I don't believe the anabolic bone building drugs are usually considered unless you're already well into osteoporosis (and insurance will usually only cover them if you're at high risk of fracture or have already fractured due to osteoporosis). The bisphosphonates are the most "common" defense to stop/slow bone loss. My sisters was caught just pre-osteoporosis (-2.4 t-score) so she went directly onto bisphosphonates and has maintained the same density. Mine was already well into osteoporosis at my first DEXA (spine -3.5 with the lower lumbar -.4), so didn't want to "maintain" that hence the bone building drug first and now that it's a bit better will go onto the bisphosphonates to maintain where I'm at. You can still take the bone building drugs after, they just aren't quite as effective but can still build bone! Note that Evenity, for example, is only indicated for those that have been on other drugs for two years without improvement (so essentially to have insurance cover it you have to have used a bisphosphonate for two years with poor results or have a doctor convince them why it's necessary). Why, well, I understand part of it was how their FDA approval reads but mainly I imagine due to the fact that it's around $10k per infusion so insurance doesn't want to approve it unless they absolutely have to. My insurance refused both Tymlos and Forteo initially, but my bone doctor appealed and they eventually agreed (it took several months). I would also note Evenity has only been around a few years and Tymlos not much longer so Forteo would likely have been the only anabolic option when you first fractured. It's ridiculous how they won't do DEXA scans (insurance standard notes they won't cover them until 65 except in specific circumstances). I started requesting them when I was 40, I got one doc to agree and then insurance refused and my appointment was cancelled. My next doc simply refused to order one regardless of my high risk family history - even when I went through menopause early. Was super frustrating. I hope your appointment goes well on Friday and you get your questions answered! My Reclast infusion is on the 14th (fingers crossed it goes well!).