I was on a Zoom call Tuesday night with Dr. Andy Bush, an orthopedic surgeon who works with REMS bone scanning technology, when one of his patients joined in to share her own story. I have not stopped thinking about it since. She told it in her own words, and I want to tell it to you close to how she told it to us.
If you have not already read the first story we shared on this topic, about a patient who fell on the ice multiple times and broke nothing despite a DEXA scan that said she should have, here it is, along with the deeper clinical breakdown of why your DEXA scan may be misleading you about your bone health.
Key Highlights
- She was told, in her own words, that a bone density test put "the fear of death" in her.
- Months later, she was told she had a spinal compression fracture, days before a trip she could not cancel. She flew across the country believing her back was broken.
- It was never broken. When she got home, another doctor confirmed there was no compression fracture at all.
- She says Dr. Bush "saved my life," because she believed she was going to be, in her words, "an eggshell for the rest of my life."
- A newer type of scan, called REMS, measures bone structure rather than density alone using ultrasound, with no radiation involved, and it is useful for a wider group of people than most realize.
- Everyone over 45 should consider getting a baseline scan, because the most useful comparison is never to another woman's bones. It is to your own bones over time.
1. "It Literally Put the Fear of Death in Me"
She had been in a serious Vespa scooter accident, ejected in a hard, high-energy trauma. She shattered her clavicle and tibia, fractured a rib, broke her fibula, and by her own account, "was a mess." Once she had recovered enough, she decided to get a bone density test done out of caution.
During the scan, a technician asked her a series of standard questions. Had her mother ever had osteoporosis. Had her mother ever broken her hip. She answered honestly that she did not know. Every time she said "I don't know," the technician recorded it as yes, without telling her.
The results came back warning of a thirty-eight percent chance of fracturing her leg or her spine. In her own words: "They literally put the fear of death in me." A rheumatologist handed her a stack of research on medication, including Fosamax and its side effects, and told her to come back in a month with a decision. She does not like taking pills. She likes to go, in her words, "as holistic as possible." The material did not reassure her. It scared her further.
2. She Did Her Own Homework, and He Still Would Not Listen
She started researching on her own. She joined osteoporosis groups online. That is where she first heard about REMS. Before her REMS appointment, she went back to the rheumatologist with what she had found: she had spoken to her aunt, and no one in her family had ever had osteoporosis or broken a hip. The intake answers recorded on her behalf were wrong, and she told him so.
He refused to change the diagnosis. In her words, "he refused to listen to me." She says he "basically blew me off," and that it upset her deeply.
3. "I Was Flying With What I Thought Was a Broken Back"
A few days before she was scheduled to travel to see Dr. Bush, and from there to help move her mother into a nursing home, her back started to hurt. She went in for imaging, and they told her she had a compression fracture in her spine. Between the earlier diagnosis and this new one, she says, "I feel like I'm walking on eggshells now."
She got on the plane anyway, because the trip could not wait. In her own words: "I was flying with what I thought was a broken back."
4. He Saved Her Life
When she arrived, Dr. Bush ran the REMS scan and also pulled up her existing X-rays. Looking at the same images that had produced her compression fracture diagnosis, he told her plainly that he did not understand how anyone had read a fracture into them at all, since her own arm was in the way of the relevant area in the image.
Her REMS results placed her in the yellow zone, not the green zone outright, but nowhere near what the fear-inducing numbers had implied. When she got home, she saw another doctor, who confirmed what Dr. Bush had already told her. There was no compression fracture. There never had been.
In her words: "I swear to God, he saved my life, because I thought I was gonna be an eggshell for the rest of my life."
5. Where She Is Now
She has kept going since that appointment. She describes a shelf of osteoporosis books at home from how deep she went into researching this for herself. She added targeted supplements, started hormone replacement therapy to support her bone density, and is now looking forward to her follow-up REMS scan on September 18th, which will take place at my office here in Menlo Park with Dr. Bush. She wants to see how her numbers have moved since her last scan in 2024, and she is genuinely excited to see the progress. Her own words: "It really changed my life."
