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What We Got Wrong About DEXA Scans, Bisphosphonates, and Hormones
When I first interviewed Dr. Wendy Warner, she planted a seed in my mind that completely changed how I look at bone health. She questioned the reliability of the DEXA scan — and that moment shifted everything for me.
In this episode, we dive deep into what went wrong in women’s bone health over the past 30 years. And it starts with the DEXA scan.
How the DEXA Scan Changed Everything
Before the 1990s, we didn’t “monitor” bone density the way we do now. A woman was diagnosed with osteoporosis after a fracture — not before.
Then DEXA scans entered the picture.
On the surface, this seemed revolutionary. Finally, a way to measure bone density and prevent fractures. But what most women don’t realize is this: a DEXA scan measures mineral density — not bone strength.
Your bones are made of a collagen protein matrix (the scaffolding) and minerals (the hardening component). The DEXA only measures the mineral. It does not assess the integrity of the collagen structure that actually holds the bone together.
Dense does not always mean strong.
And that distinction matters.
The Bisphosphonate Era
When DEXA scans became common, bisphosphonates like Fosamax were the only pharmaceutical option available. The idea made sense at the time: slow bone breakdown so bone-building cells could catch up.
But what we didn’t know in the early years was what would happen long term.
Years later, we began seeing spontaneous fractures and osteonecrosis of the jaw. By suppressing bone turnover for too long, bones could become brittle — like chalk. Dense, but fragile.
That’s when drug holidays became part of the conversation. And if a medication requires a mandatory break because of potential harm, that should raise questions.
This isn’t about being anti-medication. It’s about understanding the full picture.
Risk vs. Rate: Understanding the FRAX Score
Most women focus only on their T-score. But the FRAX score — which you can calculate online — gives a 10-year fracture risk based on additional factors like age, smoking status, prior fractures, and steroid use.
A key point Dr. Warner made: risk does not equal rate.
Many women with low DEXA scores never fracture. Meanwhile, fracture risk depends on much more than density — including muscle mass, balance, inflammation, stress, autoimmune activity, and nutrient absorption.
If you have an autoimmune condition, chronic stress, blood sugar instability, or gut dysfunction, your fracture risk increases — regardless of your DEXA score.
That’s where functional medicine becomes critical.
The Hormone Crisis That Changed Women’s Health
Then came the early 2000s Women’s Health Initiative study. The headlines told women hormones caused breast cancer. Overnight, hormone therapy stopped.
What followed was a generation of women denied hormone support.
Today, we understand that bioidentical hormones are not the same as the synthetic hormones used in that study. We also know timing matters.
Estrogen always benefits bone health — even later in life. It supports bone remodeling and protects against accelerated loss.
But hormones alone aren’t enough.
If your cortisol is chronically elevated from stress, you stimulate osteoclasts (bone breakdown cells). If DHEA is low, you reduce osteoblast stimulation (bone-building cells). Blood sugar instability, inflammation, autoimmune disease — all of these contribute to bone loss.
You cannot isolate bone from the rest of the body.
What You Can Do Now
If you’ve been told you have osteopenia or osteoporosis:
- Look at your FRAX score — not just your T-score.
- Address chronic stress and cortisol imbalance.
- Optimize blood sugar stability.
- Heal your gut to improve nutrient absorption.
- Evaluate autoimmune activity and inflammation.
- Consider hormone therapy (if appropriate) as part of a broader strategy.
- Work with a practitioner who sees the whole picture.
Bone health is not just about density. It is about resilience.
Final Thoughts
The management of women’s bone health has been fragile — not your bones.
When we reduce complex physiology to a number on a scan, we miss the opportunity to restore balance at the root.
You are not your T-score.
And you deserve better than a one-size-fits-all solution.
If you’re ready to take a root-cause approach to bone health, explore my Healthy Gut, Healthy Bones program at:
https://debirobinsonwellness.thrivecart.com/hghb-self-paced-group-program-pp/
Part 2 of my conversation with Dr. Wendy Warner is coming next — and we go even deeper.
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Frequently Asked Questions (FAQs)
Oxalates, also known as oxalic acid, are naturally occurring compounds found in many plants, vegetables, and fruits. They are part of a plant’s defense mechanism against predators and can be found in high concentrations in foods like spinach, rhubarb, beets, nuts, chocolate, tea, and certain beans.
Regarding bone health, oxalates can bind to minerals such as calcium in the gut, forming calcium oxalate. This compound is not easily absorbed by the body, meaning the calcium that could have been utilized for bone strengthening is instead excreted. This process can potentially lead to lower calcium availability for bone health, which can be particularly concerning for individuals at risk of osteoporosis or other bone-related issues.
However, for most women, dietary oxalates do not pose a significant threat to bone health, especially if their diet is balanced with enough calcium and they do not have a history of kidney stones.
Your gut is crucial for stronger bones for several reasons:
- Nutrient Absorption: The gut is where most nutrient absorption occurs. For bones to be healthy and strong, they need a variety of nutrients, particularly calcium, phosphorus, magnesium, and vitamin D. A healthy gut efficiently absorbs these essential nutrients from your diet and facilitates their transportation to the bones.
- Gut Microbiome and Bone Health: Research has shown that the gut microbiome (the community of bacteria living in your intestines) can influence bone density. Certain gut bacteria help in producing short-chain fatty acids (SCFAs) like butyrate, which have been shown to promote bone health. SCFAs can enhance the absorption of minerals necessary for bone strength and play a role in reducing inflammation, which can negatively affect bone health.
- Hormone Regulation: The gut helps regulate hormones that are involved in bone metabolism, including insulin, thyroid hormones, and sex hormones like estrogen. For example, estrogen is vital for bone density, and gut health can influence estrogen levels through the enterohepatic circulation, where estrogens are processed in the liver and intestines.
- Reducing Inflammation: Chronic inflammation, which can stem from poor gut health, is linked to many conditions that compromise bone strength, such as osteoporosis. A healthy gut helps to reduce systemic inflammation, protecting bones from inflammatory damage.
- Immune System Modulation: The majority of the immune system is located in the gut. An imbalance in the immune system can lead to autoimmune conditions, some of which affect the bones. Maintaining gut health helps to ensure the immune system works correctly, protecting against autoimmune reactions that could impact bone health.
In essence, maintaining a healthy gut contributes significantly to stronger bones by ensuring the effective absorption of vital nutrients, regulating hormones, reducing inflammation, and supporting a healthy immune system. Therefore, a diet rich in bone-healthy nutrients, prebiotics, and probiotics, along with lifestyle factors that promote gut health, is key to maintaining strong bones.