High T-scores from DXA may be due to either artifacts, drifts in calibration of the DXA apparatus, large sized bones (or people), or underlying bone “sclerosis”. It is prudent to start with a radiograph of these regions to r/o artifacts such a s degenerative changes leading to false elevations of bone density and also to search for evidence of underlying bone disease. Underlying bone sclerosis can be caused by a variety of diseases, but one that should be kept in mind is hepatitis C which may otherwise be without any symptoms. In summary, high T-scores do require some concern and appropriate further evaluation.