Have osteoporosis many years now (ugh). I tripped over a repair man’s baggage and went flying across the room and down on to the hard tile of my kitchen floor. Bruised badly but nothing ended up being broken thank heavens. Frequent flyer at dental specialists with undiagnosed dental pain so the choice to go on bone meds was a bit simpler “no thank you” for me. The choice seems to be do you take the chance of a rock or a hard place. Quite individual decision and not an easy one.

@tiny28
It’s good you are asking questions. None of us are doctors, we can only tell you what we experienced, and everyone is different, so what one experiences with a certain treatment, another will experience something else. That said-
Your scores are low, and I think you might want to look into a bone building/anabolic drug like Forteo or Tymlos.
Here’s the thing, I am 65, and just started HRT, realistically I don’t expect to grow a ton of bone, my hope is to stabilize what I have. My scores are not as low as yours. However, since 2018, I have been on 5 different osteoporosis drugs, and while they “worked”, I had serious reactions to them all. But that’s me.
At your age and with your scores, I don’t think HRT is going to do the job.
Talk to your doctor about starting an anabolic so that you can grow some bone and improve your scores quickly.
You will need to follow up with another drug like a bisphosphonate to hold the gains.
You should at least try an osteoporosis drug.
Fractures are no joke, I had 6 pelvic fractures back in 2022, they were fragility fractures. You don’t want to have to deal with that.
Try the meds, see how you do. However, I will tell you that if you are sensitive to meds, like I am, DO NOT take Prolia. If you have to stop it like I did, rebound fractures are a real thing! Keep researching and find a good endocrinologist to help you. Educate yourself so you can advocate for yourself.
Best of luck