@brendammc I’m sorry to hear about the fractures you sustained - I hope you’re recovering well.

With two recent vertebral fractures and a T-score of -4.5, you would almost certainly qualify for an anabolic such as Forteo (or biosimilar teriparatide) and possibly also Evenity (romosozumab), which is often prioritized in people at very high fracture risk, especially with recent vertebral fractures. Here in the U.S., doctors usually submit a prior authorization if insurance initially denies coverage, though I’m not sure how the process works in Canada. Both drugs are strong bone-building options, though Evenity isn’t recommended for people with significant cardiovascular risk.

I think it’s important to consider getting a baseline bone turnover marker before starting therapy. That gives a snapshot of your bone metabolism. If turnover is very low, your endocrinologist might later adjust follow-up treatment - for example, zolendronate (Reclast, or Aclasta, or Zometa) dosing or dosing interval can sometimes be modified, while Prolia is always given at a fixed dose.

Regardless of which anabolic you start, you’ll still need to transition to an antiresorptive afterward to preserve the gains. Reclast is often the simpler “exit” option, while Prolia could continue to increase bmd but requires a careful discontinuation plan to avoid rebound bone loss in the event that you need to stop using it.

I’ve personally used Forteo and HRT, and I’ve spent a lot of time reading about osteoporosis treatments. Just thought I’d share what I’ve learned, in case any of it helps in your conversations with your doctor.

All the best to you! Please keep us updated on which medication you and your doctor decide on.

@brendammc I live in Canada and have been on Forteo twice now. I also had a severe reaction to bisophonates and as it turns out, anabolic works better if you have not taken them, so glad it worked out that way. I would not do Prolia as first line treatment.