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@hopefullibrarian I wish I was in your area to make a recommendation. I am post-menopausal and over 65, and had cancer treatment that opposed estrogen, so the cause of my osteoporosis is obvious. Are you pre-menopausal? If older, I am afraid the cause is loss of estrogen and basically age-related.

I hope you find a doc who will discuss info with you and let you make choices. I have often posted about how I chose Tymlos because the dose is adjustable and I could ramp up.

My doc is willing to do a 20% test dose of Reclast as follow-up and has now relented in prescribing Evenity first. With the impressive research you have done, you may already know what you want so the main challenge is finding the right doc who will work with that. Keith McCormick does consults by phone and I use him as an adjunct.

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Replies to "@hopefullibrarian I wish I was in your area to make a recommendation. I am post-menopausal and..."

I'm 2 years post menopausal, however I've almost certainly had undiagnosed osteoporosis for several years.
I've had hip pain off and on for about 10 years. It would come and go, so I never saw a doctor about it. I wish that I had, because now I know that can be one of the signs of osteoporosis.
I have epilepsy with rare tonic clonic seizures. Three years ago during one such seizure, I suffered a vertebral compression fracture. Even though I was 50 years old and in perimenopause at the time, no one (ER doctors, GP, Neurologist) seemed to know the cause. I burned through 3 doctors, and a physio before one of them considered the possiblilty of osteoporosis. Even then, I had to push for a DEXA scan.
When I was finally diagnosed 11 months ago, my t-scores were very low---3.2 femoral neck and -3.7 lumbar.
I also had a CMP which showed that my vitamin D levels were extremely low despite supplementing for several years with a high quality tincture of 5000 IU per day.
In my estimation, all of these factors comined suggest that my bone loss is due to in part by something more than aging. Side note: AEDs (anti-epileptic drugs) can cause bone loss, however the one that I take supposedly does not.
Recently, I asked my Osteopath to run more tests to explore the cause of the vit. D deficiancy. His reply, and this is a quote, was, "That would take a lot of work on my part."
It's time to find a new doctor.

windyshores, again, I really like your doctor.