8/8 — WHEN LIFESTYLE ISN'T ENOUGH For established osteoporosis, recent fragility fracture, T-score at or below −3.0, or multiple risk factors — lifestyle is the foundation, not the whole answer. Escalate without apology. Denosumab (Prolia) — potent anti-resorptive, every six months, strong fracture reduction at spine and hip. Never stop abruptly without transitioning to another agent. Teriparatide (Forteo) — anabolic, actually builds new bone. Daily injection, typically limited to two years, then follow with an anti-resorptive to lock in the gains. Romosozumab (Evenity) — dual action. Monthly for 12 months, then transition. Note the cardiovascular boxed warning — screen carefully. Sequence matters enormously: in very high-risk patients, starting with an anabolic and then following with an anti-resorptive produces larger density gains than the reverse order. Here's where I've landed after twenty years. I no longer treat bone as secondary. Independence in your final decades is not a lifestyle preference — it's everything. Bone is not destiny. It is living tissue that responds to the signals you send it. Send it better ones. Starting this week.