Hesitant to begin drug treatment for my osteoporosis

My apologies - I wasn't clear about uNTX; I should've specified urine NTX, which I thought you had a reading. I was wondering if your endo's Fosamax prescription was based on that result.

When given the choice, starting with a bone builder such as Forteo or Tymlos is generally more advantageous than beginning with an antiresorptive like Fosamax.

Bone turnover markers such as CTX and P1NP are now among the most recommended tools to monitor treatment, although their use is not yet a standard protocol. A baseline before therapy followed by a repeat lab a few months into treatment is a useful way to assess whether a drug is working.

So I was confused thinking uNTx meant something else. Is it the N-Telopeptide/Creat test on my bloodwork showing bone growth? My results were 33nMBCE/mM Cr.
The endocrinologist didn’t order the uNTx (my GP ordered the test) but I shared the results with her. I don’t know why she went with Fosamax but I did ask her about taking Fosamax and Jinteli concurrently. She said taking both would not be a problem. My GP recommended sticking with HRT switching over to the transdermal patch and micronized progesterone and not taking Fosamax. I picked up the Fosamax but I haven’t started taking it yet since I’m still undecided about what to do.

I'm trying to deal with osteopenia with diet and exercise. I have just started this journey. Wondering if anyone has had luck with this approach?

You can, but get a DEXA each year to make sure you're not losing ground. Are you taking supplements? Vitamins D3 and K2 are important. Look into collagen peptides (a tablespoon a day mixed into a liquid.) Weight-bearing exercises.

Thank you. I have started weight bearing exercises as well as walking and other exercises. I do take D3 and K2 supplements as well as magnesium. My PA said to take calcium but gave no idea as to how much. If I need this also, what strength should I be taking and what should I look for in the kind of calcium I get?

Calcium target depends on age. 800-1200mg a day. It's better to get it from food, but that can be difficult.
https://www.health.harvard.edu/nutrition/choosing-a-calcium-supplement

Yes, I was referring to the N-telopeptide/creatinine test you had. Was that a blood or urine test? If you have a baseline prior to your start of HRT and /or lab reference range, you might have some idea how well HRT is working, in addition to your dexa results. It is possible that your endo prescribed Fosamax partially based on these results.

In the end, whether to start a bone medication and which one to choose, is a personal decision. Factor to consider including your physicians' advice, current effectiveness of HRT, your FRAX risk and the recommended sequence of medications, among others. I feel like the decision is toughest when someone is dealing with borderline osteoporosis- like in your case,