Is Your Bone Density Program Actually Working? 5 Ways to Know Beyond the DEXA Scan

A bone density score is one number, taken once. Here's what to watch the other 99% of the time.

A DEXA scan is a snapshot. It tells you bone density at one point in time. It tells you nothing about whether you’ll fall, whether you’ll catch yourself if you do, or whether your training is working between scans.

If you’re only tracking T-scores, you’re flying blind for 22 of the next 24 months. Here’s what to track in between.

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Why a DEXA on its own isn’t enough

DEXA is the gold standard for measuring bone mineral density. It’s also limited in three specific ways most people don’t realise.

It’s a snapshot, not a trend. Most clinicians won’t re-scan more often than every 2 years. The “least significant change” threshold (about 0.03 g/cm²) means smaller shifts are likely measurement noise, not real bone change. So you’ll often wait 18-24 months to know whether your training is actually working.

It only measures bone. It doesn’t measure the things that actually decide whether you’ll fracture such as muscle quality, balance, reaction speed, coordination, walking power, or how consistent you’ve been with food and training. Around 90% of hip fractures happen during a fall. The fall itself, and how strong you are when you hit the ground, matters as much as the bone density number.

It can hide bad trends behind decent numbers. Lean muscle mass loss often happens silently along with balance decline. By the time the next scan flags it, you’ve lost 18 months of correctable ground.

The fix: track functional metrics monthly or quarterly. They tell you whether you’re moving in the right direction long before the scan does.

The 5 metrics to track

In order of priority. Don’t try to add all seven at once. Pick three to start.

1. Strength gains

Strength is the single best proxy for bone-loading stimulus. If your big lifts are going up, your bones are being told to stay.

Track one rep max (or estimated 1RM from 5-rep sets) on four lifts:

• Squat or leg press,

• Deadlift or hip hinge,

• Press (overhead or bench),

• Row or pull.

• Add grip strength with a hand dynamometer (around £25 on Amazon).

Test monthly. Look for 1-3% improvement per month in your first year of training, slowing thereafter. Grip strength under 27kg in men or under 16kg in women correlates with frailty risk.

Log it in a notes app or a spreadsheet. The act of tracking is half the value.

2. Balance

Balance failure is what turns a low T-score into a fracture. Good news is it’s trainable, and it improves faster than bone density does.

Test these three monthly, same time of day, no shoes, hand near a wall but not touching

• Single-leg stand, eyes open. Goal: 30+ seconds each side.

• Single-leg stand, eyes closed. Much harder. Goal: 10+ seconds. Under 5 seconds is associated with increased injurious fall risk.

• Tandem stance (heel directly in front of toe). 30 seconds.

If one side is significantly worse than the other, that asymmetry is a red flag. Train it.

3. Walking speed and power

Gait speed is one of the strongest single predictors of falls, fractures, and all-cause mortality in older adults. It’s also free to measure.