I responded to another thread about exercise...

Perhaps you are thinking of Prolia with the bone loss after stopping? It is known to cause a rebound and requires a bisphosphonate afterward.

Two of the five med choices are bisphosphonates (Fosamax/alendronate, Reclast) or Prolia (my docs won't use Prolia). These meds increase density by lowering bone turnover. They are called "anti-resorptives." They may have some impact on the effectiveness of bone builders later on, which is one concer, (see below) but are used after bone builders for many of us.

Meds that build new bone (anabolics) one (are Forteo, and Tymos, which both work through the parathyroid. And Evenity is a bone builder in the first half and anti-resorptive in the second half (it is said to be quite potent).

On this forum we can't say whether starting with Fosamax is a good idea or not with his mostly not bad scores but I hope he can discuss a stronger bone builder with his doctor as a first medication (insurance can be an obstacle).

Many doctors seem to be prescribing Evenity these days. I did Tymlos first because I was sensitive to meds and the dose is adjustable. My gains were excellent in the spine.

If hope he can talk to a good endocrinologist. Another resource is Keith McCormick, who had osteoporosis himself. He wrote the recent book "Great Bones" which is encyclopedic and a good reference.

I like Dr. Ben Leder's video on YouTube "Combinations and Sequencing Approaches to Osteoporosis" and others may chime in with more ideas.

His spine is the one that looks worrisome but with a good doctor he can do well, as many of us do. The meds actually work for most of us!