It’s tough to know what’s right. Spinal compression fractures concern me the most. But as you mention @babs10 the meds over time are concerning, too.
I’m 69, family history of osteoporosis. I’m mostly a moderate exerciser, but my diet has always included calcium, protein, and I get enough D. My doctor wrote prescriptions for oral alendronate in my late 50s for osteopenia but I hesitated over expectations of stomach issues.

At 67, with osteoporosis, I finally did take it, and couldn’t tolerate it. I had a Reclast infusion in July 2023 and by November 2023 had a 6% increase at spine. The rheumatologist and bone specialist I see at MD Anderson is happy with my numbers, see attached, and recommends that I do another Reclast in 2024, then maybe every other year. I also see a local endocrinologist who does the actual order/infusion for Reclast.

My mother (osteoporosis) and two older sisters (osteopenia) have never broken a hip - even with some falls that would have caused broken bones in many others. My mother did have some compression fractures in her back, diagnosed at about age 86. Some of the bone density drugs are better at building/preserving the spine, others build more femur/hip bone.

I will definitely continue to take what my doctor recommends as these drugs deter bone metastasis if breast cancer spreads. That’s worth it to me.