A month ago, I was diagnosed with osteoporosis, and the report indicated that it appeared fairly severe. However, I have always been slim and small-boned, with a BMI of 18, and that naturally makes a difference. A person with a smaller frame and lower BMI is going to have less bone density than someone with a BMI of 25 or 30. It’s also important to remember that your T-score is a comparison to the average 30-year-old, while your Z-score is a comparison to the average person your age. Because of this, I was neither surprised nor shocked by the diagnosis, and I don’t feel the need to be in emergency mode. I don’t expect my bone density to ever match that of the average person, but I do intend to work on the problem.
I’m also not planning to change my lifestyle dramatically out of fear of a fracture. In my opinion, bone quality is more important than bone density, as long as the osteoporosis is not extremely severe. I’ve already researched the causes of osteoporosis and the ways bone density can be improved, and I plan to make only minor adjustments. My analysis showed that I was getting only about 60% of the recommended daily allowance for calcium, so I’ll be making small changes to my diet and supplements to correct that. In addition, I’ll be adding more high-impact exercise to my routine to help stimulate bone density. I expect this combination to make a meaningful difference.
I’m also considering “the big guns”—various peptides, SARMs, and hormones—as possible ways to improve bone density. This is a complex area, with many potential benefits as well as side effects, so it requires careful study. I’ve looked into the standard medications for osteoporosis as well, but I’m not convinced they’re necessarily better options than peptides, SARMs, or hormones. They also carry the risk of side effects, and some require follow-up treatment with a bisphosphonate after the main drug protocol is completed. The possibility of osteonecrosis, even if rare, is enough to make me wary of bisphosphonates.
During this research phase, I also sought out YouTube doctors who specialize in osteoporosis. I came across Dr. Doug Lucas. Like most others on YouTube, he is promoting his own services, but his 20- to 30-minute videos generally provide useful information, with only a brief mention of self-promotion. He covers a wide variety of topics, and I recommend taking a look.
Here is what ChatGPT found on bone-building drugs for osteoporosis for anyone interested. The most common first-line prescription is usually a bisphosphonate, but that is not a bone-building drug, so it is not included in this table.
Note: Strontium ranelate is banned in Europe.
| Drug (Brand) |
MOA |
T½ |
Dose |
Eff % |
Bone Impact |
SFX |
Therapy / Follow-up |
Antiresorptive Follow-up |
Cost/mo |
Ins. |
| Romosozumab (Evenity) |
↑Wnt, ↓resorp |
~12 days |
210 mg SQ monthly ×12 |
100 |
↑↑ BMD, ↓ spine/hip fx |
HA, arthralgia, ↑CV (rare) |
12 months; follow with antiresorptive |
Denosumab (Prolia, Xgeva) |
~$2,500 |
 Prior auth |
| Abaloparatide (Tymlos) |
PTHrP analog |
~1 hour |
80 mcg SQ daily ×24 mo |
90 |
↑ BMD, ↓ fractures |
Dizziness, nausea, osteosarc (rat) |
24 months; transition to antiresorptive |
Denosumab (Prolia, Xgeva) |
~$1,600 |
Tier 5 |
| Teriparatide (Forteo, Bonsity) |
PTH analog |
~1 hour |
20 mcg SQ daily ×24 mo |
85 |
↑ BMD, ↓ fractures |
Cramps, nausea, osteosarc (rat) |
24 months; must follow with antiresorptive |
Denosumab (Prolia, Xgeva) |
$1,300–2,000 |
Covered |
| *Strontium ranelate (Protelos) ** |
↑ formation, ↓ resorp |
~60 hours |
2 g oral daily |
80 |
↑ Spine/hip BMD, ↓ fractures |
GI upset, HA, ↑CV (if risk) |
Long-term use possible |
N/A |
$100–200 |
 OTC (EU) |
| Vit D3 + K2 (Thorne, LE, Pure) |
↑ Ca²⁺, osteocalcin |
D3: 15h, K2: 3d |
D3 2–5k IU + K2 90–200 mcg |
50 |
↑ Remodeling, ↓ fractures |
None or ↑ Ca (rare) |
Continuous adjunct |
N/A |
$15–30 |
OTC |
