Diet and exercise are not always enough to prevent fractures. Medications are needed if you are fracturing or BMD is falling despite your best efforts. We have many posts about when medications should be considered and the differences among medications.
Traditionally DXA and BMD had been the main determinant of bone health. Relying solely on BMD often lead us astray. FRAX helps correct for factors other than BMD. VFA, looking at the lateral spine, often finds patients with unrecognized crumbling of the spine. TBS can be added to DXA to identify bone quality issues missed by DXA and BMD alone.
NOF has 16 pages of information at https://cdn.nof.org/wp-content/uploads/Bone-Basics_Osteoporosis-Medicines-FINAL-6.12.19.pdf
Picking the best medication for you personally requires a complete bone health evaluation and consultation with your healthcare professional.
Jay Ginther, MD