How to Read Your DEXA Scan: T-Score, Z-Score and What Your Bone Numbers Mean
A DEXA scan grades your bone density against a healthy 30-year-old — that comparison is the T-score, and it is the number that carries the most weight after age 30. Dr. Vonda Wright walks through the full result sheet (bone mineral density, T-score, Z-score, trabecular bone score) and shows her own spine and hip numbers as a worked example. Her central point: waiting until 65, when insurance typically covers the scan, means measuring after the loss has already happened.
Overview
Dr. Vonda Wright, an orthopedic surgeon and founder of Skeletal Longevity, frames bone health as a lifelong topic rather than a late-life one, and orders DEXA scans broadly for that reason. She notes that peak bone density is reached around age 30, and that during perimenopause and menopause — roughly ages 40 to 52 on average — as much as 20% of bone density can be lost as estrogen declines. Because changes in fracture risk can take up to a decade to register, she argues for measuring early rather than waiting for the age at which scans are routinely reimbursed.
The session then becomes a reading lesson: a DEXA report gives bone mineral density (around 1 g/cm² described as healthy normal), a trabecular bone score (1 to 1.3 described as healthy), a Z-score that compares you to age-matched peers, and a T-score that compares you to a healthy 30-year-old. On the bell curve, zero is that 30-year-old reference; any positive number sits above it, around -1 marks osteopenia, and below -2.5 marks osteoporosis.
She explains the underlying biology — osteoclasts resorbing bone and osteoblasts rebuilding it, a balance that estrogen helps regulate — and then reads her own 2023 versus January 2026 scans across spine, both hips and both femoral necks. She closes with the levers she attributes her own gains to: mindset, hormone optimization, heavy lifting, impact work such as jumping, and an anti-inflammatory, protein-forward nutrition plan.
Key quotes
5Did you know that we peak out on our bone density at 30?
If we wait until we're 65, which is when insurance will pay for your DEXA scan, you've already lost your bone density.
A T score, which is the most important score we commonly use, compares your current bone density to that of a healthy 30-year-old.
Osteopenia is reversible.
I've increased my spinal bone density by about 9%. That's amazing. Do you know what that's from? It's from jumping, it's from lifting, it's from eating in a diet high in protein.
Key ideas
9Bone density peaks at 30
Peak bone density arrives around age 30, which is why every score on the report is anchored there. Everything after that is a question of how well the peak is defended.
The perimenopause window
As estrogen declines through the 40s into menopause — on average roughly ages 40 to 52 — up to 20% of bone density can be lost. This is the window she wants measured, not skipped.
Measuring at 65 is measuring after the fact
Insurance coverage typically begins at 65, but changes in fracture risk can take up to ten years to show. Getting a baseline earlier gives you something to compare against.
The report has four numbers, not one
A DEXA report gives bone mineral density, T-score, Z-score and trabecular bone score. She describes roughly 1 g/cm² as healthy normal density and 1 to 1.3 as a healthy trabecular bone score.
Z-score compares you to your peers, T-score to your peak
The Z-score matches you against people your own age; the T-score matches you against a healthy 30-year-old. After 30, she treats the T-score as the number that carries the most weight.
The bell curve thresholds
Zero is the healthy 30-year-old. Any positive number sits above that reference, around -1 marks osteopenia — literally low bone — and below -2.5 marks osteoporosis, bones full of holes.
Osteoclasts and osteoblasts
Bone is constantly remodeled: osteoclasts resorb bone to release stored minerals, osteoblasts rebuild it. Before menopause the two are roughly in balance, and estrogen is central to keeping the resorbing side in check.
Which body parts matter most
She reads the lumbar spine, both hips and both femoral necks, because those are where the clinically significant fractures happen for women. A femoral neck fracture carries a 30% first-year mortality figure, and half of those who survive do not return to pre-fall function.
Genetics set the floor, behavior moves the number
She puts roughly 40 to 50% of bone density down to genetics — which means a good-faith effort can still land in osteopenia. The remaining levers are mindset, hormone optimization, heavy lifting, impact work and nutrition.
Practical takeaways
7- 1
Get a baseline, whatever your age 2:20
The first scan is not a diagnosis, it is a starting line. Without it, there is nothing to compare a future scan against.
- 2
Read all four numbers on the sheet 3:40
Find bone mineral density, T-score, Z-score and trabecular bone score before drawing any conclusion. Trabecular bone score speaks to internal bone structure rather than density.
- 3
Place your T-score on the curve 5:20
Positive is above the 30-year-old reference, down to -1 is still described as normal territory, around -1 is osteopenia, below -2.5 is osteoporosis.
- 4
Ask for spine, hips and femoral necks 9:40
A well-done scan reports several sites. Those are the ones she considers most relevant for women's fracture risk.
- 5
Load the skeleton on purpose 12:50
Lifting heavy and impact work such as jumping from roughly an eight-inch step are the mechanical signals she credits with driving bone building.
- 6
Feed the structure 13:50
She points to an anti-inflammatory, protein-forward eating plan on the grounds that bone is about 50% protein.
- 7
A low score is a starting point, not a verdict 15:00
She describes osteopenia as reversible and reports patients who stabilised and even rebuilt density while already in osteoporosis, in conversation with their own doctor.
Topics & chapters
15Why bone health is a lifelong topic
Dr. Wright introduces herself as an orthopedic surgeon and founder of Skeletal Longevity, and explains why she orders DEXA scans broadly.
Peak at 30, then the 40s
Peak bone density arrives around 30, and the decline through perimenopause can reach 20%.
Why waiting until 65 is too late
Insurance coverage arrives at 65, but fracture-risk changes can take up to ten years to register.
The bell curve explained
A DEXA scan is graded like a test against a curve, where zero is a healthy 30-year-old woman.
The four numbers on your report
Bone mineral density, T-score, Z-score and trabecular bone score, with the healthy ranges she uses.
T-score vs Z-score
Z-score is age-matched; T-score compares you to peak bone density at 30.
Osteopenia and osteoporosis thresholds
Around -1 is osteopenia, below -2.5 is osteoporosis — the words broken down to their roots.
The biology of remodeling
Osteoclasts resorb, osteoblasts rebuild, and estrogen keeps the balance.
Building bone is still possible
She references her own video on ten ways to build better bone, and insists measurement comes first.
Reading her own scans: 2023 vs 2026
Which body sites she reviews and why spine, hips and femoral necks matter most.
Spine: T-score 1.7
A roughly 9% increase over two years, which she attributes to jumping, lifting and protein.
Femoral neck stakes
Why the femoral neck is a critical site, with the mortality and disability figures she cites.
Her hip and femoral neck numbers
Left femoral neck 0.1, left hip 1.2, right femoral neck 0, right hip 1.
The levers that build bone
Genetics, mindset, hormones, heavy lifting, impact, and an anti-inflammatory high-protein plan.
Recap: how to read your scan
The full result sheet reviewed once more, ending on what to do if the numbers are low.