How bad is a spine T-score of -4 ?

@paige479 I don't think vitamins or supplements can reverse BMD, but only slow down more bone loss. However, the right kind of exercise has been shown to build bone. Check out Brick House Bones on Facebook by Dr Lisa Moore, a PT who specializes in osteoporosis. She has free exercise videos and great information.

..can anyone explain the different between bisphophonates and anabolic (eg Forteo) for me please?. From Prolia, and bone fractures this winter, i am still having trouble lifting. Gardening is what i have to do for awhile now anyway. And i look with horror at the rocks i have lifted last summer, which perhaps caused the bone fractures of late January , although it wasn't coincident in time. anyway, a long haul i guess. It's hard to look after oneself...!

leemeadows,
we have two cells that work in units to build "remodeled" bone. In the best of times these two types of cells are balanced. Cells that breakdown bone are followed by the cells that build new bone. In age the cells that break down bone exceed the number cells that build bone and we lose bone.
Bisphosphonates resolve the bone loss by reducing the number of cells that break down bone.
The anabolic drug Forteo increases the number of cells that build bone and that increases the number of cells that break down bone.
Both drugs achieve a balance between the two types of cells. Bone density measurements improve with both medications. Bisphosphonates are antiresorptive increasing the density of the bone by collecting older bone. They don't add bone. Forteo increases bone density by increasing the resorption of older damaged bone and increasing replacement of the bone that has been resorbed, in the same way that our bodies naturally replace our bones, though at a greater speed

Prolia stops the resorption of bone, but unlike the bisphosphonates it doesn't kill the cells that break down bone it saves them. When you stop Prolia all of those cells are released. I'm afraid that stopping Prolia without taking a medication to stop these cells may have caused your fractures. You may be at risk for more fractures. Forteo wouldn't be your best bet currently. It is possible you would be best served by returning to Prolia. Bisphosphonates are the usual medication to follow Prolia.
It would be better not to wait.
Are you seeing an endocrinologist?

leemedows, there is something nightmarish about this video https://www.youtube.com/watch

I would like to learn from others who have experience with bone building medication and alternative approaches. I am 63 - T-score in lumbar spine of -4.2; Hip -3.3 and femoral neck -3.3; My endocrinologist has recommended Tymlos or Evenity; I have never had any previous tx. I am considering Tymlos but very reluctant to start treatment due to side effects, the lack of longitudinal data and the long term treatment requirements following a course of Tymlos. I am healthy and active, on no meds except 2000 of Vitamin D3 and K. Have others had positive outcomes with more natural approaches and if so, any recommendations of (holistic) physicians in the Boston/Providence area as I am considering seeking a second opinion. The endocrinologist simply said to start Tymlos and follow up with her in a year. Though she did a comprehensive blood work-up she did not evaluate the Bone Turnover Markers. I would greatly appreciate any thoughts.

@ldd13

Hi, I have been to multiple appointments with endocrinologist after having a density score going from osteopenia to osteoporosis spine -3.1 and femoral neck -2.3 & -2.0.
First appointment doctor suggested Evenity and I said I’d think about it and come back in three months. I also had multiple blood tests & 24 hour urine test done in the meantime. Went back for second appointment and the Doctor brought up Tymlos. Not sure why she changed original Evenity suggestion, but it was fine with me because I have a high LP(a) and that puts me at higher risk for potential heart attack/stroke. I do take a Repatha injection every two weeks to treat the high LP(a). Doctor said to come back to next appointment ready to start on Tymlos. She also gave me blood work to get a current blood test for Vitamin D (I was always taking 2000 iu’s of Vitamin D). The test came back on the very low side of normal. I called the doctor and asked if I could up the dose of Vitamin D (as I’ve read Tymlos pulls Vitamin D, and she doubled Vitamin D dose to 4000 iu’s daily). Started on Tymlos in April and have now been on it for 2 months. Also scheduled for 6 month out appointment, and before the appointment scheduled for another Vitamin D blood test and Comprehensive Metobolic Panel. My Endocrinologist has not scheduled me for any Bone Turnover Marker tests as of now. As of now, the plan for me is to stay on Tymlos for 2 years and follow it up with Reclast.
Good luck to all of us going through these treatments!

@leemeadows Here are two articles. Google "Fosamax vs Forteo" and you will find other articles.
https://www.drugs.com/compare/forteo-vs-fosamax
https://www.goodrx.com/compare/fosamax-vs-forteo

@ldd13 For alternative approaches, check out Brick House Bones on Facebook by Dr Lisa Moore, a PT specializing in osteoporosis. She has a lot of free exercise videos and information. Drugs are not discussed however. Another good website is Better Bones.

@daisy17 Thank you for these resources-very helpful and much appreciated!