@mayblin Thank you for the reply. I'm going to see my gynecologist in January to discuss HRT. I still suffer with hot flashes, night sweats, anxiety, thinning hair and now this....I didn't want HRT in the past because the risks didn't outweigh the benefits for me, but now I'm thinking the risks are worth taking. I'll see what my doc says. My FRAX is quite low because it doesn't take into account my rather poor TBS scores. I have no family history of osteoporosis and I have never broken a bone (at least not that I'm aware of). I am thin and always have been. When I was running marathons I was even thinner! I'm very active and was shocked by my DEXA since I spent the summer building a stone wall and sawing up fallen trees. I've fallen and twisted my back in all sorts of awkward positions from skiing-could I have fractured my vertebrae without even feeling it? I agree that a PTH analog would probably be the best place to start if the HRT doesn't help. I really want to avoid any antireabsorbative medication at all costs. MONJ scares the daylights out of me! I'm told it's rare-maybe for those with great teeth-but I'm not one of those people!