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

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.

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.

Those are great numbers! Congratulations!! Are those of your spine or hip? Also, I didn’t know we can get REMS tests closer together. I am looking for a place to get one near me; it is TOUGH to find!
Getting TBS score would help so much to see the quality of my bones. I did fall this year; backwards, from my dogs running towards me, and nothing broken!!

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

Have you listened to this podcast from dr mccormick and Margie Bissinger? Very educational. He is so good at explaining the various medicines and how they work at the cellular level.

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

Sophie, I was diagnosed with severe osteoporosis a year ago. My T score for my spine was -3.6. After 12 months of Evenity my T score was -3.5. I did everything possible from a high protein and calcium diet to walking 3 to 5 miles a day, lifting free weights and physical therapy twice a week for one whole year. I was told by my doctor that I’m in the 5% group where Evenity did not work for me. Not sure why, it could have been my own antibodies neutralized the drug, my thyroid disease or the osteoporosis was so severe when diagnosed that is was too late to turn it around. I’m on Prolia now and still maintaining my same routine of diet, exercise and prayer in hope of a lower score come 2026. I pray that you will have a better outcome than me.

It amazes me how some drugs work for others and then not for some. I did really well on Evenity went from -4.6 to -3.3. Then went on Prolia and basically had nothing went to -3.2. I was also on hormones during the time I was on Evenity and maybe that helped also.