@lisainfl I am 60 yrs old and have similar spine score and also slight osteoporosis in my hips. My endocrinologist pretty much gave me the option of reclast, prolia or tymlos. I felt maybe the tymlos would work a little faster and then I could follow with reclast to lock in the new bone. The doctor knows the protocol for the approval process. I believe each insurance company is different on what they approve and how easily. I cannot take oral bisphosonates because I already have esophagus irritation. My endo said the approval will take about a month, which surprised me but maybe that's the longest time. I think they know that questions come back and sometimes the insurance suggests cheaper options to try first and then your doctor needs to justify the use. I would ask your doctor about the approval. I am curious if your doctor said why she chose Tymlos as first line of defense - I always like to compare what different doctors choose and why. Thank you, and good luck!