[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/betterbones.com\/osteoporosis\/bone-density-testing-do-small-boned-women-get-a-fair-shake\/#Article","mainEntityOfPage":"https:\/\/betterbones.com\/osteoporosis\/bone-density-testing-do-small-boned-women-get-a-fair-shake\/","headline":"Bone Density Testing: Do Small-Boned Women Get a Fair Shake?","name":"Bone Density Testing: Do Small-Boned Women Get a Fair Shake?","description":"Print PDF eBook Facebook Twitter Gmail 14 LinkedIn 1 Pinterest 2 Are small-boned women being misdiagnosed with osteoporosis? For decades, I\u2019ve seen it again and again: petite, light-framed women\u2014often active, vibrant, and otherwise healthy\u2014being told they have osteoporosis based on their bone density test results. They haven\u2019t had fractures. They don\u2019t show major risk factors. […]","datePublished":"2026-01-20","dateModified":"2026-04-22","author":{"@type":"Person","@id":"https:\/\/betterbones.com\/author\/brownbetterbonesgmail-com\/#Person","name":"Dr. Susan E. Brown, PhD","url":"https:\/\/betterbones.com\/author\/brownbetterbonesgmail-com\/","identifier":72,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/8e08d87bd45250c6616e1752933a6576aba077f335d97ee337a0cde5e435cbd3?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/8e08d87bd45250c6616e1752933a6576aba077f335d97ee337a0cde5e435cbd3?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Center for Better Bones","logo":{"@type":"ImageObject","@id":"https:\/\/betterbones.com\/wp-content\/uploads\/2018\/12\/Better-Bones-AMP.png","url":"https:\/\/betterbones.com\/wp-content\/uploads\/2018\/12\/Better-Bones-AMP.png","width":150,"height":60}},"image":{"@type":"ImageObject","@id":"https:\/\/betterbones.com\/wp-content\/uploads\/2026\/01\/BB-Blog-Headers-416-7.png","url":"https:\/\/betterbones.com\/wp-content\/uploads\/2026\/01\/BB-Blog-Headers-416-7.png","height":1109,"width":2120},"url":"https:\/\/betterbones.com\/osteoporosis\/bone-density-testing-do-small-boned-women-get-a-fair-shake\/","video":{"@context":"http:\/\/schema.org\/","@type":"VideoObject","@id":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE#VideoObject","contentUrl":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE","name":"Bone Density Test Results - WRONG?","description":"Did you know your bone size can affect your bone density test results?\n\nResearch shows that small-boned, shorter, or very low-weight individuals often get inaccurate bone density readings \u2014 making their bones appear weaker than they truly are.\n\nDr. Susan Brown explains why bone density scans can underestimate bone strength for smaller frames and why your test results don\u2019t always tell the full story.\n\n\u2705 Learn what affects bone density accuracy\n\u2705 Understand how size and structure influence readings\n\u2705 Discover what really determines bone strength\n\nAlways take your bone density score with context \u2014 especially if you\u2019re small-framed or under 5 feet tall.","thumbnailUrl":["https:\/\/i.ytimg.com\/vi\/kMh1O-nG6GE\/default.jpg","https:\/\/i.ytimg.com\/vi\/kMh1O-nG6GE\/mqdefault.jpg","https:\/\/i.ytimg.com\/vi\/kMh1O-nG6GE\/hqdefault.jpg","https:\/\/i.ytimg.com\/vi\/kMh1O-nG6GE\/sddefault.jpg","https:\/\/i.ytimg.com\/vi\/kMh1O-nG6GE\/maxresdefault.jpg"],"uploadDate":"2025-12-26T15:01:29+00:00","duration":"PT56S","embedUrl":"https:\/\/www.youtube.com\/embed\/kMh1O-nG6GE","publisher":{"@type":"Organization","@id":"https:\/\/www.youtube.com\/channel\/UCm6Zry9uGdrZpm05sQLIxMw#Organization","url":"https:\/\/www.youtube.com\/channel\/UCm6Zry9uGdrZpm05sQLIxMw","name":"Dr. Susan E. Brown","description":"Dr. Susan E. Brown, PhD, is a medical anthropologist, a New York State Certified Nutritionist, and the author of Better Bones, Better Body -- the first comprehensive look at natural bone health. Dr. Brown specializes in osteoporosis, osteopenia, bone health regeneration, and auto-immune disease. She is also famous for her natural approach to bone health; check out her Better Bones programs and products.","logo":{"url":"https:\/\/yt3.ggpht.com\/ytc\/AIdro_m0l08uY9k8RO1FbN8-VsYIOa8fiq9BtocNNM_k3xw7a7s=s800-c-k-c0x00ffffff-no-rj","width":800,"height":800,"@type":"ImageObject","@id":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE#VideoObject_publisher_logo_ImageObject"}},"potentialAction":{"@type":"SeekToAction","@id":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE#VideoObject_potentialAction","target":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE&t={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"},"interactionStatistic":[[{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE#VideoObject_interactionStatistic_WatchAction","interactionType":{"@type":"WatchAction"},"userInteractionCount":2673}],{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=kMh1O-nG6GE#VideoObject_interactionStatistic_LikeAction","interactionType":{"@type":"LikeAction"},"userInteractionCount":108}]},"about":["Osteoporosis"],"wordCount":1490,"articleBody":" Print PDF eBook\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tFacebook\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTwitter\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tGmail\t\t\t\t\t\t14\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tLinkedIn\t\t\t\t\t\t1\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tPinterest\t\t\t\t\t\t2\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAre