Insurance policies need to change so that patients can all start with bone-builders like Forteo, Tymlos or Evenity, which improve bone quality. In fact, I have read that Forteo and Tymlos improve bone quality even if there is no change in bone density. (Evenity does have some anti-resorptive properties so may not improve bone quality as much: I really don't know.)

However, if I had testing (which I don't) which showed bone quality was good but bone density was not, I would still want medication. I would think the fracture risk would still be high. Picture the bones like swiss cheese. Even if the solid parts are "quality" there are still big holes!

I just post here because I, like you and others, was afraid of osteoporosis drugs. Then suffered life-changing fractures. People don't realize what can happen in seconds to bring life-long pain and disability.

You posted about one man who didn't take drugs. Do we know what happened to him? I just hope people will consider meds when their DEXA scores show significant loss of bone density. I have not had any tests on bone quality but assume that without adequate density there would be collapse anyway.