I chose to not go the osteoporosis medication route. Similar to you at age spine was diagnosed in osteoporosis and my T score was -2.7

Spinal bone is the quickest to turnover because of the type of bone.

I am using very low dose topical bioidentical hormone therapy. Least amt of risk for me given family history of breast cancer.
Am also using supplements, but I don't have any cardiovascular or kidney concerns at the moment. As supplements are not right for everyone.

Based on my bone markers (blood test) comparison before and after starting BHRT my bone loss has stabilized.

If i had gone the medication route I would have insisted on pursuing a bone building medication such as Tymlos. Although insurance was probably going to be hurdle due to costs.