Many thanks again for your detailed reply.
In my case, I have had no fractures and my DEXA score on the same machine was stable after 6 years. Without being close to one of the few U.S. places that do the bone quality test, I am going by my hip replacement surgeon who said I was definitely not as severe as others he has seen. For many years I have followed the other important things recommended here--appropriate nutrition and appropriate exercise and fall prevention.
I am daily following a lot of the comments and am deeply disturbed by the insurance problem with not starting with bone builders. I also appreciate your reminding those with severe arthritis to seriously consider meds.