno. I am the author of “Your Bones”. And I’m here to share some information with you that I hope will help you to have healthier bones.

In this video, I’d like to tell you about the trabecular bone score.

“It’s quality, not just quantity that counts.”

As my husband keeps telling me when I wish I was several inches taller, “It’s quality, not just quantity that counts.” While whether I agree with him in regards to my lack of height, I definitely do agree as far as our bones are concerned and so do the experts in bone assessment who have developed a new tool called the trabecular bone score.

You’ll see it shortened to TBS that uses our DEXA results to analyze not only our bone mineral density but our bone quality.

A lot of research has now shown that bone mineral density alone does not reliably or adequately predict fracture risk especially in those of us who have diabetes or are osteopenic. I’ll talk about the reasons why your trabecular bone score is so important if you have either one of these conditions in our next video. But here, I want to explain why getting your trabecular bone score is important, really, for all of us.

Your trabecular bone score is a better indicator of whether your bones are strong and flexible or if they are weakening than your bone mineral density alone, again, particularly if you have diabetes or are osteopenic.

Your bone mineral density can be fine while the internal microarchitecture of your bones is not fine. Here is the really great news.

Both your bone mineral density and your trabecular bone score can be evaluated on the same DEXA test.

So you don’t have to run yet another extensive test to find out what your bone quality is like.

So just what is the trabecular bone score?

It’s the analysis of the internal texture inside your bones, whats called their microarchitecture, that can be extracted from the lumbar spine image in your DEXA. Just like your bone mineral density is shortened to BMD, trabecular bone score, you’re going to begin to see shortened to TBS.

And TBS provides skeletal information that is not captured by the measurement of your bone mineral density. In fact, TBS can see differences between DEXA scans that shows similar bone mineral density measurements.

  • A higher TBS score indicates much better skeletal microstructure.
  • And low TBS score correlates with a weaker skeletal microstructure.

Why is this so important?

Whether your bones are healthy and can resist a fracture is determined by more than just how much mineral content they contain.

Bones can be mineral dense and still be brittle which is exactly what happens when people take certain drugs commonly prescribed for osteoporosis which prevent osteoclasts from removing old brittle bone. Bone mineral density goes up on these drugs but what you have is old and increasingly brittle bone. We’ve now learned the hard way after all the fractures cause by these drugs that bone microarchitecture, not just bone mineral density, determines bone quality or the ability of your bones to resist fracturing.

Bone microarchitecture is considered a marker of bone quality while bone mineral density is a measure of bone quantity.

And the two taken together, your bone microarchitecture quality and your bone mass are what contribute to bone strength. And your bone microarchitecture can now be evaluated easily with your same DEXA by determining your trabecular bone score from your DEXA images.

In our next video, I will explain why getting your TBS score is especially important to know if you have diabetes or if you are osteopenic. I hope this information has been helpful for you and you will tune in next time.


Briot K. DEXA parameters: beyond bone mineral density. Joint Bone Spine. 2013 May;80(3):265-9. doi: 10.1016/j.jbspin.2012.09.025. Epub 2013 Apr 23. PMID: 23622733

Kim JH, Choi HJ, Ku EJ, et al. Trabecular bone score as an indicator for skeletal deterioration in diabetes. J Clin Endocrinol Metab. 2015 Feb;100(2):475-82. doi: 10.1210/jc.2014-2047. Epub 2014 Nov 4. PMID: 25368976

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Article Comments

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  1. Jo-Ellen

    July 20, 2018 , 7:08 pm

    Please tell me how to get the TBS when my insurance only recognizes Dexa Bone Scan for coverage.

  2. Jenna AlgaeCal

    July 23, 2018 , 12:40 pm

    Hi Jo-Ellen,

    Both your bone mineral density and your trabecular bone score (TBS) can be evaluated on the same DEXA scan! Before your next DEXA scan, ask your doctor about having your trabecular bone score measured.

    – Jenna @ AlgaeCal

  3. Barby Darby Cahill

    August 25, 2019 , 7:15 pm

    Lara, would the AlgaeCal, Strontium, Triple Power Fish Oil help my husband as well? He has been diagnosed with Degenerative Spine Disease? Thank you so much for your work!!!

    I will continue to learn through your videos.

  4. Megan AlgaeCal

    August 27, 2019 , 1:18 pm

    Hi Barby, we’re glad you reached out!

    While AlgaeCal was not studied for degenerative disc disease, it contains nutrients that support not only our bones but our muscles and discs as well. These include calcium, magnesium, vitamin D3, K2, C, and boron. Triple Power Fish Oil can also be beneficial for your husband as inflammation may play a role in the pain associated with degenerative disc disease. Strontium Boost is recommended for those with low bone density as it triples the rate of bone-building and reduces fracture risk.

    Hope this information helps! Glad you are enjoying our videos. If you have any questions or need clarification please feel free to email [email protected] or call our Bone Health Consultants at 1-800-820-0184! ?

    – Megan @ AlgaeCal

This article features advice from our industry experts to give you the best possible info through cutting-edge research.

Lara Pizzorno
MDiv, MA, LMT - Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.,
Dr. Liz Lipski
PhD, CNS, FACN, IFMP, BCHN, LDN - Professor and Director of Academic Development, Nutrition programs in Clinical Nutrition at Maryland University of Integrative Health.,
Dr. Loren Fishman
MD, B.Phil.,(oxon.) - Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.,
Prof. Didier Hans
PHD, MBA - Head of Research & Development Center of Bone Diseases, Lausanne University Hospital CHUV, Switzerland,