Are Small-Boned Women Being Misdiagnosed With Osteoporosis?

A groundbreaking study suggests that thousands of small-framed women may be receiving false osteoporosis diagnoses due to flaws in standard bone density testing. Australian researcher Dr. Henry Paul Golding's 2022 research demonstrates that dual-energy X-ray absorptiometry (DEXA) scans systematically underestimate bone strength in smaller bones, creating widespread misdiagnosis among petite women.

Why Do DEXA Scans Favor Larger Bones?

The problem lies in how DEXA technology actually works. Despite being called "bone mineral density" testing, DEXA doesn't measure true bone density at all. Instead, it provides a two-dimensional measurement of mineral content spread across a bone's surface area, not within its full three-dimensional volume.

Dr. Golding's team used artificial vertebrae of varying sizes to prove this bias. They found that DEXA readings decline as bone size decreases, even when the actual bone density remains identical. "The areal bone mineral density testing results given by both DEXA devices are not in any way corrected for the difference in bone size," Dr. Golding emphasized.

How Accurate Are Current Bone Density Tests?

The reliability issues with DEXA testing extend beyond size bias. Research reveals several concerning limitations that affect diagnosis accuracy:

• Error Rate: Studies suggest that as many as 90% of DEXA scans contain errors, with about half significant enough to alter diagnosis or treatment decisions due to calibration issues, positioning errors, and operator variability
• Poor Fracture Prediction: Up to 80% of fractures occur in people with normal or osteopenic DEXA results, not in those labeled osteoporotic, indicating the test fails to predict actual bone resilience
• Limited Scope: DEXA focuses on a single number while ignoring bone architecture, turnover rate, mineralization, collagen quality, and muscle support—all crucial factors in bone strength

These findings suggest that bone density testing provides limited value when used alone to diagnose osteoporosis or determine treatment plans.

What Should Women Do Instead of Relying on DEXA Alone?

Rather than depending solely on bone density scores, experts recommend a comprehensive approach to bone health assessment. This includes evaluating multiple risk factors such as nutrient status, exercise patterns, chronic inflammation, family history, medication use, and hormonal balance.

Key strategies for supporting bone health include strength training and resistance work, which research shows can dramatically improve both bone density and fracture resilience. The muscle-bone connection is particularly important, as studies demonstrate that bone and muscle tissue are gained and lost together.

Nutritional optimization also plays a crucial role. Bones thrive in a slightly alkaline environment supported by a diet rich in colorful vegetables and fruits, adequate protein, and all 20 key bone nutrients. These include essential minerals like calcium, magnesium, and potassium, plus vitamins K2, C, and B vitamins.

For women concerned about previous DEXA results, especially those who are small-framed, this research offers reassurance. As Dr. Golding's findings confirm, many petite women have been unfairly labeled as having osteoporosis when their bones may be perfectly healthy. Bone health remains dynamic and responsive to lifestyle factors, meaning women have significant capacity to maintain and even rebuild bone strength throughout their lives.