@vabird that is a really great point and I do try to make that distinction - about severity of osteoporosis- when discussing meds. I am an advocate, through personal experience, of medications for osteoporosis that is significant (better word?), but also feel that people may be medicated too early (mainly because sequencing and time limit issues lead eventually to problems with "what's next"!).

So from what I gather, first, decisions are not just based on DEXA scores. There is also bone quality and some are able to measure that- trabecular bone score is possible with some machines. Second, fracture history is important. Third, I keep a chart of my DEXA's since 2003 and they jump around a bit- less if you use the same machine but still, there are variations.

So with a -3.1 most docs would say that is significant and at that level you also have a chance to get out of osteoporosis. "Severe" would probably be -3.5 and less (according to Dr.McCormick). But then again, -3.1 is kind of borderline. If I had it to go over again, I would try hard to get on Tymlos at that level. I fractured in the mid- -3's.

The problem right now is that insurance tends to require use of Prolia or bisphosphonates first and then the bone builders. There are exceptions with fractures. There is a lot of research going on about the proper order of these meds (see video by Ben Leder on Combinations and Sequencing if you can find it). Much better to do bone builders (Forteo, Tymlos, Evenity) first then bisphosphonates to "lock in" gains. In fact the bone builders are less effective after the first line meds that PCP's prescribe. Hoping insurance policies change!