Mild osteoporosis DEXA scores: what would you do?

I think your approach is wise, and getting info on bone quality is also wise. I am surprised you were medicated at -2.5. My doc won't use Prolia because it is so ricky to get off in terms of rapid bone density loss (unless you go on Reclast). We are all between a rock and a hard place. I have been told bone builders should come first, not Prolia or bisphosphonates, but you would probably not get insurance coverage: your scores are too good.

Dr. Keith McCormick, a chiropractor expert on osteoporosis, might be a resource for you. He wrote "The Whole Body Approach to Osteoporosis" and "Great Bones" and does phone consultations (first one is $300). I am often a proponent of meds for those below -3.0 but in your case, maybe not! Getting info, testing and opinions seems like the best course and you are doing that!

I was warned to have DEXA at same location/machine or results may vary

Results can vary at the same site as well, depending on positioning and the "area of interest" scanned. I look at trends more than actual numbers.

I saw in your other post that you are 59. In answer to your "what would you do" question, I would suggest considering bioidentical hormones (transdermal estradiol and oral bioidentical progesterone). Your dexa scores are not severe and you are in what is considered the safe window for HRT. Barring a prior or current cancer diagnosis or CVD, hormones, along with a healthy diet and exercise, will provide a safety net of maintaining your density. I wish that I went on them sooner than I did as I would not have had the volume of loss that I suffered. I ended up having to go on Forteo to build back some density and afterwards, I chose HRT to maintain the gain which seems to have worked effectively.

Thank you, @windyshores! Yeah, the endo cited insurance limitations but had not actually investigated it. The only drug that was allowed at the very beginning was Fosamax. I did just buy the McCormick book The Whole Body Approach to Osteoporosis. Excited to delve into it!

@busyyaya Yes, I have recently learned that myself, and I did originally intend to go back to the previous machine. But when I found out my hospital system has a TBS-equipped DEXA machine in another location, I thought that would be a good new start. No idea whether my insurance carrier will cover it after only a year, but I will be finding that out. Thank you so much for replying!

@windyshores Good to hear that. I thought having a TBS equipped machine in my city was something to be taken advantage of, even though it would be a new machine for me.

Thank you, @teb! I don't know anything about those hormones. Do you have a preferred web source for information? The endocrinologist who suggested Prolia also said HRT was not an option. I've been in menopause for seven years, and I've had no fractures that I know of. This was my first experience with an endo; I've been hearing they tend be pretty curt.

prettyflower,
some describe severe osteoporosis as established osteoporosis. So, you've had osteopenia and now your T score is -2.5 or lower you are considered to have established ( or severe) osteoporosis. The scale seek doesn't exist, so we veer off.
Other describe four stages. On this scale -2.5 T score with a fracture would be considered stage 4. You' would be at stage 3 until (luck forfend) you fracture.
Being small boned can exaggerate your bone loss on DXA. And DXA doesn't measure at bone quality. Still, you don't want to fracture and be stage 4 especially in the spine. You never recover the height of the vertebra after spinal fractures, in spite of the best efforts of kyphyplasty.
I think:
You have a good plan for May.
No skydiving, motorcycles, heavy lifting-- especially while bending or twisting.
And I'd say that nothing warrants or justifies the use of Prolia.
I fully recommend the use of Forteo or Tymlos.

The replies containing the deepest regret are those who delayed treatment until after fracture and those who took Prolia.

@gently I appreciate all of this very much, thanks. My next-step plan HAD been Forteo, so I'm glad to have that support. The small bone theory is useful; I am on the borderline of small/medium.