Baseline Bone Density Measurement
Johnson recommends a DEXA scan as the essential first step. The report yields two numbers: a T-score (vs. a peak 30-year-old of same sex) and a Z-score (vs. age/sex/size-matched peers). For those in their 20s/30s, the Z-score becomes the peak to maintain. He emphasizes that a bad baseline is not permanent because the entire skeleton is replaced every 10 years, meaning applied exercise, nutrition, and sleep can rebuild density. He cites a large study showing women over 65 with stronger bones had 51% reduced death risk and 30% fewer mobility issues; men 65–76 had 23% lower 8-year mortality. This re-frames DEXA as a dynamic, actionable metric rather than a static verdict.
Bone undergoes constant remodeling: osteoclasts resorb old bone, osteoblasts deposit new matrix. Over a decade, this turnover replaces the entire skeleton, which is why lifestyle interventions can meaningfully shift DEXA scores.
When you get your report from your DEXA scan, you're going to get two numbers, a T-core and a Zcore. Your T-core is going to compare your bone middle density to a peak 30-year-old of the same sex. Now, your Zcore compares you to those who are your same age, sex, and body size.

