How bad is a spine T-score of -4 ?

I think if someone is looking for someone who specializes in osteoporosis treatment, the best search is "metabolic bone specialist."In general, I would agree that an orthopedist is probably not the best option, but my first specialist was an orthopedic surgeon who is Chief of the Metabolic Bone Disease Service at HSS in NYC. I was referred to him - otherwise I never would have found him. My endocrinologist is not current on osteoporosis treatment and isn't interested in becoming so. My new doctor is a rheumatologist who specializes in osteoporosis and I love her.

Totally agree re: Prolia.

@shail Did you start the Prolia yet?

Once you've familiarized yourself with the medications and their classifications (very basically they either build bone or retain bone) then you can find out what the suggested sequence would be after each one. I'm trying to keep it really simple as I know there's so much information and it can feel overwhelming. Kudos to you for being proactive!

I had never thought of consulting an endocrinologist earlier. only now on this site I saw people talking about their endocrinologists and was wondering why. thanks so much for for specifying it.

now after all your advice I'll get the CTx and P1NP tests done and then consult an endocrinologist. I was contemplating doing a zoom consult with Dr keith mc cormick before talking to my doctor here.

your inputs are valuable

thankfully I haven't as yet. I've been fortunate to have come upon this wonderful community in my search. I was relying upon chatgpt but have realised it's not enough at all, and yet I gathered more answers on it than the doctor!
The importance of getting the bone markers before the medication is so important as well as doing it 3 monthly to track it's progress and deciding on the next treatment based on blood tests as well as dexa [not only dexa!]
what I learnt from chatgpt is that prolia builds while zoledronic acid preserves so that gains are not lost and prevents the rebound.
yet I was under the impression that once started I 'll be on it for life which was daunting. Dr. keith mc cormick gave hope that it's possible to get off while keeping track so that one can restart it if required. tho I have yet to understand it better 🙂
thankyou for the guidance & encouragement, a big hug

Had MRI and will see results with Orthopaedic surgeon this week…Endocrinologist appointment in a few weeks

@shaila If you'd like to take a deeper dive, you might want to check out Tymlos, Evenity and Forteo as alternatives to Prolia. Amongst others, @gently has experience with Forteo, and @mayblin has experience with Tymlos (as do I).

There are pros and cons to all of these medications. As you can imagine, these are powerful drugs. You will find many reports of negative side effects here, all of them valid. I would like to suggest that you also search for positive responses to these medications as those are valid too.

For reference, I have been on Fosamax, then Evenity for one year, Tymlos for one year, and I had my first Reclast infusion in May 2025. So far, so good!

As always, best wishes to you moving forward.

@shail I'd like to suggest that you also search for a "metabolic bone specialist" as that's a broader search that includes many specialists. So far, I've seen an orthopedic surgeon who is Chief of the Metabolic Bone Disease Service at HSS in NYC, an endocrinologist who is not current on osteoporosis treatment and isn't interested in rectifying that, and my current specialist is a rheumatologist who specializes in osteoporosis and is wonderful.

I am on Dr Doug Lucas’s program. I began Sept 2024. Among many components, I am lifting heavy weights and doing high impact. My spine bone density increased 9.2% from Apr 2024 through early Aug 2025. Even with a 2% margin of error associated with a Holologic scanner, this is a win. Caution: I work out with a trainer who spots me when I lift. I started lifting in June 2024 with never having picked up a bar bell before, so I needed a trainer.

Can you share your Tscore with us before Dr Lucas and after? Are you doing other things besides weightlifting? I am trying to stay off the meds; no fractures, FRAX score is great, but TScores not so great (-3.2 spine, -2.2 hips).. I am seeing a dietitian to help eat healthier, working with a trainer, have started Dr McCormick’s collagen supplement, among other things. My endocrinologist, after many many tests to rule out secondary causes of osteoporosis, said my OP is due to menopause and calcium deficient diet. My CTX number is around 479, P1NP is 63. So not crazy numbers, but then I don’t know what would be “normal” for me. I am going to try to get a consultation with Dr McCormick (for those who haven’t heard of him, he wrote Great Bones, an encyclopedia on Osteoporosis) just to get his input.

A better indicator than T-score is BMD (bone mineral density) because of how the graph lines plotting T-scores decline as one ages (y-axis = BMD; x- axis = age; T-score is represented as a slight downward slope on the graph). At any rate, Apr 2024 L1-L4 BMD = .709 (T-score = -3.1). Aug 2025 BMD =.775 (T-score= -2.5).

I also had REMS analysis in Jan 2025 and Aug 2025; spine quality has improved about 6%.

NOTE: I did not begin weightlifting until June 2024 and I did not begin Dr Doug’s program until last Sept.

It has taken much daily diligence and grit to improve; OP, as Dr Doug says, is not a disease that you can supplement your way out of.