How to best manage severe, severe osteoporosis? Have tried all types of services, just started Prolia, increased calcium, increased vitamin D.

Ask about Forteo. Ask your physician about Forteo, which is the only osteoporosis treatment which actually builds bone (for the most part, all of the other treatments simply prevent further breakdown of bone). Unfortunately, insurance coverage can be an issue for Forteo, and also it requires a daily subcutaneous injection (a very tiny needle) for 2 years. Add daily walking to your treatment as well.
Varies . It sounds like you are doing the right things. Serial bone density tests can tell if you are responding to current regimen; and if not, there are other options. Regular exercise and avoiding substances that worsen osteoporosis can be helpful as well.