I just wanted to post an update and say a huge thank you to everyone for your kindness, support, and suggestions. In particular, after reading @oopsiedaisy's comments, I asked my GP for a referral to a rheumatologist. I also requested a repeat DEXA scan and additional tests, including parathyroid hormone (PTH) and a 24-hour urine calcium test to check for any underlying causes or excessive calcium loss. Both came back normal. While waiting for the repeat DEXA, my GP also encouraged me to complete the Australian iPrevent online breast cancer risk assessment. It now incorporates breast density, which is now routinely reported with mammograms in Australia, and is particularly useful when discussing whether HRT might be appropriate.
The repeat DEXA results were very different:

• Spine: T-score -0.8 (previously -1.2)
• Left femoral neck: T-score -1.4 (previously -2.8)
• Right femoral neck: T-score -1.5 (previously -2.3)
• Total hips: -0.5 and -0.9 (previously -1.7 and -1.9)

This was a huge surprise and a real wake-up call about the importance of advocating for yourself and actively focusing on bone health. My GP is still encouraging me to consider HRT, although there isn't a clear plan beyond five years. The rheumatologist's approach is quite different—they would wait until my FRAX risk reached 20% or my T-score was around -3.0 before recommending osteoporosis medication.

For now, my GP has given me a year to focus on lifestyle changes before making any decisions. I'm now consuming around 1,300 mg of calcium a day from food, taking vitamin D, and I've found a fantastic physiotherapist with expertise in osteoporosis. I've been doing my prescribed exercises five days a week, and next month we'll start introducing resistance training and weights.