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Do DEXA scans accurately predict fracture risks ?

I am a 75 old man, physically active ( biking, swimming, jogging and windsurfing).

I recently had a DEXA scan and I am currently scheduled for my 1st appointment with the doctor at the end of the month, to discuss the results.

As I was curious, though, I decided to have a “ sneak-preview” of the results from my medical file and I learnt that I am osteoporotic, with -4.3 T-score on the spine and , therefore, a high risk of fractures ( the T-score at the hips is better and the fracture risk is rated as moderate).

The DEXA scan also shows a possible fracture at L1 and a compression fracture at T3, both absolutely painless. ( I believe the T3 compression fracture may not be related to osteoporosis, but to a bad fall on the ice two years ago. I fell why running home, almost flat on the back.

I am sure I was already osteoporotic, Retrospectively, I wonder why, with such a bad fall and with a T score that low I didn’t suffer more than ONE compression fracture and a pulled muscle!
Could it be because my bones are stronger than what the T-score indicates?

I am also quite surprised that with such a low T-score, which obviously didn’t develop overnight, I should have been able to practice all my usual sports ( including windsurfing ) as a normal person, until today, without ever ever having back problems or, worse, fractures!

I attribute this to my strong muscular build, both in the upper and lower body

This brings me to my question.

Does bone density really accurately predict the fracture risk?

By searching the internet I found clinical studies indicating that this may not be the case..
1. It seems that statistically, more than 50% of all the reported fractures occur in people with a normal BMD.
2. The DEXA scans the bones two dimensionally. It does not scan their three dimensional volumetry,
A 3 dimensional scan could bring forth other elements (the architecture and microstructure of the bone, etc) , which may contribute more significantly to its strength than the mere density. Some introduce a distinction between bone density and bone strength or quality. This could explain why I never fractured any bones or vertebrae in spite of my low T-score

3. One of the studies also observes that the bone of young individuals reach their maximum resistance to fractures while the density has not yet attained its maximum.
4. Is it advisable to wear a lumbar support brace while practicing some sports ( windsurfing?)

To be honest with you, although I’ll be as cautious as possible, I am less afraid of fractures than of having to substantially cut, as a precaution, my favorite sport, windsurfing.

You can find the above-mentioned clinical studies at: /casebased/ccjm/compression-fractures-norm al-bone-density/media/CCJM-v76-6-331.pdf and articleviewer.aspx?year=2010&issue=03000&a rticle=00028&type=Fulltext

I'd like to have comments on the 4 points above.


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