Hi nemesis
I am back after a two-plus-week absence due to a death in the family (elderly mother; died of CHF, which, contrary to what you state, was very definitely an acute vs. chronic disease, at least in her case).
You asked "why on earth" I'd consider Jarvinen et al. a more authoritative source than some of the popular websites; I already gave my reason, that being that "all of the sites ... tend to parrot the mainstream view." This is not to say that I "completely accept what Jarvinen et al. says and then dismiss professional expertise, findings and advice from [a list of healthcare sites that you gave]" but rather that I found their assertions about harm:benefit ratio and very high numbers of patients needed to treat in order to prevent even one fracture to be well argued. The widely read sites, such as Mayo and Cleveland Clinic, tend to simply state that medications are "needed" in vast numbers of people without making much if any mention of potential catastrophic side effects or offering any critical analysis about these drugs' dubious benefits. Nor do they mention that the meds seem to work by increasing bone mass but not by strengthening it -- thus the paradoxical side effect of atypical femoral fracture, in which the meds lead to the very outcome they are intended to prevent.
I didn't contend that cancer lacks "viable treatment." I would, on the other hand, maintain that there is, as yet, absolutely no drug that has any demonstrable effect on Alzeheimer's progression. But then, cancer, Alzheimer's, etc., aren't our focus on this site.
My real concern is less the reported frequency of side effects of OP meds, though I believe these are vastly underreported, but rather the stunningly long half-life of the drugs -- ten years or more -- that magnifies the risk of side effects well beyond that for other classes of (non-OP) drugs. I would disagree that my thinking is "catastrophizing"; rather, it is CRITICAL thinking: the questioning of the dominant strain of thought of the medical establishment in terms of risk:benefit, high numbers of patients needed to treat in order to see any actual benefit, and other factors. BTW, even if one doesn't suffer "the absolutely worst senario," there are countless internet forums where patients who took bisphosphonates were disabled by joint pain, severe digestive distress, and other comparatively minor (since eventually they subsided) effects from the drugs. These patients had to discontinue the bisphosphonates altogether. The rate of adherence to bisphosphonate recommendations is reported to be quite low due to the considerable amount of misery they cause. I don't see how such drugs can be called "very effective" as what can't be tolerated obviously isn't effective.
You cite "the rest of us [who] MAY be living dangerously if we refuse treatment." Well, I am among this population, as I've refused treatment; I'm not distinct from it. And I have experienced the pain of having had a fracture (wrist, due to fall on black ice) so have no illusions that a fracture of the hip, e.g., would be less disabling. I am actually deeply frustrated that the pharmaceutical industry has so far failed to come up with any treatments that are not unacceptably dangerous or more effective; I'm not in the least sanguine about it.
That said, everyone on this forum must of course decide for his- or herself whether the risks and benefits posed by OP drugs are acceptable and significant, respectively. I would never advise anyone to forego a treatment based simply on whether I, personallly, considered it safe/effective. We are on this forum in the first place, if I'm not mistaken, to share our views, not to have to hold back out of fear that someone might somehow miss out on a medication that they would otherwise take that might (or might not) help them.