small-boned women being misdiagnosed with osteoporosis?For decades, I\u2019ve seen it again and again: petite, light-framed women\u2014often active, vibrant, and otherwise healthy\u2014being told they have osteoporosis based on their bone density test results. They haven\u2019t had fractures. They don\u2019t show major risk factors. Yet they leave the testing center with a diagnosis that can feel devastating.Over time, I began to suspect what now many researchers are confirming\u2014these women are being misdiagnosed. Their low DEXA (bone density) scores do not necessarily mean their bones are weak. In fact, for women with smaller bones, these test results may be giving a false picture of fragility.What Dr. Henry Paul Golding\u2019s research revealsRecently, Australian researcher Dr. Henry Paul Golding published a groundbreaking study confirming what many of us have observed for years: individuals with smaller bones are disproportionately diagnosed with osteoporosis when, in reality, their bones may be perfectly strong and healthy.Dr. Golding\u2019s 2022 study, published in Bone Reports, demonstrated that the current bone mineral density (BMD) testing method\u2014DEXA\u2014systematically underestimates bone strength in smaller bones. His team used artificial vertebrae of varying sizes to show that DEXA readings decline as bone size decreases, even though the actual \u201ctrue\u201d bone density remains the same.In other words, the machine isn\u2019t measuring bone weakness\u2014it\u2019s measuring bone size, and confusing smaller volume with lesser strength. This creates a widespread pattern of false positives for osteoporosis among petite women.Why this happens: DEXA\u2019s design problemTo understand this, we need to look closely at what a DEXA scan really measures. The term \u201cbone mineral density\u201d makes it sound as if the test measures how dense or solid your bone tissue is\u2014but that\u2019s not quite true.A true density measurement would require a three-dimensional (3D) assessment of bone volume\u2014its length, width, and depth. DEXA, however, is a two-dimensional (2D) imaging technology. It projects X-rays through bone and records an areal (surface-based) measurement\u2014essentially the mineral content spread across an area of bone, not within its full volume.Because the DEXA scan flattens a 3D structure into a 2D image, people with smaller bones naturally appear to have \u201cless dense\u201d bone, even when the mineral concentration per unit of volume is the same. That\u2019s why a petite woman\u2019s bones can look osteoporotic on paper, when in reality, her bone strength may be perfectly normal.The problem has been known for decadesThis isn\u2019t a new revelation. The influence of bone size on DEXA readings has been known in the scientific community for decades\u2014but rarely discussed in clinical practice or public health messaging.Unfortunately, DEXA manufacturers have not corrected this flaw. As Dr. Golding emphasized, \u201cthe areal bone mineral density testing results given by both DEXA devices are not in any way corrected for the difference in bone size.\u201dSo while DEXA technology has become the \u201cgold standard\u201d for diagnosing osteoporosis, its results can be misleading for millions of women\u2014particularly those who are short, thin, or small-framed.More cracks in the DEXA modelDEXA\u2019s size bias isn\u2019t the only problem. There are several other reasons why bone density testing may not tell the full story:High error rate: Studies suggest that as many as 90% of DEXA scans contain errors, and about half of these are significant enough to alter diagnosis or treatment decisions. Calibration issues, positioning errors, and operator variability can all skew results.Poor fracture prediction: DEXA results are not reliable predictors of fracture risk. Research from around the world documents that up to 80% of fractures occur in people with normal or osteopenic DEXA results, not in those labeled osteoporotic. Clearly, something more than \u201cdensity\u201d determines bone resilience.Narrow definition of bone health: Bone strength is a complex interplay of bone architecture, turnover rate, mineralization, collagen quality, and muscle support\u2014none of which are measured by DEXA. The test focuses narrowly on one number and ignores the living, dynamic nature of bone tissue.Taken together, these limitations make diagnosing the disease of osteoporosis by DEXA bone density, a \u201cgood try that didn\u2019t quite work out.\u201d DEXA bone density testing value as one piece of information\u2014but it should never be used in isolation to define a person\u2019s bone health , diagnosis the disease of osteoporosis or to dictate treatment.A better way to view bone healthIf bone density testing has these flaws, what should women do instead? The answer lies in taking a broader, more holistic view of bone health\u2014one that considers the whole person, not just a single scan result.Here are a few empowering steps you can take right now: Know your real risk factorsYour fracture risk depends on many variables\u2014nutrient status, exercise patterns, chronic inflammation, antioxidant status, toxic load, family history, use of bone-depleting medications, pH balance and degree of chronic low grade metabolic acidosis, balance of numerous hormones including