Key Topics & Timestamps
- 00:45:05 – Introduction to bone health myths and why calcium isn’t enough
- 00:46:03 – Dr. Susan Brown’s background and the Better Bones approach
- 00:47:42 – Muscle vs. bone: why strength training matters more than you think
- 00:48:33 – Acid-alkaline balance and its role in bone density
- 00:49:06 – Kidney health, cortisol, and bone loss connection
- 00:50:08 – Testing methods, including DEXA scans and their limitations
- 02:04:24 – Reframing osteoporosis as a signal, not an inevitability
How Accurate Are DEXA Scans? A Deeper Look at Bone Health
As a triple board-certified OB-GYN and functional medicine expert, one of the most common concerns I hear from women—especially in midlife—is about bone health. We’re told to “get a DEXA scan,” check our bone density, and then… what? Take calcium? Start medication?
But what if I told you that the conversation around bone health—and even how we measure it—is incomplete?
In this powerful discussion with Dr. Susan Brown, we go far beyond surface-level metrics to uncover what true bone health really means—and whether DEXA scans are giving us the full picture.
Let’s dive in.
What Is a DEXA Scan—And What Does It Really Measure?
A DEXA (Dual-Energy X-ray Absorptiometry) scan is considered the gold standard for measuring bone mineral density (BMD). It provides a numerical score—your T-score or Z-score—that categorizes your bone health as normal, osteopenic, or osteoporotic.
But here’s the truth:
DEXA scans measure bone quantity—not bone quality.
And that distinction is everything.
You can have “normal” bone density but still be at risk for fractures. Conversely, someone with lower density may have strong, resilient bones due to better bone architecture and metabolism.
So while DEXA scans can be helpful, they are not the whole story.
The Missing Piece: Bone Quality vs. Bone Density
Bone is living tissue. It’s constantly being broken down and rebuilt—a dynamic process influenced by:
- Hormones
- Nutrition
- Inflammation
- Movement
- Stress levels
Dr. Susan Brown emphasizes that bone strength is not just about how much mineral is packed into your bones—it’s about how well your body is maintaining and remodeling them.
Think of it this way:
- Density = how much material is there
- Quality = how well it’s structured and maintained
DEXA scans don’t measure:
- Collagen matrix integrity
- Microarchitecture of bone
- Turnover rates (how fast bone is being rebuilt)
This is why relying solely on DEXA results can lead to incomplete—or even misleading—conclusions.
Why Osteoporosis Is Not Inevitable
One of the most empowering takeaways from this conversation is this:
Osteoporosis is not an inevitable part of aging.
If it were, we would see it consistently across all cultures—but we don’t.
Instead, osteoporosis is a signal.
A signal that something in the body is out of balance.
And when we shift our perspective from fear to curiosity, everything changes.
The Acid-Alkaline Balance and Your Bones
This is where things get fascinating.
Dr. Susan Brown has spent decades researching the role of acid-alkaline balance in bone health. And what she reveals is profound:
Your body will sacrifice bone minerals to maintain blood pH balance.
When your internal environment becomes too acidic—due to stress, poor diet, or metabolic imbalance—your body pulls alkaline minerals (like calcium and magnesium) from your bones to neutralize that acidity.
This means:
- Chronic stress → increased acidity
- High cortisol → more mineral loss
- Poor diet → greater demand on bone reserves
So instead of asking, “Am I getting enough calcium?” we should be asking:
“Is my body in a state that supports mineral retention?”
The Kidney-Bone Connection
Another often-overlooked piece of the puzzle is kidney health.
In traditional Chinese medicine—and increasingly in modern science—the kidneys are deeply connected to bone health.
Why?
Because the kidneys regulate:
- Mineral balance
- Acid-base equilibrium
- Hormonal signaling
When your kidneys are under stress (from dehydration, high cortisol, or metabolic dysfunction), your body becomes more acidic—and your bones pay the price.
This is why hydration, electrolyte balance, and stress management are foundational—not optional.
Muscle: The Overlooked Key to Strong Bones
One of my favorite insights from Dr. Brown is this:
“To build strong bones, you must show your body you need strong bones.”
And how do you do that?
Through muscle.
Muscle and bone are intimately connected. When you build muscle, you stimulate bone formation. When you lose muscle, you lose bone.
This is especially critical for women in perimenopause and menopause, when muscle mass naturally declines.
So if you’re only focusing on calcium supplements—but not strength training—you’re missing a huge opportunity.
Why Calcium Alone Isn’t the Answer
For decades, we’ve been told:
“Drink more milk. Take more calcium.”
But Dr. Brown challenges this outdated narrative.
Calcium is important—but it’s not the star of the show.
In fact, without the right environment, excess calcium can:
- Deposit in arteries instead of bones
- Contribute to inflammation
- Fail to improve bone strength
True bone health requires a team of nutrients and conditions, including:
- Magnesium
- Vitamin K2
- Potassium-rich foods
- Protein
- Proper digestion
And most importantly—a balanced internal environment.
So… How Accurate Are DEXA Scans?
Let’s bring it back to the original question.
DEXA scans are useful—but limited.
They can:
✔ Provide a baseline measurement
✔ Track changes over time
✔ Help identify risk categories
But they cannot:
✘ Measure bone quality
✘ Predict fractures with full accuracy
✘ Reflect metabolic or hormonal health
So instead of relying solely on DEXA results, we must take a more comprehensive approach.
A Functional Medicine Approach to Bone Health
In my practice, I always look beyond the numbers.
Here’s what truly matters:
1. Optimize Your Internal Environment
- Reduce inflammation
- Balance blood sugar
- Support hormone health
2. Focus on whole, nutrient-dense foods
- Include alkaline-forming vegetables
- Ensure adequate protein intake
3. Support Digestion
If you’re not absorbing nutrients, you’re not building bone.
4. Build Muscle
Strength training is non-negotiable.
5. Manage Stress
Chronic stress = chronic acidity = bone loss.
6. Stay Hydrated
Hydration supports kidney function and mineral balance.
The Empowerment Shift
What I love most about this conversation is the shift from fear to empowerment.
You are not a victim of your bone density score.
You are not destined for osteoporosis.
Your body is intelligent. It is responsive. And it is capable of regeneration when given the right support.
Listen to the Full Episode
This blog only scratches the surface of the powerful insights shared in this episode.
If you want to truly understand:
- The science behind bone remodeling
- How to interpret your DEXA scan results
- What steps to take today to protect your bones
I invite you to listen to the full podcast episode.
Listen On: YouTube | Spotify | Apple Podcast
It’s one of those conversations that can truly change how you see your body—and your future.
Q&A
Q: Are DEXA scans reliable?
A: They are useful for measuring bone density but do not assess bone quality or overall bone health.
Q: Can you have normal DEXA results and still be at risk?
A: Yes. Bone strength depends on more than density alone.
Q: What’s more important—calcium or overall balance?
A: Overall metabolic and mineral balance is far more important than calcium alone.
Q: How does stress affect bones?
A: Chronic stress increases acidity and cortisol, leading to mineral loss from bones.
Q: What’s the fastest way to support bone health?
A: Build muscle, improve nutrition, and reduce inflammation.
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Disclaimers: The information provided is for educational purposes only and should not be construed as medical advice. Always consult with your healthcare professional before starting any supplement program.