6. Why a Baseline Matters, and Who Should Get One
REMS uses ultrasound, the same category of technology used in pregnancy scans. There is no radiation involved, which means it is something you can repeat regularly without the exposure concerns that come with X-ray-based testing.
This is worth considering for several groups, not only people with a suspected fracture:
- Everyone over 45. The single most valuable thing a REMS scan gives you is a baseline. The most meaningful comparison for your bone health is never to a reference population of women who do not have your body. It is to your own results, years later. Getting a baseline now gives you the clearest possible picture of how you are actually changing over time.
- Women already diagnosed with osteoporosis or osteopenia through a standard bone density scan. A second read that assesses bone structure rather than density alone often tells a very different story than the original diagnosis.
- Women who have never had a bone density scan at all. This newer test measures fragility directly, rather than relying on a statistical comparison that was never built around any one individual body.
- Women who already have bone density results on file. Bone strength and bone density are not the same thing, and strength is what actually predicts whether a bone holds up under real-world stress.
- Men. This is not only a women's issue. Men are diagnosed with osteopenia and osteoporosis regularly, and the same statistical limitations that distort women's results apply to men's results, even though the conversation around bone health rarely includes them.
7. The Real Reason This Matters
A large part of why I care about this goes beyond the test results. It is about the fear these diagnoses create, and what that fear does to a woman's life afterward. Here is the pattern I see over and over:
- A woman gets a diagnosis of osteoporosis or osteopenia.
- She becomes afraid of falling, of lifting, of doing the activities she has always done.
- She stops skiing, stops hiking, stops picking up her grandchildren, stops moving the way she used to.
- Reduced movement leads to weaker muscles, which leads to weaker bone, since bone responds to load and stress by getting stronger, not weaker.
- The stress and fear add another layer of harm, since chronic stress raises cortisol and other stress hormones that actively break bone down over time.
- A year or two later, her bone density has, in fact, declined, and the original diagnosis feels confirmed.
This is a self-fulfilling prophecy. The diagnosis did not predict the decline. The fear response to the diagnosis caused it.
What This Means for You
A test result is data. It is not a verdict, and it is not always accurate on the first read. If something in a diagnosis does not match your actual history, your family history, or what your body has proven through real events, that gap deserves a second look before it changes how you live. And if you have never had any bone health testing at all, there is real value in starting now with a baseline you can measure yourself against for years to come.
Bone health rarely stands alone. Declining estrogen during perimenopause and menopause has a direct effect on bone density, which is one more reason bone health deserves to be looked at alongside your broader hormone balance, not as an isolated number on its own. This is exactly why I never treat a single lab value, scan, or score as the whole story. A full picture, built from your actual history alongside comprehensive functional lab testing, tells you far more than one number ever will.
A Note on Finding the Right Care
Every patient deserves a doctor willing to look again when the data does not add up. If you have been handed a diagnosis that never sat right, or that does not match what you know about your own body and your own history, it is worth getting a second, closer look before you accept it.
If you are over 45 and want to establish your own bone health baseline, or want a second look at results you already have, you can schedule your REMS scan.
Frequently Asked Questions
Is a REMS scan safe? Does it involve radiation?
REMS uses ultrasound, not X-rays, so there is no radiation exposure involved. It uses the same category of imaging technology used for pregnancy scans.
Why does a baseline scan matter so much?
The most accurate way to track your bone health over time is to compare your own results to your own results years later, not to compare yourself against a reference population of women who may not share your body type, frame, or history.
Who should consider getting a REMS scan?
Everyone over 45 benefits from establishing a baseline. Beyond that, anyone with an existing osteoporosis or osteopenia diagnosis, anyone who has never had a bone density scan, and men, since bone fragility is not only a women's health issue despite how the conversation is usually framed.
Should intake questions during a medical test ever be answered on a patient's behalf?
No. An "I don't know" answer should be recorded as exactly that. Assuming an answer and entering it without telling the patient can change a risk calculation significantly, as it did here.
Can fear about a diagnosis actually make bone health worse?
Yes. Reduced activity from fear of injury weakens muscle and bone over time, and the stress response itself raises hormones that accelerate bone breakdown.