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The Z-score in bone mineral density is utilized to evaluate bone density in comparison to a matched reference population, typically considering age, sex, and other demographic characteristics. The Z-score indicates how a person's bone mineral density compares to the average bone density of a healthy population of the same age and sex.

This comparison is critical, especially in clinical settings, as it helps healthcare providers determine whether an individual’s bone density is within a normal range or if it is lower than expected, which may signify an increased risk for conditions like osteoporosis. A Z-score of 0 indicates that the bone density is average for the matched population, while a negative Z-score indicates lower than average bone density, prompting further investigation or intervention.

Other options do not directly relate to the Z-score: dietary calcium intake and physical activity can affect bone density but are not evaluated by the Z-score itself. The risk of heart disease is not assessed through bone density measurements, making the Z-score distinctly relevant only when comparing bone density against a population benchmark.