I think we are all scared of taking meds, also of not taking meds. I too have “severe” OP numbers similar to yours. I did not receive any information about diet or exercise other than “resistance exercise” (been doing aerobics with weights for decades) and “eat calcium rich food, here is a list”. No PT until I asked since I need to have a referral to schedule. No specific osteoporosis physical therapist that I could find, but I did learn a lot from the one I saw. My CTX which I requested after reading about bone markers was at 52. Have no idea if that means anything; also had NTX which according to the lab paperwork was in normal range. Fosamax 8 months then reclast last July. I also am checking out the Y for weight bearing machines as the PT said that would possibly help. The doc scared me with the lecture about holding handrails, no shoveling, no bending or twisting, no golfing etc. made me think I should wrap up in bubble wrap and stay home! PT rolled her eyes a bit and said, after watching my so-called golf swing that I’d be fine to golf. She said strengthening core and keeping back flat; don’t bend over curved like a shrimp. OP was silent for me, no back issues like you. I did break my wrist in a car wreck couple years ago, EMT and ER doc said happens all the time (airbag injury) and the surgeon who fixed it said my bones looked good. He isn’t a DEXA machine though! I am 68, asked about HRT or BHRT and that was a hard no from gyne, mom had breast cancer.