Your Good Health: A low T-score and a low Z-score signify severe osteoporosis

Dear Dr. Roach: The results for my last bone density test show not only a T-score but also a Z-score. For my spine , the T-score is -3.4, while the Z-score is -1.4. Can you please explain the difference between the two measurements?

Four years ago, I switched to a whole-food, plant-based diet, and I no longer drink milk. I am thinking this may be the reason behind my poor T-score.A bone density test looks at the amount of minerals in the bone, and newer devices also give a “trabecular bone score,” which looks at the structure of the bone and provides additional information to help estimate the risk of fractures.

The Z-score compares you against an average person of your age and sex. So, an elderly woman might have a low T-score of -2.6 and a Z-score of 0, meaning that she has the expected bone loss of a woman of her age and still has osteoporosis. Since your Z-score is also low, well below zero, it suggests that there is an additional reason beyond age to explain your osteoporosis.

The decision to restart therapy should be guided by your current FRAX score, which combines clinical information about you with the results of your bone density test. After 14 years, you would benefit greatly from restarting treatment, which could mean bisphosphonates like Actonel or Fosamax, or other agents that work differently like teriparatide.

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