I started on letrozole after 2 years on Tamoxifen. I was 49 at the time and had my ovaries removed just prior to starting on Letrozole. I had some osteopenia and in just 6 months or so on Letrozole this deteriorated rapidly to osteoporosis level in lower back. The recommendation was to start on Prolia but I stumbled upon a facility that treated bone density issues with both diet and weight bearing exercise. I saw their dietician who examined my diet in detail. Calcium (through food sources) is important but so are a number of other things, such as getting enough protein to build and maintain muscle (which in turns promotes bone strengthening).
I also saw their exercise physiologist who evaluated my ability to commence an exercise program including weight lifting, core strengthening and balance exercises.
For me this was preferable to another medication (prolia) with potential side effects.
There are choices about how to deal with bone density, and diet and exercise are important, even if on medication as well. I think this is an area of treatment that doctors could improve their knowledge and recommendations on. For some people medication is the best choice but for others maybe they just need a little assistance with diet and exercise choices. We are all individuals and should be given all the information to make the best choice for ourselves. I’m glad that I found the right thing for me but my doctors were not helpful in this unfortunately.