Mild osteoporosis DEXA scores: what would you do?

I am 72, living in NE KS. I have all my parts intact, have never been on HRT. Recently had a DEXA scan: Spine - mineral density of 0.975 grams/cm squared. This is a T-score of-1.8. Femoral necks - demonstrate a bone mineral density of 0.628 grams/cm squared. This is a T-score of-2.9.
My primary mentioned treatment with prolia or fosamax, but was unclear as to any side effects, etc.
He never mentioned HRT.
Does anyone know of a specialist of any kind in this area (NE KS, KC, or NW MO) I could see about guidance and advice?

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.

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!

My numbers are similar to yours and I’m not worrying about it unless I start to get fractures easily. I broke one bone my entire life and I’m 65! I do pretty intense strength training (trainer led with 6 women - most aged 40ish) and I started Osteostrong (heavy load). Once a week. Many women who go there (some traveling 2 hours to get there) have seen big improvements. I also take Algacal. I’ll retake my Dexascan (same place) in 2 years and see what happens. My OB/Gyn really put my mind at ease. The Osteoporosis doctor appt scared me like crazy and immediately suggested drugs. That’s ridiculous. IMO. That said, if a break a bone - just stepping off a curb - I’ll adjust my plan. Maybe.

@,prettyflower I think you are doing exactly what I would do. Your values aren’t that bad , you have time to figure out a plan. And I personally would not go on Prolia after all I’ve read and understand about it. are you doing other things to help your situation like appropriate exercise, eating well, getting the protein you need, , taking supplements that are indicated, managing stress , getting good sleep, etc…. I think getting a DEXA with a TBS is a great plan. Some people, not saying this is you , but if they begin to understand what the root cause of why they are losing bone becomes known they can really help their situation and may not need drugs. It all depends. Finding out the root cause I’m told is best to work with a Functional/Integrative physician. And I would suggest getting a copy of Dr Keith McCormick’s book. And there’s a great place to learn all things about osteoporosis this upcoming week. Go to https://morebone health.byhealthmeans.com/?idev_id=30380. And if you don’t have time at least go to a podcast by Margie Bissinger put out on Jan 4 , 2024 with Craig . Title is something like - Osteoporosis 101 with Craig and Margie Bissinger. Good luck to you!!!!

My numbers are similar to yours and I’m not worrying about it unless I start to get fractures easily. I broke one bone my entire life and I’m 65! I do pretty intense strength training (trainer led with 6 women - most aged 40ish) and I started Osteostrong (heavy load). Once a week. Many women who go there (some traveling 2 hours to get there) have seen big improvements. I also take Algacal. I’ll retake my Dexascan (same place) in 2 years and see what happens. My OB/Gyn really put my mind at ease. The Osteoporosis doctor appt scared me like crazy and immediately suggested drugs. That’s ridiculous. IMO. That said, if a break a bone - just stepping off a curb - I’ll adjust my plan. Maybe.

Thanks so much for this, @ans. You tapped on everything I'm attaching to, including this week's osteoporosis online seminar. What a service. Also I'm hearing great things about seeing a functional/integrative physician, but I don't know yet how to find one (is it a category in a provider directory?) or how insurance figures in. If anyone has any inside tips or knowledge, your input would be much appreciated!