Your spine is pretty bad. I got fractures with a score that was the same. I strongly suggest you advocate for Tymlos, Forteo or Evenity. I know that Tymlos is really good for spine: I had a 20% gain and went back to -2.5 which is borderline.

The only reason docs start with bisphosphonates is insurance. You can bypass that by calling the companies. There are coupons available and patient assistance programs, as I wrote before. Or take a bisphosphonate and then "fail" it. Or get your doc to do an aggressive medical authorization given your unusual situation.

I had breast cancer that was hormone driven. Even after menopause the adrenals and fat produce estrogen. The concerns of that study have been questioned since it came out. There are bioidentical forms of hormones but you may need a functional medicine doc or integrative gynecologist.

Being without ovarian estrogen at such a young age has its risks too. What is the family history of breast cancer? Mother, sister? Was it determined to be genetic? My breast cancer is not genetic so even my daughters are not concerned.

Ironically I usually comment on here about cancer risks when women are going on HRT for bones. But your situation is so different. I don't know what the right answer is. It is exhausting to try to find the right docs and balance differing opinions.

I strongly suggest a consultation with Keith McCormick. He is easy to find online. I will PM you.