are T-scores 3.5 and 3.9 severe osteoporosis?

@njx58 I agree doing nothing shouldn't be an option. I am just confused as to what to do. The more I read, the more confusing is is. There's so many different drugs. Thank you for your response.

@rosemariewalters, I agree that doing nothing is not an option. I’m not a doctor, but I’d like to share what I’ve learned from my own journey with severe osteoporosis as an older adult (I am 73 years old).

I’ve come to believe that whatever you decide to do should be grounded in science‑based and reliable information about all the options available to you. When I started my osteoporosis journey in 2004, I had no access to good information about the long‑term use of alendronate, and no doctor was really tracking my 12‑year use of this drug (with drug holidays, but still longer than I should have been on it).

In June 2025, my doctor started me on Tymlos. He insisted I stay on the full label dose of 80 mcg, despite my 90‑pound body weight and very small frame. I quickly developed severe heart palpitations, unbearable joint pain, tinnitus, mouth infections (which later led to a tooth resorption that now requires extraction), and significant hair loss. One day, I even lost my ability to walk. After four months, in October, he finally decided I should stop Tymlos—but he still refused to let me taper; I had to stop abruptly. I have since left that doctor and committed to educating myself.

Through my research and listening to experts who have devoted significant amounts of time learning about osteoporosis, I decided I would no longer take osteoporosis drugs, given my specific risk profile and history:
I can’t safely return to bisphosphonates because I used them longer than recommended;
I can’t take Evenity, Duavee, or Evista because they increase cardiovascular risk, and heart disease runs deep in my family;
I refuse to go back to Tymlos or Forteo after my experience;
I can’t take HRT because I’m a breast cancer survivor; and
I can’t take Prolia because there is no clear, safe follow‑on drug after stopping it.

I also learned about REMS scanning and had one done. Despite my very low T‑scores (similar to yours), the REMS showed that my actual 5-year fracture risk for hips (3%) and spine (5-10%) is low, especially for my age. That was a turning point for me.

From there, I changed my diet and filled the gaps with supplements. I discovered ONERO, a science‑based osteoporosis exercise program, and enrolled in a once‑a‑week class. Less than three months after starting ONERO, I can now deadlift a 50‑pound barbell, back squat with a 35‑pound barbell, and row pulling 40 pounds (I can't do overhead lifting with greater than 20 pounds because I tore the rotator cuff on both shoulders). For someone with severe osteoporosis, that has been incredibly empowering.

I also learned about bone turnover markers and found an endocrinologist willing to support me by ordering the necessary blood tests. My CTX is 241 and my P1NP is 35.4, which together suggest a good balance between bone formation and bone resorption for me.

In short: I truly believe you should do something—but that “something” should be based on educating yourself as thoroughly as you can, so you can ask the right questions and make the best‑informed choices for your own body, history, and risks. You deserve a plan that is tailored to you, not just to the average patient.

My PCP prescribed Prolia for a -3.7 spinal Dexa reading. Since everyone I know with similar readings is sent to an endocrinologist, I found one and went. He recommended Evenity and then Prolia. At that point I consulted my United Healthcare insurance and USC Medical hospital support and they recommended seeing an in-network "geriatrician."

"A geriatrician is a primary care physician who specializes in the healthcare of older adults. They complete specialized training to diagnose and manage complex, age-related conditions—such as dementia, osteoporosis, and fall risks—and focus on optimizing patients' independence and quality of life.
Training and Qualifications - Geriatricians are fully licensed medical doctors who typically board-certified in either internal medicine or family medicine. Following their primary residency, they complete an additional 1- to 2-year fellowship specifically focused on geriatrics. This advanced training prepares them to manage the physiological and psychological complexities of aging.
When to See a Geriatrician - While there is no strict age limit, patients typically begin seeing a geriatrician around age 65 or older. You may want to consider consulting one if you or a loved one:
Suffer from multiple chronic health conditions simultaneously.
Take multiple prescription medications (a risk factor often referred to as polypharmacy).
Experience age-related changes such as memory issues, balance problems, or frailty.
Need help navigating complex care coordination among various specialists, social workers, and caregivers.
How Geriatricians Differ - Unlike doctors who focus on a single organ or disease, geriatricians take a holistic approach. They evaluate the "whole patient," prioritizing overall function, cognitive health, and emotional well-being alongside medical treatments. To find a specialized geriatrician near you or learn more about elderly care planning, you can explore resources and physician locators provided by https://www.americangeriatrics.org/

They are in short supply. I have an appointment in early October. Will report after that.