You sound a lot like me. Super active my entire life and I ended up with the same scores as you at 40 years old. Since I was already doing all the right things already to prevent osteoporosis, the best option for me was using medication. I couldn’t imagine having to live another 40-50 years being so careful to not fracture something and restrict myself from doing the activities and exercises I love. I’ll gladly take medication for that long, if needed, if it allows me to live the life I want - side effects or not. That’s my take on it but everyone is different in their comfort level of taking medications.