Beyond the DEXA Scan: Discovering Your Fracture IQ™ and the Hidden Risk Factors for Bone Loss
Posted by: Dr. Rivka Lomedico, Orthopedic Spine Surgeon & Founder of OsteoCore
As an orthopedic spine surgeon, I spend a significant amount of my time in the operating room fixing fragility fractures. Every year in the U.S., there are over 2 million of these low-energy fractures—more than heart attacks, strokes, and breast cancer combined.
When patients come to my clinic after a fracture, they are often shocked. They tell me, "But Dr. Lomedico, my DEXA scan said my bone density wasn't that bad!"
This is a critical misunderstanding in bone health. Up to 50% of patients who suffer a hip or nonvertebral fragility fracture do not actually have osteoporosis as defined by a standard DEXA scan. Bone density only accounts for a portion of your actual bone strength. Relying solely on a T-score gives many patients a false sense of security while ignoring dozens of other variables that actively weaken their skeletal foundation.
That is exactly why I developed the Fracture IQ™ assessment.
What is Fracture IQ™?
Your Fracture IQ™ is a personalized bone health score that goes far beyond a simple X-ray. It evaluates over 50 individual risk factors—from your genetics and medical history to your lifestyle habits and fall risk—to calculate your 10-year probability of sustaining a major osteoporotic fracture.
By looking at the complete picture, we can identify your true risk category (Low, Medium, High, or Very High) and take action before a fracture occurs.
The Risk Factors: What is Actually Impacting Your Bones?
To understand your Fracture IQ™, you have to understand the wide array of factors that influence bone remodeling. Some of these you can't change, but many of them are entirely within your control.
1. The Non-Modifiable Risks (Your Baseline) We start by looking at your demographic and genetic baseline. Advanced age, being of female sex, having a slender or low body weight, and being of Caucasian or Asian descent naturally increase your risk. One of the most powerful red flags is your family history: if you have a parent who suffered a hip fracture, your own risk of fracturing increases significantly.
2. The "Sneaky" Medications One of the most critical things we look at is your medication list. There are over a dozen classes of common drugs that actively deplete bone density or increase fracture risk, including:
Glucocorticoids (Steroids): Long-term use of medications like prednisone severely compromises bone-building cells.
Proton Pump Inhibitors (PPIs): Frequently used for acid reflux, these can interfere with your body's ability to absorb calcium.
SSRIs and Anti-Seizure Medications: Commonly prescribed for depression and epilepsy, these are well-known bone thieves.
3. Secondary Medical Conditions Osteoporosis doesn't happen in a vacuum. Endocrine disorders (like hyperthyroidism and diabetes), digestive conditions (like celiac or inflammatory bowel disease that impair nutrient absorption), and autoimmune diseases (like rheumatoid arthritis) all silently weaken your skeleton from the inside out.
4. Lifestyle and Nutrition Your daily habits dictate your bone remodeling cycle. Smoking and excessive alcohol consumption (three or more drinks daily) are toxic to bone-building cells. A sedentary lifestyle removes the mechanical loading that your bones desperately need to stay strong, and poor nutrition deprives your skeleton of the calcium, vitamin D, and protein it requires to rebuild.
5. The Surprising Role of Sleep Most people don't connect their sleep to their skeleton, but recent longitudinal studies show a fascinating link. Consistently poor sleep quality, or getting less than 6 hours or more than 9 hours of sleep per night, is significantly associated with a higher risk of developing osteoporosis. Chronic sleep deprivation increases cortisol (the stress hormone), which actively inhibits bone formation while promoting bone breakdown.
Take Control of Your Fracture IQ™
Age amplifies all of these factors. A 45-year-old with multiple risk factors has a very different fracture risk than a 75-year-old with those exact same factors.
The beauty of the Fracture IQ™ tool is that it is dynamic. If you quit smoking, optimize your vitamin D, start a progressive resistance training program, or work with your doctor to find bone-safe medication alternatives, your risk score will improve.
You do not need to wait for a fracture to take your bone health seriously.
Want to know your score? Take the free, 5-minute Fracture IQ™ assessment on the OsteoCore app today. You will receive immediate results, a breakdown of your specific risk level, and personalized recommendations for exercise and nutrition to help you build a stronger foundation.
(Disclaimer: Fracture IQ™ is an educational assessment tool and is not a substitute for medical advice, diagnosis, or treatment. Always consult your healthcare provider.)
