@garycorb Sorry about the rough road you've had with osteoporosis and the meds.
You are in a complicated situation. You have to weigh many factors to decide what is best and then you have your insurance and costs to factor in.
I can just say that I'm not the only guy getting Medicare to cover Evenity. And I had no prior fragility fractures. No spinal or hip fractures - just bad DXAs. It was complicated though and I do not think that Medicare will give you a definite pre approval for osteoporosis drugs. For some drugs they will give pre approvals. In my case I got it covered by Amgen Safety Net and then the docs office submitted it to Medicare after giving me the first shots and lo and behold they covered it.
As to your CV concerns that's where you have to weigh the risks of one thing vs another. In my case it was easier because I seem to be doing ok CV wise. I would not rule out Evenity due to CV concerns. Certainly carefully consider the pros and cons but don't rule it out without considering all the angles. Personally I find Prolia much more scary. In fact other than the possible very slightly elevated risk of CV events I do not find Evenity scary at all. Of course I was nervous at first.
Wishing you all the best on your decisions