It depends on your particular situation and your risk tolerance. When my doctor saw my DEXA results she wanted me to go on Prolia. I declined because I wasn't comfortable with the risk, plus the doctor didn't say anything about time frame, risks, and the need to relay off the drug after stopping its usage. So I wasn't comfortable with her advice. As it turned out the DEXA scan was inaccurate so it was definitely the right decision for me, and I turned to strength training and trying to do better with diet even with the ultrasound saying osteopenia with low fracture risk. Even with the osteopenia DX my bone breakdown marker was too high; it did go down a lot after a year of increased exercise. Now if I really had the -3.8 t score, would I have done things differently? I don't know. I had two doctors tell me an anabolic med would be best, but insurance wouldn't cover it. If I could have been ok'd for a bone building drug, maybe I would have done that. My point was whatever you do, you can more easily check whether what you are doing is working if you have a baseline with the markers. Why take a drug for a year or two if it's not working but you have to wait that long to find out because that's how long you have to wait for a follow up DEXA scan?