Canada has several effective medications for osteoporosis, from affordable generic bisphosphonates to newer bone-building biologics. Understanding your options — how they work, what they cost, and what your provincial drug plan covers — helps you have a more informed conversation with your doctor.
Not everyone with low bone density needs medication. Canadian guidelines, developed by Osteoporosis Canada, typically recommend treatment when:
If your T-score is in the osteopenia range (−1.0 to −2.5), the decision depends on your overall fracture risk. A DEXA scan is the starting point for any treatment conversation.
Bisphosphonates are the most widely prescribed osteoporosis medications in Canada. They work by slowing bone breakdown (resorption), allowing bone density to gradually increase or stabilize. Generic versions are available, making them the most affordable option.
Alendronate is taken orally — typically 70mg once weekly. It's been in use since the 1990s and has an excellent long-term safety record. Studies show it reduces vertebral fracture risk by about 47% and hip fracture risk by 51% in women with osteoporosis. Generic alendronate costs roughly $10–$25/month in Canada, and it's covered by most provincial formularies.
Important instructions: Take on an empty stomach with a full glass of water. Remain upright (sitting or standing) for at least 30 minutes after taking. This prevents esophageal irritation, the most common side effect.
Risedronate comes in daily (5mg), weekly (35mg), and monthly (150mg) formulations. It has a similar effectiveness profile to alendronate and may cause less gastrointestinal irritation in some people. Generic risedronate is available in Canada and costs approximately $15–$35/month. Provincial coverage varies — check your provincial formulary.
An IV bisphosphonate given once yearly by infusion at a clinic or hospital. It's an excellent option for people who can't tolerate oral bisphosphonates or who have difficulty with the weekly pill regimen. Flu-like symptoms (fever, muscle aches) can occur for 1–3 days after the first infusion but are less common with subsequent doses. Most provincial plans cover it when oral bisphosphonates have failed or aren't tolerated.
Denosumab (brand name Prolia) is a biologic medication — a monoclonal antibody that works by blocking a protein called RANKL, which drives bone breakdown. It's given as a subcutaneous injection every 6 months, typically at a clinic or doctor's office.
Clinical trials show denosumab reduces vertebral fracture risk by 68% and hip fracture risk by 40%. It's often recommended when bisphosphonates haven't worked well or aren't tolerated, or as a first-line choice for patients with kidney disease (bisphosphonates are contraindicated in severe kidney impairment).
Prolia costs approximately $800–$1,000 per year (two injections). Provincial drug plan coverage varies significantly — see the table below.
Romosozumab (Evenity) is a newer medication with a unique dual action: it simultaneously stimulates bone formation and reduces bone resorption. It's given as monthly injections for 12 months, after which treatment switches to an antiresorptive like denosumab or a bisphosphonate.
In clinical trials, romosozumab reduced vertebral fracture risk by 73% at 12 months — the most dramatic short-term effect of any osteoporosis drug. It's approved by Health Canada for postmenopausal women at high fracture risk.
Cardiovascular caution: Evenity carries a warning about potential increased risk of heart attack and stroke. It should not be used in people who've had a heart attack or stroke within the past year. Your doctor will review your cardiovascular history before prescribing.
Cost is significant — roughly $12,000–$15,000 for the 12-month course. Coverage varies by province; it's listed on some formularies but often requires special authorization.
Teriparatide is a synthetic form of parathyroid hormone (PTH) that actively stimulates new bone formation — unlike most osteoporosis drugs, which slow bone breakdown. It's given as a daily self-injection for up to 24 months.
It's reserved for people with very severe osteoporosis (multiple fractures, T-score very low), or those who haven't responded to other treatments. After the 24-month course ends, an antiresorptive medication is needed to preserve the gains. Cost is high — roughly $10,000–$15,000 for the full course.
Coverage varies considerably across Canada. Always verify with your provincial plan, as formularies change.
| Province | Alendronate/Risedronate | Prolia (Denosumab) | Evenity (Romosozumab) |
|---|---|---|---|
| Ontario (ODB) | ✅ Covered (generic) | ✅ With criteria | ⚠️ Limited/EAP |
| British Columbia (BC PharmaCare) | ✅ Covered | ✅ With criteria | ⚠️ Special authority |
| Alberta (AB Drug Benefit) | ✅ Covered | ✅ With criteria | ⚠️ Special authorization |
| Quebec (RAMQ) | ✅ Covered | ✅ With criteria | ⚠️ Exceptional access |
| Manitoba | ✅ Covered | ✅ With criteria | ❌ Not listed |
| Saskatchewan | ✅ Covered | ✅ With criteria | ❌ Not listed |
| Nova Scotia | ✅ Covered | ✅ With criteria | ❌ Not listed |
If your provincial plan doesn't cover a medication, check whether you have employer-sponsored private insurance, or ask your doctor about manufacturer patient assistance programs. Amgen (Prolia/Evenity) has a Canadian patient support program.
Treatment duration is individualized. For bisphosphonates, current guidelines generally recommend:
Every osteoporosis medication works better when your body has adequate calcium and vitamin D. Without them, your body may pull calcium from bones even while on treatment. Osteoporosis Canada recommends 1,200mg calcium daily (from food + supplements) and 800–2,000 IU vitamin D daily for adults on osteoporosis medications. See our calcium guide and vitamin D guide for details.
If you've been diagnosed with osteoporosis or had a fragility fracture and haven't been offered medication, it's reasonable to ask directly: "Should I be on treatment?" Studies in Canada have found that many people — especially men — are diagnosed with osteoporosis after a fracture but never start preventive medication. Being an advocate for your own bone health matters. See also: understanding your fracture risk and DEXA scan results explained.