cortisol, DHEA, PTH, progesterone, estrogen and testosterone and much more.Our Better Bones Fracture Risk Assessment can help you identify the most relevant factors for you. A.Remember: multiple small risk factors matter more than a single DEXA score. Support your muscle\u2013bone connectionBone and muscle are intimately linked. As research shows, you gain and lose them together. Strength training, resistance work, yoga, or even regular brisk walking can dramatically improve bone density, balance, and fracture resilience. Optimize nutrition and pH balanceYour bones thrive in a slightly alkaline environment. A diet rich in vegetables and fruits of all colors, adequate protein, and all 20 key bone nutrients including minerals\u2014especially calcium, magnesium, potassium, and vitamins K2, C and all B vitamins\u2014help preserve bone structure and reduce bone-depleting acidity. Mind your hormones and thyroidHormones like cortisol, DHEA, PTH, estrogen, progesterone, and thyroid hormones profoundly influence bone remodeling. If you\u2019re in midlife or post-menopausal, or if you\u2019re on thyroid medication, it\u2019s worth working with an integrative practitioner to keep these hormones balanced. Both excess and thyroid hormone levels jeopardize bone. Manage stressChronic emotional, mental stress and worry raises cortisol, which can rob calcium from bones. Cultivating resilience, practicing meditation and deep breathing exercises, and adequate rest are not luxuries\u2014they\u2019re bone-building essentials. Get sunlight and vitamin DYour body needs vitamin D to absorb calcium and maintain healthy bone turnover. Aim for sensible sun exposure.\u00a0 Know that we produce vitamin D from a small spectrum of solar ultraviolet radiation.\u00a0 Dermal production of vitamin D precursors occur when your shadow is shorter then you are.Due to the limited amount of time we spend outdoors and contemporary concerns with excessive unlight exposure, most individuals need to supplement with vitamin D3. At the Center for. We suggest reaching an optimum. 50 to 60 ng\/ml vitamin 25 OHD level (equivalent to 125-150 nmol\/L in European units.The power of perspective: take heart and take actionIf your DEXA results have worried you\u2014especially if you\u2019re small-framed\u2014take a deep breath. Numbers don\u2019t define your health or your destiny. As Dr. Golding\u2019s research and decades of clinical observation show, many small-boned women have been unfairly labeled \u201costeoporotic\u201d when they are not.Bone health is not static\u2014it\u2019s dynamic and reversible. Your bones are living tissues, constantly remodeling in response to how you move, eat, think, and rest. You have enormous capacity to rebuild and maintain bone strength naturally.At Better Bones, our goal is to help you understand the bigger picture\u2014to replace fear with knowledge and confusion with empowerment. If you\u2019re ready to go deeper, explore our Better Bones Solution 6-Step Program \u00a0and the Better Bones Solution Masterclass to learn how you can build Better Bones and a Better Body for life.Take heart, take action, and remember: your body has an extraordinary ability to renew itself when given the right support.\u00a0Reference:Golding, H. P. (2022). Dual-energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) for diagnosis of osteoporosis\u2014experimental data from artificial vertebrae confirms significant dependence on bone size. Bone Reports. PubMed linkAbout the AuthorDr. Susan E. Brown, PhDNew York State Certified Nutritionist & Medical Anthropologist  |  Founder, Center for Better BonesDr. Brown has dedicated more than 40 years to bone health research, clinical nutrition, and health education. She is the founder of the Center for Better Bones and the Better Bones Foundation, and author of Better Bones, Better Body \u2014 the first comprehensive guide to natural bone health. Her whole-body, alkaline-centered approach has helped thousands of women build stronger bones naturally.📖 Wikipedia📚 Amazon Author Page\u2192 Full Bio{  \"@context\": \"https:\/\/schema.org\",  \"@type\": \"Person\",  \"name\": \"Dr. Susan E. Brown\",  \"honorificSuffix\": \"PhD\",  \"jobTitle\": \"New York State Certified Nutritionist & Medical Anthropologist\",  \"description\": \"Founder of the Center for Better Bones and Better Bones Foundation. Author of Better Bones, Better Body. 40+ years of clinical nutrition and bone health research.\",  \"url\": \"https:\/\/betterbones.com\/about\/\",  \"image\": \"https:\/\/betterbones.com\/wp-content\/uploads\/2025\/08\/DrBrown.webp\",  \"sameAs\": [    \"https:\/\/en.wikipedia.org\/wiki\/Susan_E._Brown\",    \"https:\/\/www.amazon.com\/Susan-E-Brown-PhD\/e\/B001HOFHX8\/\",    \"https:\/\/betterbones.com\/about\/\"  ]}For a complete guide to rebuilding bone naturally, see our resource on natural osteoporosis support and bone rebuilding.Read our complete guide to bone density testing explained.To build bone through movement, explore the Better Bones Exercise for Osteoporosis program."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Osteoporosis","item":"https:\/\/betterbones.com\/osteoporosis\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"Bone Density Testing: Do Small-Boned Women Get a Fair Shake?","item":"https:\/\/betterbones.com\/osteoporosis\/bone-density-testing-do-small-boned-women-get-a-fair-shake\/#breadcrumbitem"}]}]