If I already have a vertebral fracture, what would DEXA change?

The short version: a DEXA scan will give you a number, but you already have the diagnosis that matters—a vertebral fracture on x-ray—and the scan will not explain your sciatic pain or change what you are willing to do.

You are right to question it. The scan measures bone density at the hip and spine, and the evidence shows that people who have already fractured often have low density at those sites [1]. But you already know your bone is brittle. A fracture on x-ray is the strongest possible proof. The scan adds a number, not a diagnosis.

The sciatic and buttock pain is a separate question. That is nerve territory, and a DEXA scan cannot see nerves or discs. It will not tell you why you hurt now. The old fracture on x-ray is likely incidental to the pain, not its cause.

You are 62, not 50. The evidence shows bone density declines with age, and fracture risk climbs steeply after 80 [4]. But you have already beaten the wheelchair prediction by 12 years. Your current approach—ibuprofen, heat, avoiding mind-altering drugs—is a reasonable choice. The question is whether the scan would change it. If you will not take bisphosphonates or denosumab, the scan changes nothing. If you might, you already qualify for treatment based on the fracture alone, no scan needed.

The evidence on bone drugs is mixed. Bisphosphonates reduce vertebral fractures in most trials, but one trial found more fractures in the treated group than placebo [3]. Teriparatide outperformed risedronate for vertebral fractures in severe osteoporosis [2]. These are real effects, but they come with side effects and no guarantee. The scan does not settle which drug, if any, is right for you.

My call: skip the DEXA. It confirms what you know and ignores what you feel. If the sciatic pain persists, ask for imaging of the nerve roots, not a bone density scan. Confidence: high.