What would you do? Medication.

Thank you for all of these ideas, several of which are new to me. I'll be sure to investigate them. I appreciate you taking the time to write all of that out.

I have an update on my status. I care for my grand baby on Thursdays. On Friday, she woke up vomiting and then happily carried on with her day. I got the same bug, vomited, FAINTED and ended up on my back on my bathroom (tile) floor, bleeding. My Apple Watch jolted me awake and called 911. I ended up in the ER and now I have staples in the back of my head. I had all kinds of work ups and x rays and CT scans and NO FRACTURES!!! It's testimony to how things can turn on a dime (my primary goal has been not to fall and here we are). I think it's also testimony that my bones are doing well so far (key words, I realize).

So sorry to hear about your fall, but isn’t it strange how that plays with our heads. I took a bad fall a year ago, slipping on a surprise patch of mud and goose poop on a lake trail. My feet flew out from underneath me like a comedy banana peel routine. I landed flat on my -3.7 T score back and banged my head. After assuming I would now crumble and my life would be forever changed, I got up and walked a half mile to my car…filthy but in one piece. Suffered incredibly painful glutes for a few weeks but that was it. So do we look at these near misses as better indicators of bone health than a standard deviation from a 30 year old, or do we just feel lucky, or both? I’m not smugly saying this is wise, but it did make me hesitate even more before starting medications that might make me feel icky enough to not workout, which is likely what strengthened my glutes enough that they fired up and protected my lumbar?! Throw the dice!

I think twisting and contorting are more of a risk than falls, from my personal experience. And opening windows, bending over to lift things, etc. Excessive weight too.

I follow Dr. Doug Lucas, as well, and think he has just the right balance between trying to use methods other than medication and recommending medication, because some people need them. Full disclosure: I'm a physician myself, and am well aware of how many unhelpful physicians there are out there.

Sorry I forget how you fractured but did you fracture from bending and twisting and also had you had falls where you did not fracture? I think this is a topic I have not seen fleshed out anywhere. There are of course the usual statements about the danger of falls but not so much of considering the activities of daily life where you bend, twist or strain.
I'm curious how many people might share your experience that "twisting and contorting" are as risky as falls.

It's not the same as fracturing of course but I've had low back / hip issues since my late teens. I have finally in the past few years managed to stop straining my back with a key factor being learning to avoid movements that trigger pain and discomfort and finding alternative ways of moving my body that do not. Most of how to do that comes from Stuart McGill a noted low back expert. This may not directly translate to avoiding fractures but there might be some correspondence. Of course you can gently experiment with what causes one's low back pain and I don't know how you could do that for potential fractures. Still, I'm hoping the heightened awareness I've gained in avoiding pain triggers for low back pain might help me to some degree avoid movements that would result in a fracture. BTW some of the movements that I've learned to avoid are hip rotation exercises often recommended for low back pain.
I have not fractured. I quit playing pickleball once my DXA got in the mid -3's. I'm -4.1 now. My doc advised me to keep playing but play in a moderate manner. I told him I did not play sports in a moderate manner and was quitting. I exercise daily. Exercise I can do in a vigorous but controlled manner without sudden unexpected movements that you have in many sports. It's not as fun of course but I do enjoy it. I also play Beat Saber which is incredibly fun, great exercise and is safe for me.

@glojo, I'm right there with you. When I started this thread one month ago, I referenced a few fracture-less falls I'd taken while preparing for a long hike that I completed in September (diagnosed in October). Those falls made me wonder about my actual bone health despite my low DXA hip score and, further, if I could somehow impair good bone by taking medicine if I really don't need it due to good bone quality. I participated in an excellent webinar yesterday with Debi Robinson (Bone Health Expert, Certified Yoga Therapist C-IAYT, Certified Health Coach FDN-P at Functional Diagnostic Nutrition®). She referenced my body size indicating that smaller framed people are likely to come up with low DXA scores. So I DO feel extremely lucky and the fall DID increase the faith I have in my bones. At the same time, I don't want to be stupid about this because once you fracture, troubles compound. My most recent idea is to fly to CA to see an integrative medicine specialist (Kim Millman, MD) so I can get both perspectives (natural remedies + meds if necessary). I've been all over the place in my thinking, as many of us have. I'm so glad I have taken time to educate myself, and to narrow down the list of people I follow and whose opinions I trust.

@babs10 Tymlos and Forteo build quality bone.

Yes, thanks. I'm not eligible for Tymlos (at least on my current plan). It appeals to me since you can adjust the dosage. I'll probably end up on Forteo - I'm just not there yet.

When you say you "follow Dr. Doug Lucas," do you mean by reading and watching his videos or do you participate in one of his programs? Thanks.

