My own opinion so take it for what it is worth. I would start with the anabolic drugs first; tymlos or Forteo. They build bone don't patch it. If I remember correctly the trabecular bone is the inside (what you want) and the outside is cortical bone (is that right)?. They also will not cause jaw necrosis a rare side effect. Yes, some people get it but it is rare. Medicare or your insurance may require you to take another drug first but get your doc to write a letter saying you really need to start with one of these first. He/she should know how to phrase it. It may work.
After 2 years maybe something better may come along as a follow up drug.
Exercise and diet are also possibilities but you have to be diligent. I know someone who hasn't gained any density but hasn't lost any either.
Good luck