Osteopenia, Osteoporosis, and Bone Spurs: What Your DEXA Scan Really Shows

If you've ever had a DEXA scan that mentioned both osteopenia and osteoarthritis, you are not alone.

I recently had a cortisone shot in my left thumb CMC joint (the small joint at the base of the thumb). My thumb was painful from opening jars, tying my shoes, and even holding a golf club. X-rays confirmed the arthritis I already suspected:

“Advanced degenerative changes in the 1st CMC joint, and to a lesser extent in the pisiform-triquetral joint.”

I was at the orthopedic office for my wrist, but my thumb images caused my PA to offer me a cortisone injection right then and there.

This summer, the thumb pain started holding me back from activities I love — and that’s when I knew: it was time for an intervention.

Because that’s the real red flag 🟥- when you stop doing something you love because of pain or fear of pain.

Bone Loss and Bone Spurs? Yes, You Can Have Both

As I scheduled my shot and had updated imaging, I was reminded of a question I’ve been asked many times — and one I’d like to clear up:

Can you have bone growth from arthritis and bone loss from osteopenia or osteoporosis at the same time?

Yes, you can. And it’s more common than most people realize.

Let’s break down what’s really happening in the bones and joints — and how it may be affecting your DEXA scan results.

What’s the Difference Between Osteoporosis and Osteoarthritis?

Osteopenia and Osteoporosis:

• Osteoporosis and Osteopenia occur when bones lose minerals (like calcium) and become less dense, making them more susceptible to fractures (side note: if you need calcium suggestions, read my post on Non-dairy sources of Calcium for Women with Osteoporosis and Osteopenia).

• This bone loss occurs throughout the skeleton, especially in the spine, hips, and wrists.

Osteoarthritis (OA):

• Osteoarthritis is a “wear and tear” condition of the joints, not a bone density issue.

• Cartilage (the smooth tissue covering the ends of bones) breaks down, which can lead to pain, swelling, and stiffness.

• Your body tries to “repair” the joint by producing extra bone, often forming bone spurs (osteophytes).

• These are most often found in the knees, hips, spine, and thumbs.
  

  
  Can You Have Both Conditions? Yes!

• Osteoporosis and osteopenia affect the inside of bones, reducing bone density and strength.

• Osteoarthritis affects the joints and produces extra bone at the edges as the cartilage breaks down.

• That means you can have:

  • Thinner, more fragile bones overall (osteoporosis/osteopenia)

  • Extra bone growth around your joints (osteoarthritis with bone spurs)

  Two different processes, often happening at the same time.

How Osteoarthritis (OA) Affects DEXA scans

Here’s where it gets tricky: if you have OA in your spine or hips, those bone spurs can make your bones appear denser on a DEXA scan.

• This can lead to a false reading—the scan might show your bones as more dense than they are because it’s measuring the extra bone from your osteoarthritis.

• As a result, your osteoporosis or osteopenia may be underestimated. If this is the case, your DEXA report will most likely say something like:

  • "Degenerative changes are present in the lumbar spine, which may elevate bone mineral density measurements."

  • "Osteoarthritic changes (such as osteophytes or disc space narrowing) are noted in the lumbar spine, which may affect the accuracy of the DEXA results in this region."

  • "Results for the lumbar spine should be interpreted with caution due to the presence of degenerative disease/osteoarthritis."

  • "Elevated bone density in the spine may be due to degenerative changes rather than a true increase in bone mass."

A Test That Helps: Trabecular Bone Score (TBS)

When you schedule your DEXA, ask that they will be able to give you a Trabecular Bone Score (TBS). These numbers will help clarify results when arthritis may be clouding the true picture. I wrote about the TBS numbers and how to read them here: What do the TBS numbers on my DEXA scan mean?

So yes, I have both osteopenia and osteoarthritis, and it’s pretty common.

The good news?
​Exercise with progressively heavier weights is the recommended intervention for both of these conditions. I addressed this here: Can I Build Bone with Exercise? Yes!

Why does exercising with heavy weights work?

💪 Strong muscles unload your joints.
💪 Strong muscles also pull on and activate bones, preventing further bone loss
​WIN-WIN!

Key Takeaway

You can absolutely have osteoporosis (or osteopenia) and osteoarthritis at the same time. They’re two different processes, and they can even affect how your DEXA scan looks.

Don’t be discouraged — movement and strength training remain the best tools we have to manage both.

I would love to see you in my Strong Women, Strong Bones program and work to manage both conditions with you, join my newsletter and get upcoming dates and programs.