<s>[INST] Hello doctor, I am a 43 year old male. I had been diagnosed with autoimmune polymyositis four years ago. I was previously a sportsman for most of my life with a reasonably healthy diet. I have been on Prednisolone and Azathioprine for four years, on Methotrexate for four years and Folic acid. I just had a DXA bone scan with a Z-score of -3.4 in the spine, and -1.7 in the hip. I know corticosteroids can contribute to reducing BMD, but is this extent normal in less than four years? My rheumatologist is away for few weeks. Please help. What do these results mean? Does it imply osteoporosis?  Please advice as to what I can do next. Should we eliminate causes other than corticosteroids? [/INST] Hello. I hope this helps. If you have any further questions please feel free to contact me. For more information consult a rheumatologist online --> </s>