Mild osteoporosis DEXA scores: what would you do?

Same here with the hypothyroidism (Hashimoto's). My first addressing of osteoporosis (-2.5) was by my primary care doctor, and the Rx was for Fosamax. I wouldn't expect her to know about the bone markers, but I imagine she should/could have known about the relationship between low thyroid and bisphosphonates treatment. What bothers me is that the endocrinologist she referred me to later should have been aware of BOTH of these things instead of zeroing straight in on Prolia and citing insurance as the probable reason for that path. I hesitate to go back to her at all, but on the other hand I feel I haven't given her the full opportunity to bring things around. I was not as knowledgeable then as I am now. As far as the DEXA, I have new insurance now and am told they will cover it in my age group (over 50) in full as long as the doctor supports it. Good direction on the DEXA comparison, thanks!

I agree with @ans that good integrative docs are hard to find and very expensive. Even the ones that are not great will charge you around $650 for the first appt. I've had many integrative docs over the years and most have had a similar approach. They put you through a battery of expensive blood, stool, mold, food sensitivity, heavy metal and toxin tests. I think some of these tests are valid but I'm not sure we all need all of them so if you do pursue this route, start small and targeted with your testing. The validity of food sensitivity tests have been called into question. A better and cheaper approach is to do an elimination diet of a single food of category like gluten or dairy for 4 days to a week and see how you feel. Then reintroduce for a couple of days and see how you feel. Almost all integrative docs will tell you to eliminate gluten if you have any type of inflammatory issue. Secondarily, they will advise you to eliminate dairy. In my case, after doing much research on my own, I eliminated those two things in my diet and my alopecia went into remission. So, it is helpful to figure out if any foods are causing malabsorption issues or inflammation.

Most integrative docs are not experts in osteoporosis so I think you're best bet is an appt with Dr McCormick. The fact that your bone density was stable after meds and then dropped might be a good thing to explore with him. He is knowledgeable enough to have a perspective on what tests to do to potentially determine a root cause, and recommend which medication might be best for you and at what point in time. And he's half the cost of an integrative doc.

My most recent appt with an integrative doc was with Felice Gersh who is an MD specializing in menopause, with extensive experience prescribing hormones. Since I've been on HRT for 5 years, I thought it would be a good idea to speak with someone knowledgeable to discuss dose and long term use. She charged $650 for the initial appt and $350 for the second appt (1/2 hour). I felt those two appts provided a valuable perspective and I agreed that a dose adjustment might be helpful. Of course, she tried to hook me in to becoming a regular patient with ongoing follow up as many of them do but I didn't feel it was necessary other than a check-in every few years perhaps. And commonly, she tried to sell me lots of supplements so I had to exercise discretion.