@mj20 with scores like that, I would think you would qualify for bone-building drugs like Forteo, Tymlos and Evenity. Evenity builds bones very fast but cannot be followed by Forteo or Tymlos.

I chose Tymlos and will follow with Evenity if results aren't good enough. I also chose Tymlos because the delivery pen has 8 "clicks" and I could start at a low dose of two clicks and move up as my body adjusted. This minimized side effects.

With a spine score of -4.7 I would start with a bone-builder not an anti-resporptive like Fosamax. You need something stronger, I think. And I also would not do weight-bearing exercises, or I would be very careful with them. Seek advice on that. I do tai chi instead!

As @callalloo indicated, there are studies that indicate the bone-building drugs work better if you have not taken the anti-resorptives (Fosamax and other biphosphonates, or Prolia).