I guess I will play devil's advocate here for @bunky44 and anyone reading this thread. I also had one fracture from a fall, and a DEXA score about the same as @bunky44 - after my 5 years of cancer meds.

My doc did not want me on Prolia, and had concerns about Reclast due to now disproven exacerbation of existing afib. I tried Forteo and really could not tolerate a second dose, went to an immunologist and tried to get desensitized, and then tried to enter a study for the Tymlos patch, but my two doses of Forteo disqualified me. In other words, I tried hard to get on meds for more than 10 years.

Posts on natural methods used to reassure me. I did tai chi, walked and did the usual supplements. (No strontium- it throws off DEXA.) Then last spring I fractured 3-4 new spinal vertebrae, with one unwise movement. The pain had me crawling on the floor and I could not do dishes, laundry, cook...impossible to lift a glass of water. A year later and there is improvement w/meds and healing but much of the disability seems permanent.

I tried Tymlos and landed in the ICU with afib shortly after. This happened infrequently before Tymlos but it did feel connected. I stopped, and met with two cardiologists and two endocrinologists. I was given a choice of Tymlos restart or Evenity and chose to restart Tymlos at a low dose, in the morning instead of evening, and moved the dose up slowly over months. I am now in my 7th month.

I really liked Keith McCormick's book "The Whole Body Approach to Osteoporosis" but noted that he himself did meds at one point.

I just feel I should share my experience to prevent others from fracturing like me. I will do anything to stay on Tymlos. There is no point in listing side effects, but yes, they are sometimes hard. Imagine if I had found this way to get on it, and found this kind of commitment, BEFORE my fractures instead of after. My whole life would be different.

I did sword tai chi before my fractures, with a lot of young people. I worried but a big part of me felt immune and didn't think fractures would happen to me. It is a form of denial.

People say they want to avoid meds to preserve quality of life. Well, fractures affect quality of life more than meds, in my experience! Hope this helps someone.