Mild osteoporosis DEXA scores: what would you do?

It would be an option for you to explore. There are risks in taking any medication whether they are osteoporosis meds or hormones so you have to decide which risk you are most comfortable with. There's also the "do nothing" or "diet and exercise" approach which risks further bone loss and fracture. These are really tough decisions for each of us to make. Personally, I chose pharmaceuticals that I felt were most "natural" to the body after a failed diet and exercise approach led me to go from -2.8 in my spine to -3.2. I knew I needed a bone builder at that point and since Forteo was synthetic parathyroid hormone, and mostly built spine where I had all of my loss (typical of bone loss progression, from spine first to hip secondarily), I felt that it was something the body was accustomed to and recognized. The same with hormones. I am replacing something that was natural to my body and that maintains bone in a natural way so I chose that after Forteo to maintain the gains. Hormones were once readily prescribed for osteoporosis but that changed after the results of the WHI study were widely publicized and vastly misrepresented. You can still get a prescription for HRT from your gynecologist for "menopause symptoms". If they are reluctant, you can use an online service such as Alloy Health if you are in the USA. They have MDs on staff who are menopause specialists and will evaluate your situation and prescribe a dose they feel is appropriate. You do this all by email. There are no fees unless you chose to proceed with a prescription and then you are charged for the medication only. If you want a more in-depth consultation with a physician, that is available for a $35 fee and is done through private messaging on their website. The lowest dose of transdermal estradiol is .025 which is also considered the safest and is a dose that is likely sufficient to stem bone loss. I was on that dose for 5 years. I've had only the slightest loss in all that time so I just increased my dose to .0375 as a further safeguard. If you have a uterus, you must be on progesterone as well and the safest option is bioidentical progesterone, not synthetic progestin. The typical dose prescribed is 100 mg oral.

Here are some options for you to read further:
Estrogen Matters by Dr Avrum Bluming
https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/

What doctors have you seen and where are they located?

@prettyflower McCormick's recent book "Great Bones" is even better.

I was diagnosed with osteoporosis of the spine Nov 2023. My doctor suggested I go on Prolia. I did not instead I went to homeopath doctor. She put me on supplements. In January 2023 I bought the Marodyne vibration plate. I use it twice a day, go to physical therapy three times a week and take the supplements. I walk about a mile everyday. In December 2023 I went for another bone scan, same machine and had good results. No change. My doctor said first year no change is good.
Next year I hope bone mass will increase.

Thanks for mentioning HRT, I'm also curious. It was never brought up to me until recently except to scare me away after the WHI study. I've heard you can't take them after 59, or 10 yrs past menopause. I'm 57, seven years past menopause, -2.6 femoral neck. If I tried HRT would I have to stop in two years and my bone density would drop? I.e., does it give any lasting benefit or only delay the inevitable by two years?

I think the original poster subsequently posted that the endocrinologist advised her that HRT was not an option. Perhaps as a first step, the basis of that medical opinion should be fully understood.

You do not discuss your approach to nutrition and exercise. Hopefully after you read a McCormick book, the importance of this will become more obvious....whether or not you pursue meds, it is a critical component to dealing with many medical conditions....including but not limited to osteoporosis. I am 74 and an ovarian cancer (thus far) survivor.

I cannot agree with anyone who suggests that adequate and focused nutrition and exercise might equate with 'doing nothing.'

My Prolia experience was good (except for the cost). In one year (after 2 injections), my DEXA score improved dramatically (in the hips.....no bone loss problem so far with the spine, only some arthritic concerns) and I was taken off Prolia. The only remaining issue is whether going back on Fosamax for one year (and upping my nutrition and exercise game) to preserve those Prolia gains actually works. We will see in May/June 2024.

The two do not equate and that wasn't my intent to suggest that. They are not equivalent approaches but both approaches include the risk of additional bone loss. I can't even stress how important and how big a focus diet and exercise is for me in my life so if my statement inferred otherwise, then I did not communicate it correctly.

We all lose bone starting in our 30s and once we hit menopause, the drop is precipitous with some of us being faster losers than others. Diet and exercise are essential and a necessary adjunct to some type of medication if the loss is great. I'm a very health conscious person, was a dancer, weight trained, and ate a healthy diet of all organic food so my diagnosis was a big shock to me. I was determined to address my bone loss naturally and so I went all in, adding to my daily exercise program, standing at my computer, heel bumps, prunes, hiking, lifting weights, etc, and calculating my nutrition every day to make sure I met all goals, supplementing when I did not. I could not possibly have done much more. The additional loss I suffered during that 2 year diet and exercise trial was really detrimental and I share that experience so that others hopefully won't suffer that same fate.

I have always believed in consuming a healthy, nutritious diet and having a well rounded exercise program and I still do all of those things religiously in addition to the pharmaceuticals that helped me build back what I lost and subsequently maintain. A healthy lifestyle is important not just for our osteoporosis but for how we want to function and live as we age. They are just not very likely to build bone on their own once you're past peak bone mass and starting to lose bone naturally.

You are still within what is considered the safe window to take hormones (up to age 60 or 10 years past menopause). Hormones will work while you are on them and once you stop taking estrogen, your bone mass will drop. I started hormones at 62, about 10 years past menopause. I've been on them for 5 years and my bone loss has pretty much stabilized. I'm on a very low dose and plan on staying on them for the rest of my life, or until they present an issue and I no longer can. To me, the total body benefits they provide are worth the small risk.

Yes and yes! I wish I had too! Obgyn recommended, bio identical, endo said no, bad info, based on outdated studies.
I’d love to know what doses hrt you’re using to maintain! I’ve read so much. Easier to find dosing for estrogen than testosterone. Really frustrating.