@researchmaven

My own history of it helps. First to current.

Alendronate 3 years
Forteo 2 years very modest gains
Alendronate 2 years
Evenity 1 year great
gains
Prolia 4 shots so far

I have been on bhrt for 1 1/2 years: estradiol/testosterone pellet, estradiol vaginal
cream, progesterone

As you can see, even with the start on a bisphosphonate I still had modest gains on forteo and great gains on Evenity.
Some others may be able to comment on whether Prolia now rather than an anabolic might be suggested.
Have you already investigated whether there is an endocrinologist or rheumatologist who is well trained in osteoporosis treatment in your area. Or, as some others have done, you might seek a consult with dr. KeithMcCormick. He is a chiropractor and athlete who developed osteoporosis and in his efforts to get proper treatment he became a resource for others. His book is Great Bones