Understanding Your Results

How to read your bone density results

Your report has three numbers on it. Here's what each one measures, and what it does and doesn't tell you.

What's in your report

Bone density is measured at two sites — your lumbar spine and femoral neck (the top of your hip bone) — because bone loss doesn't happen at the same rate everywhere. Measuring both gives your physician a fuller picture than either site alone.

At each site, your report includes the parameters commonly used to diagnose osteoporosis, plus one measure that goes beyond density:

Bone Mineral Density (BMD)

The raw measurement — how much mineral is in a given area of bone. This is the number everything else is calculated from.

T-Score

Your density compared to a healthy young adult. This is the number used to diagnose osteoporosis.

Z-Score

Your density compared to other people your own age and size. Useful for spotting bone loss that's unusual for your age.

Fragility Score

A measure of bone quality — the internal structure that determines whether a bone breaks. Reported for both spine and hip.

The T-score, explained

The T-score is the number your physician will focus on first. It compares your bone mineral density to that of a healthy young adult, and it's what the World Health Organization's diagnostic criteria are built around.

Normal

T-score -1.0 or above

Your bone density is in the expected range for a healthy young adult.

Osteopenia

T-score -1.0 to -2.5

Lower than ideal bone density, but not yet osteoporosis. This is often where prevention matters most.

Osteoporosis

T-score -2.5 or below

Meets the World Health Organization's criteria for osteoporosis.

These are diagnostic categories, not a verdict. A T-score sits in a range, and ranges have edges — a score of -2.4 and one of -2.6 are nearly identical measurements that land in different categories. Your age, history, medications, and other risk factors all matter alongside the number.

Why your Z-score is reported too

A T-score compares you to a healthy young adult, which is the right comparison for diagnosing osteoporosis. A Z-score compares you to other people your own age and size — which answers a different question: is my bone density unusual for someone like me?

A Z-score of -2.0 or below is considered below the expected range for your age. When that happens, your physician may look for a secondary cause of bone loss — a medication, an underlying condition, or another factor that's accelerating bone loss beyond what aging alone would explain.

The Fragility Score, and why bone quality matters

Here is the thing most people don't learn until after a fracture: bone density only explains part of your fracture risk. Many people with dense bones still break them. Many people with thinner bones never do. Density tells you how much bone you have — not how strong the structure is.

The Fragility Score measures that other half. It analyzes the raw ultrasound signal from your scan for the textural signature of fragile bone, comparing your results against a reference population of people who have and have not previously fractured. In effect, it asks: does this bone look like the bone of someone who breaks?

This isn't a theoretical advantage. In a five-year study of 1,989 patients, the Fragility Score predicted who would actually fracture more accurately than either the DEXA T-score or the REMS T-score — and the advantage held at both the spine and the hip, in both women and men, even after adjusting for age and body mass index.

What this means for your report: you're getting two independent measurements, not one. Your T-score says where your density stands. Your Fragility Score says how strong the bone structure appears. Together, they give your physician a better basis for deciding whether to monitor, treat, or do nothing yet.

The full study — and the other published research behind REMS — is available on our research library page, with original PDFs and citations so your physician can read them directly.

What happens after your scan

Your scan is analyzed and a report is prepared for you and your physician, covering BMD, T-score, Z-score, and Fragility Score at both the spine and femoral neck.
If you have a referring physician, let us know when you book — we're glad to send the results directly to their office.
Bring your report to your next appointment and ask what it means for your specific situation.

Your report is a measurement, not a treatment plan. Interpreting it in the context of your history, medications, and other risk factors is your physician's role — and it's the right way to decide what, if anything, to do next.

Common questions

What is a good T-score?

A T-score of -1.0 or above is considered normal. A T-score between -1.0 and -2.5 is classified as osteopenia — lower than ideal, but not osteoporosis. A T-score of -2.5 or below meets the World Health Organization's criteria for osteoporosis. The lower the number, the lower your bone density.

What does a Z-score tell me that a T-score doesn't?

A T-score compares you to a healthy young adult, which is the standard used to diagnose osteoporosis. A Z-score compares you to other people your own age and size. A Z-score below -2.0 is considered below the expected range for your age — which is a signal your physician may want to investigate further, including looking for a secondary cause of bone loss.

What is the Fragility Score, and why does it matter?

The Fragility Score is a measure of bone quality, not bone quantity. It analyzes the raw ultrasound signal from your scan for the textural signature of fragile bone, comparing your results against a reference population of people who have and have not previously fractured. In a five-year study of 1,989 patients, the Fragility Score predicted who would actually fracture more accurately than the DEXA T-score or the REMS T-score — with accuracy improving even after adjusting for age and body mass index.

Can I have a normal T-score and still be at risk?

Yes — and this is one of the most important things to understand about bone health. Many people with dense bones still sustain fractures, and many with thinner bones never do. Bone density explains only part of the picture; bone quality matters too. That's why the Fragility Score is reported alongside your T-score rather than instead of it.

What happens after my scan?

Your scan is analyzed and a report is prepared for you and your physician. It covers your bone mineral density at both the lumbar spine and femoral neck, your T-score and Z-score at each site, and your Fragility Score. If you have a referring physician, let us know when you book and we're glad to send the results directly to their office.

Should I make treatment decisions based on my report?

No — your report is a measurement, not a treatment plan. Interpreting it in the context of your history, medications, and other risk factors is your physician's role. Bring your report to your next appointment and ask what it means for your specific situation.

Know your numbers before you need them

A REMS bone density scan takes about 15 minutes and reports your T-score, Z-score, and Fragility Score — two independent measurements in one radiation-free scan. Serving patients across New York and New Jersey.

Schedule My Bone Scan Call 833-454-7263

See what a report looks like on the REMS scan page, or read what osteoporosis is.