Osteoporosis is often called a "silent disease" — bones lose density gradually over years with no symptoms until a fracture occurs. Over 2 million Canadians are currently living with it, and millions more have low bone mass that puts them at risk. Here's what every Canadian should know.
Osteoporosis is far more common than most people realize. According to Osteoporosis Canada, the national patient and research organization:
Osteoporosis-related fractures are more common in Canadian women than heart attack, stroke, and breast cancer combined. A hip fracture in a person over 65 carries a 20–24% one-year mortality risk. These aren't just statistics — osteoporosis is a serious public health issue that is largely preventable with early action.
Osteoporosis literally means "porous bone." Healthy bone has a dense, honeycomb-like internal structure. With osteoporosis, the pores in that honeycomb become larger, and the connecting struts thinner and fewer. The result: bones that are structurally weaker and far more likely to fracture under forces that normal bone would handle easily — sometimes even from a minor stumble, a cough, or everyday lifting.
Bone is living tissue that's constantly being remodelled — old bone is broken down by cells called osteoclasts and replaced by osteoblasts building new bone. In youth and early adulthood, this process favours building. Peak bone mass is typically reached between ages 25–35. After that, the balance gradually shifts toward more resorption than formation. Osteoporosis develops when this shift is severe enough to compromise structural integrity.
Osteopenia is the stage between normal bone density and osteoporosis — bone density is below average but not yet in the osteoporosis range. Not everyone with osteopenia will develop osteoporosis, but it's a signal to take bone health seriously. Both conditions are diagnosed using a DEXA scan (see below).
Many risk factors for osteoporosis are well-established. Some can be modified; others can't. Knowing your risk factors helps you decide when to talk to your doctor about bone density testing.
Osteoporosis is diagnosed through a bone mineral density (BMD) test called a DEXA scan (dual-energy X-ray absorptiometry). It's fast (about 10–20 minutes), painless, and uses very low radiation — far less than a chest X-ray. DEXA typically measures bone density at the hip and lumbar spine, the most fracture-prone sites.
Results are reported as a T-score, which compares your bone density to the average peak bone density of a healthy young adult:
| T-score | Classification |
|---|---|
| -1.0 and above | Normal bone density |
| -1.0 to -2.5 | Osteopenia (low bone mass) |
| -2.5 and below | Osteoporosis |
| -2.5 and below with fracture history | Severe osteoporosis |
Osteoporosis Canada recommends baseline BMD testing for:
Talk to your family physician about a referral. DEXA scans are covered by provincial health insurance in most provinces when medically indicated.
Treatment for osteoporosis in Canada is guided by fracture risk assessment, not bone density alone. Many people with osteopenia or even mild osteoporosis are best served by lifestyle modification and monitoring rather than medication.
When fracture risk is high enough to warrant pharmaceutical treatment, several evidence-based options exist:
All osteoporosis medications require a physician's supervision and are generally covered under provincial drug plans when criteria are met.
Regardless of whether medication is prescribed, adequate calcium and vitamin D are considered standard of care for all Osteoporosis Canada patients. Calcium (1,200 mg/day total from food and supplements) and vitamin D (800–2,000 IU/day) support the effectiveness of bone medications and independently slow bone loss. Read our calcium guide → and vitamin D guide →
The most powerful time to build bone is in childhood and early adulthood — but it's never too late to slow loss and reduce fracture risk. Here's what the evidence supports:
Weight-bearing exercise (walking, running, dancing, stair climbing) and resistance training (weights, resistance bands) are the two most effective categories. Exercise puts mechanical stress on bone, which signals osteoblasts to build new bone tissue. Even adults over 70 show meaningful BMD improvements with consistent resistance training. Aim for at least 30 minutes of weight-bearing activity most days, plus 2–3 resistance training sessions per week. See our exercise guide →
Ensure adequate intake of calcium, vitamin D, protein, and magnesium. A varied diet emphasizing dairy or fortified alternatives, leafy greens, legumes, fish, and nuts covers most bases. See our foods guide →
For older adults, preventing fractures is as much about preventing falls as it is about bone density. Key strategies include: balance training (tai chi, yoga), regular vision checks, medication reviews (some drugs increase fall risk), home safety modifications (grab bars, non-slip mats, adequate lighting), and appropriate footwear.
Smoking and heavy alcohol use both directly impair bone formation. Quitting smoking and keeping alcohol within Canadian low-risk drinking guidelines (≤10 drinks/week for women, ≤15 for men, with no more than 2–3/day) supports bone health along with overall health.