I tried for the first four years after I was diagnosed with osteopenia. My left hip was -2.0 and spine was -1.4. I tried diet (more protein, no processed foods, increased veggies/fruits, etc.), exercise (resistance & weight lifting), calcium/magnesium, Vit K supplements. I had also been on HRT (estrogen/progesterone) for two years at that point.

Two years later I was in osteoporosis but continued without meds for another two years. I had given it a good shot but in the end I was part of the group that needs to be on medication. I took Fosamax for five years which worked initially for my spine but never did any good for my hips.

I fractured a vertebra two years ago and was switched to anabolic therapy (Tymlos, then Forteo, and now Evenity).

In my case, I believe there is a strong genetic component because my dad had multiple fractures in his 60s and wound up very stooped and frail.

It's worth a shot to see if you can improve your scores without medication. Just make sure you continue to be monitored and look into avoiding certain movements which could cause a fracture. In my case, I fractured bending over a bathtub and pressing down hard on my rib cage.