Thanks for sharing glojo. With a lumbar Tscore of −3.7 and TBS of 1.141, guidelines often point toward starting with an anabolic first - it feels like a solid, proactive step at this stage. Evenity usually brings the fastest BMD gains and fracture protection, while Forteo and Tymlos also work very well, just over a longer timeline.

One aspect that doesn’t always get much attention is trabecular microarchitecture. TBS gives an indirect view, but increases can reflect either thicker trabeculae or true reconnection. Evenity mostly thickens what’s already there, while Forteo and Tymlos can do both. It’s hard to say how much that difference matters clinically, but it’s an interesting piece of the puzzle.

Either way, starting with an anabolic sounds like a strong first step. The bigger challenge then becomes how to maintain those gains over the long run, since optimal strategies for cycling anabolics, antiresorptives, and drug holidays are still evolving. On top of that, decisions are shaped by practical factors like insurance, what the current research shows, and the doctor’s guidance.

It’s great to see you taking charge of your bone health. Keep us posted on what you decide.