@cpd54 I hope your DEXA scores have not been too bad. In early days I had a copy of Keith McCormick's book "The Whole Body Approach to Osteoporosis."

But bone loss is inevitable after menopause regardless of nutritional status and exercise. (For me it was also exacerbated by cancer treatment.) At some point many of us are going to need meds.

The question is when and in what sequence? Dr. Ben Leder has a great video online about sequencing, and Keith McCormick's new book "Great Bones" has a lot of info on meds and sequencing as well.

There has to be a balance between delaying meds that might be too early, and doing meds too late to prevent fractures. I was about to go on Tymlos when COVID hit and I was afraid that Tymlos, like Forteo in the past, would trigger afib and land me in the hospital. So I waited on Tymlos, feeling strong at the time.

Net result: spinal fractures, pain and disability. Osteoporosis does not have symptoms and we can feel strong and confident, only to have one unwise movement cause fractures. Fractures' effects don't really go away even if they technically "heal."

That said, doctors were prescribing for osteopenia and early osteoporosis, which meant running out of time, as @serious described. Doctors need to have a more long term view. And worst of all, insurance forces them to prescribe bisphosphonates or Prolia first, which then interfere with effectiveness of bone builders like Forteo, Tymlos and Evenity and also make follow up more problematic.