@formisc McCormick also addresses CTX being too low. He says in his book that we should wait until the CTX rises enough after Prolia, before doing Reclast, for example. And anecdotally on this foruum people have said that a CTX too low can mean mircrofractures don't' heal, hence the atypical fracture- again according to McCormick.

You seem to be dealing with medications already. In my experience PCP's don't know that much about osteoporosis treatment. I strongly suggest an endocrinologist. You don't have to do what they say. And also reading and watching videos to be fully informed. This forum is all patients sharing experiences but if noone has your exact experience, it would be good to talk to an endo (and/or McCormick).