What are your DEXA scores and have you had any fractures?

Like you, my doctor recommended Fosamax (I can't take Tymlos or Forteo due to parathyroid issues). I have severe osteoporosis and decided not to take it based on articles I read that said it offers minimal fracture prevention benefits in postmenopausal women without a prior fracture or vertebral compression. It does make your DEXA numbers better because you retain old bone. The only reason I'd consider a bone drug was if it offered considerable fracture prevention, because isn't that the reason for taking a medication?

There are many articles about studies done on this, here is one: https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."

And an older arcticle, says: "Bottom line. Bisphosphonates offer only modest benefits in building bone and preventing fractures, and that should be considered along with the risks."
https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
Do some research on the benefits of high doses of vitamin K2, which I recently started taking. In Japan it's prescribed for osteoporosis and has shown positive results. There are some conversations about it on this site and on-line. Here's one article: https://www.lifeextension.com/wellness/vitamins/vitamin-k-benefits