If you went on hormone replacement before your estrogen levels dropped with menopause, then you might need to look into secondary causes besides hormonal changes. Do you take Vitamin D3, and do you know your levels? Is your parathyroid okay? Do you take steroids? Etc. I don't know much about hormonal replacement and how effective it is at addressing bone loss at menopause but maybe others can chime in.

The PCP's I know do not know enough about osteoporosis, to be frank. You can research endocrinologists and find one who specializes in or treats a lot of people with osteoporosis. Endos can also check those secondary causes.

It has been worth it for many of us to take our time. You can also do a consult with Keith McCormick in person or by phone.

They are the docs who specialize in OP. By the way, it has taken me months to get an appointment with either.

stacibw, you might not need an endocrinologist It seems you have a really good PCP. Though she lists antiresorptives, she probably understands that with "aggressive osteoporosis" or advanced osteoporosis you would usually be advised to start on an anabolic (the medications that build bones) because taking antiresorptives will blunt some of the advantage of subsequent anabolics.
Some endocrinology offices are better at insurance approvals, since they know exactly what to write. You might have more trouble getting bone markers from a PCP.
Osteoporosis is a fascinating subject and the information may seem overwhealming. Soon you'll be answering all the questions for the next guy.

An endocrinologist is who you would want to see - they specialize in endocrine system which is what impacts your DEXA scores. I am 58 yrs and put into osteoporosis from breast cancer meds and I am starting with weekly Fosamax as seemed to be gentler than annual IV infusion of Reclast (unless you have GERD) as well as having a bit fewer side effects. My numbers btw -2.7 and -3.0. Good luck and keep us posted! x