Why Bone Quality is More Important For Those with Osteopenia

Updated: October 16, 2023

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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 the latest analysis that can be done, using your DEXA image, that checks your bone quality. 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’m the author of “Your Bones.” And I’d like to share some information with you that I hope will help you to have healthier bones.

In our last video, I explained a little about a new analysis that is being done. I’m using the DEXA image, called the trabecular bone score, that checks bone quality. Your bone mineral density analysis is a measure of bone quantity, right, mineral quantity. But the trabecular bone score checks your bone quality.

In this video, I’d like to explain why getting your trabecular bone score to assess bone quality is so important for those of us who have type 2 diabetes or who are osteopenic.

So first, let’s talk about diabetes.

If you have diabetes, even if you have high bone mineral density, you are still at increased risk for fragility fracture. This is partly because many patients with type 2 diabetes are being treated with medications called Thiazolidinediones or TZDs whose use is known to double or even triple the risk for hip fracture in as little as one year. These are very frequently prescribed drugs. They’re also known as glitazones. And they’re marketed under the trade names of Avandia, Actos, and Resolin and a bunch of other names.

People with diabetes are also at high risk for fragility fractures for other reasons too.

Numerous studies have now reported that diabetes harms bone tissue through a variety of damaging mechanisms, including in resulting chronically high levels of insulin floating in the bloodstream. And these are very inflammatory, and they also result in the deposit of compounds called advanced glycosylated end products, which have been shortened to AGEs, advanced glycosylated end products or AGEs. Lots of AGEs form when too much sugar or glucose is floating around in the bloodstream, because of our high refined foods diet produces high spikes in blood sugar. And eventually, our cells become insulin-resistant and refuse to let the sugar in. AGEs bind to collagen, which is the main structural protein throughout our bodies, including in our bones. And when they bind to collagen, they distort it, so it can no longer function properly.

In the U.S., 26 million children and adults, nearly 10% of our population, including 25% of those of us over age 65 are seniors, have diabetes.

Another 79 million people have pre-diabetes. And only 7.3% of Americans with pre-diabetes have been told that they have it. If you think you might have pre-diabetes, please go talk to your doctor and get checked for this.

So if you have osteopenia, why is getting your trabecular bone score to assess your bone quality especially important for you?

Well, I’m going to share a scary thought with you here. The majority of fragility fractures occur in osteopenic women.

A number of studies have now revealed that the majority of fractures occur in osteopenic women.

More than half of fragility fractures occur in women with osteopenia, not osteoporosis.

And women with osteopenia who have experienced a fragility fracture have the same fracture risk as women with full-blown osteoporosis. What makes the difference between being osteopenic and having a fragility fracture or being osteopenic and having a low risk for having a fragility fracture. One thing, your bone quality.

In one recent study, the DEXAs of 243 post-menopausal Caucasian women, who ranged in age from 50 to 80, were evaluated for both their bone mineral density and their trabecular bone score. All of them had bone mineral density scores ranging from -1 to -2.5, but only 81 of them had a fracture. A low bone mineral density on their DEXA was found to correlate with a 54% increased risk of fracture.

But a low trabecular bone score increased their fracture risk by 153%. So, the next time you’re scheduled for your DEXA, make sure your report includes your trabecular bone score as well as your bone mineral density.

A good bone mineral density score by itself is not adequate indication of your bone’s health. But if your trabecular bone score is good, your risk of fracture will be less.

This may be very comforting and encouraging especially as bone mineral density usually does not increase at the same rate in all areas, even while the interior of your bones, your trabecular bone, is building.

And I talked about this in another video in response to questions that people sent in asking, “Why am I building bone in one area faster than in others?”

But I can assure you in getting your trabecular bone score along with your bone mineral density score the next time you have a DEXA run can help confirm that you are on the right track.

If you follow the natural healthy bone-building program that I’ve laid out in “Your Bones,” which very briefly can be summed up as identify and get rid of all of the things that are harming your bones and supply your bones with all of the nutrients they need to rebuild,” which for me definitely includes taking my daily AlgaeCal Plus, you will get both bone quality as well as quantity.

I hope this information has been helpful for you. I hope you will request a trabecular bone score on your next DEXA. And I hope you’ll tune in next time. Thanks.


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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,