@notmaggie Hi- I took bisphosphonates for over 10 years. Had good improvement tho still borderline then took a holiday. My cardiologist, whom I was seeing for MVP, was concerned re lipid levels. I wasn’t sure re taking a statin so she dud CAC scan which was totally clear in 2020. Shortly after I had a dexa that showed some worsening of the osteopenia so I upped my calcium supplements and started back on a bisphosphonate. I had trouble tolerating GI sx w the bisphosphonate so D/C’d it but continued the calcium supplement. About 2 years later I de eloped kidney stones and imaging fir another problem showed CAC. The literature shows some data that absorption of Ca is better through dietary calcium so I stopped the supplement and focused on improving my Ca intake. Two years later, no more kidney stones, CAC lower. Just one person, so completely anecdotal but I’m continuing to focus on dietary intake and consider infusions for the osteopenia if it worsens. It’s all a balancing act;-). Good luck!