I had a mountain bike accident five years ago. I was going down a steep slope at a fast pace, and my front wheel slid sideways into a rut. I reflexively grabbed both brakes and got launched over the handlebars. I probably traveled 10 feet through the air, and dropped at least 8 feet onto hard-packed dirt and rock. The impact was violent, and it fractured my pelvis in two places. Search and Rescue had to come get me, I was out in the middle of nowhere. But, three weeks later, I walked away, whistling, all healed. It was like it had never even happened! No pain since. And the ER doc and the orthopedist said, "Man, you must have strong bones!" So, I tucked away the idea of a DEXA, having been bucked off horses, fallen out of trees, you name it. I never smoked, drank very little alcohol, didn't drink soda, no stomach problems, one cup of coffee a day, ate cheese, yogurt, tofu, drank milk, and ran thousands of miles training for marathons. Took karate, did yoga, played every sport and was just very active in general. I even went through a period in my 20s where I ate lots of sardines on crackers!
My mother is 92, and she played tennis until she was 80. She fractured her ankle getting out of her hot tub 2 years ago, and the surgeon said she had great bones.

Fast forward to Jan 15th, 2024. Went out to ski a few runs with my husband (we live at Lake Tahoe). On the first run, I got caught on my outside ski edge and was headed toward some fencing. In order to stop, I simply sat down. Immediately got back up and skied away. No pain, nothing. But in the next few runs, something wasn't quite right. My legs felt weak, and I was having trouble controlling my skis. I thought I was just having a bad day. I do squats and lunges to keep my legs strong, for skiing, so it was a little strange. Nothing more for a week, but then mid back started feeling tight, then went into massive spasms. The pain was so intense, worsening when I tried to lie down. I got no sleep at all. I had never had back trouble, so I was mystified.

Long story short, I went to work (I'm a physician at a university student health clinic) and got diagnosed with an L1 compression fracture. Subsequently had a DEXA which showed osteoporosis in both spine and hips, spine the worst w/ T score -2.8, and left hip -2.6. I can't begin to tell you what an insane surprise this was. I sat in my car after the DEXA trying to digest the results. My husband doesn't believe it, and my little brother was incredulous. They've seen me just thrash myself for years.
I alternate between feeling depressed (I went skiing and turned into a decrepit little old lady) and feeling searing rage at the universe (how dare this happen when I have tried to live a healthy life).

I started piecing things together. My only real risk factors are being a slender blonde, and stopping hormones when the Women's Health Initiative suggested it wasn't a good idea to continue them after menopausal symptoms stopped. Well, well, well, the Women's Health Initiative, who served up a big kettle of bullshit stew, and the medical world lapped it up. Never mind that the findings were totally debunked later, it was that sensational headline: "Estrogen in menopause causes breast cancer, heart disease and dementia!" was blasted across the front pages of newspapers around the world. Had we all lost our minds? Something that courses through your body from the onset of menses to menopause is suddenly a deadly poison? But it was taken to heart by the medical profession, and most people never bothered to check further.
For an interesting book about how much we need estrogen, check out "Estrogen Matters" by oncologist Avrum Bluming, MD and psychologist Carol Tavris. They go over in detail the link between estrogen and breast cancer (there isn't one) and how much women need estrogen to live long healthy lives and most importantly, keep their skeletons strong.
The difference between my 92 y/o mother and I? She had her uterus yanked out (didn't everybody's mom have that back then?) and was PUT ON ESTROGEN and took it for years. I had it for 2 years and then stopped because of the good ol' Women's Health initiative misinformation.
I attempted to restart it about a year ago because I was having a drop in my sex drive and experiencing "vaginal dryness." That's a euphemism for actually feeling like your vagina was sanded down with a Brillo pad and then finished off by a blow torch after having sex. When I mentioned restarting it to the young male gynecologist I saw for a Pap smear (my older doctor had retired), he was alarmed. "No, " he said, "I've seen too many cases of cancer!" and then, unbelievably, followed that with, "If you're having a drop in your libido, maybe you should see a sex therapist." I was too stunned to reply. I've been sleeping with the same guy for 40 years; I think we have it dialed in by now.
Part of me wonders about how older women are perceived, it's like, you old harpy, your child-bearing days are over, why would you even need to have sex? Meanwhile, there are pills, pumps, creams and injections all to help men achieve erections. But women? Just be quiet and cook dinner, then go fall off a cliff, why dontcha?

Anyway, sorry for the long rant. I just want to say that we should be open to anything in terms of helping our bones. I am now on a full dose of estrogen and progesterone, taking Evista because I couldn't wait to start something, and the osteoporosis specialist I saw is getting Tymlos for me, because unlike Forteo, it doesn't have to be refrigerated. Both those drugs are anabolic; they build bone. Then I will take something like a bisphosphonate to maintain my newly built bones. My kitchen counter is littered with many types of calcium supplements and Vitamin D3 with K2, but that's not new. I have been taking BoneUp, and vitamin D3 for years, not that it seems to have done much good. And I can't tell you how many docs I have seen over the past 20 years for this or that, including Paps and preventative visits and not ONE ever suggested that I needed a DEXA scan. A slender blonde, who was resting on her laurels because she had no family history and a rough and tumble past. So I can blame myself, too.