@followheart87 I see an endocrinologist as I am followed for thyroid issues as well. You're making a very interesting point. Taking another look at my DXA scan it does show that my fracture risk has improved to 21% vs 24% pre-Evenity and risk for hip fracture is now 5.6% instead of 7%. Also my TBS, trabecular bone score shows 5.9% improvement. This isn't close to what you'd expect with Evenity but it does show a positive impact. And, most importantly, I have not had another fracture. Degenerative changes in the spine can impact the accuracy of the DXA scan and being in my early seventies this is a factor. Bone biology is very complex as you've said and it's quite challenging as a non medical person to comprehend and manage. I thank you for your insight on how this drug works and wish you the very best outcome with your course of Evenity.