@jspr422

Bisphosphonates have the fewest problems and are usually the first line of treatment. I am on Atelvia. Not every MD likes or recommends it, but my specialist did (Rheumatologist, I also have Discoid Lupus that is well-managed). You take it right after breakfast. Atelvia doesn't build bone, but slows the loss. My specialist retired but she would have likely kept me on it until I fractured something or my bone scores dropped below a certain point. Twelve years on it, so far (with drug holidays). I just found another Rheumatologist I trust; we'll see what he recommends. I exercise just like you do (likely more walking and less lifting though). Besides a DEXA, you can also get a TBS (Trabecular Bond Score).

I have found that endos and PCPs want to prevent bone loss and put you on Prolia "right away" and "forever," which I consider an off-label use. I am unsettled by the fact that much or all of the bone Prolia builds can evaporate if you don't keep to the six months injection schedule or quit cold turkey (w/o going to another drug to mitigate but not eliminate the loss). What happens if I get sick or become senile and forget about the shots? I also call Prolia bone, "fake bone,". likely an unfair moniker for what some view as a miracle drug. I think PCPs, knowing how painful lumbar spine fractures/frailty can be, want to be proactive and prevent it. The research and recommendations however, are a little more conservative on when to switch from a bisphosphonate, but maybe the research/recommendations are behind the times with so much clinical experience in existence now. I found my new Rheumatologist on Castle and Connolly. If you Google the requirements for getting listed and how the company turns a profit, I think you will find their listed MDs as great a resource as I do.