Fearfracture. Thank you so much of all the info. The BTM table is very helpful.

I went through menopause 13 years ago and I did not do HRT. Eight years ago I was put on Alendronate for 4 years by my first PCP. No secondary cause tests were considered. I ended up switching to my mother's PCP in a state wide medical group. I was caring for my mother at the time and I wanted to get both of us into a larger medical group. Only test he used was DXA results. He left the medical group and my mother and I moved to the same PCP again. She was very good and put me on a medication holiday (off Alendronate). Six months later she started looking at secondary cause tests at my request (CBC, CMP, Vit D, 24 hr urine, thyroid, NTX, Celiac). Unfortunately, she left on medical leave right before the pandemic hit and never returned. Only the 24 hr urine came back with an issue. NTX was 24 in 2020 (range 26-124). So the results were never analyzed. Fast forward to today, 3.5 yrs later. Yet another PCP who read my 2022 DXA results showing decline from prior DXA 4 years earlier. In our follow up discussion, he immediately moved to meds. He felt no additional tests are going to change the need for meds at this time. I managed to convince him to follow up with Parathyroid test (based on 2020 24 hr urine results) and re-run the NTX test. He wants to put me on Prolia (denosumab) followed by Alendronate. What I don't understand is why my NTX # is now 22 (range 26-124). Isn't that telling me my bone resorption is way down? Yet my DXA results are worse. So I still need a bisphosphonate? I can't seem to get a clear answer here. Does this mean NTX is not a good measure? Should I be asking for CTX (& P1NP test) prior to new meds? I don't know how he is going to determine if Prolia is helping, other than DXA. Why do I want to wait two years for an answer? He's anticipating I could be on Prolia up to 10 years.

My gains on Alendronate were small e.g., spine 3.5 - 3.3. Interesting my spine has stablized at 3.3 (L2 & 3 are 3.7 & 3.9), hip 2.2, femoral neck 2.7, forearm 2.4.

I just feel like I'm on a runaway train and going down a rat hole of meds. Meds that will be used up and will not be able to help me in 10-15 yrs from now. That's why I've been researching and asking my PCP questions. His answer is the same. "No test is going to change the final outcome.. meds are needed now". I understand his point, however, there has to be a compromise somewhere. He's actually a very good doctor. I'm just not comfortable with that answer and it's creating such anxiety for me that I can't sleep or eat. Obviously, not good for me or my bones.