Unfortunately, most doctors pull from their limited toolkit and prescribe bisphosphonates first as that is what insurance pays for. Since you've already been on an oral bisphosphonate and your loss is predominantly in your spine, you can push for Forteo (or similar) if that is your preference. Forteo is never offered as a first option though it should be for many of us. Some insurance companies won't pay for it and it can be expensive. The pharmaceutical manufacturer has a reduced cost program that you might be able to get. I don't remember exactly what I paid but it was inexpensive. Tymlos is another drug that works similarly to Forteo. It is newer than Forteo and has a higher dose (though adjustable, I hear from posts on this forum). I believe you can achieve slightly higher gains with Tymlos but my preference is the lower dose Forteo along with the comfort that it's been in use for decades. Good to explore all of the options before making the decision on what works best for you.

If you decide to go on Prolia, just know that you must be on a rigid schedule every 6 months. If you are late a month or go off it with no substitute medication, you are at very high risk of fracture almost immediately. Best to go on an anabolic (bone builder) drug first like Forteo, Tymlos or Evenity (anabolic and antiresorptive) and then go on Prolia or Reclast (if that is your preference) to maintain the gains. Or HRT . "They" do prescribe HRT over 60 and even with former calcifications (i'm loaded with them), you just have to get the right "they"! 🙂 It has to be someone trained as a menopause specialist and well versed in the use of HRT like the physicians I mentioned above. Otherwise, they often just go by the WHI risk data which is misleading at best.

I would highly recommend getting Dr Keith McCormick's book, Great Bones. It's research driven with great information that you can use as a reference. It doesn't, however, address HRT very thoroughly as an option. McCormick seems to be more open to that option as of late and I'll bet his next revision will include much more on HRT.

Happy to share my dexa numbers (and anything else that might be helpful). My spine went from -3.2 to -2.9 on Forteo and has maintained on HRT for 5 years since.