I would start with Evenity (or another anabolic like Tymlos or Forteo) if that's an option as it builds up bone density to improve your numbers, before you go on something to "hold steady". I believe Evenity can be taken for one year. Be cautious starting Prolia so young until they find a way to successfully go off Prolia and avoid its rebound effect when you stop taking it (they are doing a lot of studies on it currently so hopefully they'll have some more definitive options in the near future). I didn't qualify for Evenity (my insurance wouldn't approve it), so I started with Tymlos (an anabolic bone building medication). My spinal bone density increased almost 20% on Tymlos. I then had an annual Reclast infusion to "lock in the gains"). I will have two more annual Reclast infusions, then go off drugs for a few years since it stays in your system for some time. I will have bone marker testing done while on the "drug holiday" to determine when it's time for the next step. Evenity may be in my future someday. I was 51 when diagnosed, now 54 so I have a long road of osteoporosis drugs in my future - the order they are taken in matters. My mom is on Prolia, she's in her 80's however so at this point they are planning to keep her on it for the rest of her life (unless they can find a definitive way to avoid the rebound effect). It can be great for protecting from breaks with a twice yearly injection, however, if too long on it, it eventually can cause issues (as all the meds can) and coming off of it can be a challenge. Good luck!