brendammc,
the low bone density would make Evenity a consideration. It adds bone the most quickly and could give you a scaffolding effect protecting you from fracture. Personally I would go straight to Forteo, even so. But think you should give Evenity a thought considering where you've fractured and looking carefully at the accuracy of the -4.5.
Each of these drugs create a different quality of bone
Forteo just creates the best bone, the strongest and most resilient. It is one of the two medications that reconstruct the cartilage structure in the spinal vertebra. Fracture protection begins more quickly than bone density with Forteo use.
Evenity increases bone density the fastest. And it is amazing. The bone lain down is heavier without the communication channels that make integrative bone. It doesn't repair the inner layer of bone, but lays the bone on (against) the outside of existing bone. It's only tempting to me where the bone is likely to fracture very soon.
I wouldn't consider Reclast because it is just too slow. It builds bone by collecting it over time. I like that it protects against further loss, but it can't repair older fissured bone,.
The mechanism of both Reclast and Evenity prevent the repair of bone that I think you need at -4.5.

Another complication with Evenity is what do you take after it, because that bone is lost within a year.
Some few are taking a second year of Evenity. Others are following with Reclast and, of course, Amgen wants you to take Prolia.
Some agile doctors are prescribing Tymlos following Evenity which seems (from individual reports here) to be maintaining the Evenity-bone.
Remember though that I'm just a fellow traveler without the scientific background of our doctors. I hope that the truly wise will contradict me. And hope that you feel free to contact me.
Blessing your choice.