Bone health & osteoporosis

What this page helps with

Osteoporosis makes bones weaker and more likely to break from a minor fall or bump (a "fragility" or low-trauma fracture), often with no warning. This page explains how fracture risk is assessed in Canada, what a DXA bone-density scan is, and when to raise bone health with a provider. It does not calculate your fracture risk, diagnose osteoporosis or decide on treatment or scan timing.

Who assessment is for, and who needs another pathway

Assessment is increasingly based on overall fracture risk — age, fracture history and clinical risk factors — rather than a bone-density number alone. Two Canadian guidelines describe different approaches. Your healthcare provider can help apply the guidance to your situation.

Osteoporosis Canada uses targeted bone-density testing in its guideline population (postmenopausal females and males 50+): age 70 and older without risk factors; 65–69 with at least one clinical risk factor; and 50–64 with a prior osteoporosis-related fracture or at least two clinical risk factors. Important risk factors include a fragility fracture after 40, glucocorticoid (steroid) use, a parent's hip fracture, a BMI under 20, secondary osteoporosis (a condition or medication causing bone loss), current smoking, three or more alcoholic drinks a day, and recurrent falls.

Canadian Task Force recommends, for community-dwelling people not already on preventive medication, a risk-assessment-first approach for females 65 and older: a Canadian FRAX estimate without a scan, discussion of preventive treatment, and a DXA scan when treatment is being considered. It recommends against routine screening of females 40–64 and males 40 and older. That is a statement about population screening; it does not remove the importance of clinical risk assessment and secondary prevention for individuals with risk factors.

Priority reasons for assessment at any age. A low-trauma fracture after 40, prolonged or recent systemic glucocorticoids, or a condition or medication known to cause bone loss are reasons for a bone-health assessment regardless of how many other factors you have. Already diagnosed. If you have osteoporosis — treated or not — or an existing follow-up plan, monitoring and any repeat testing belong with your treating clinician; first-screening thresholds do not apply.

How to access it in Ontario

A family doctor or nurse practitioner assesses fracture risk and orders a DXA scan when indicated; a clinician requisition is needed. After a fragility fracture, ask about fracture-prevention follow-up services in your area (availability varies). Without a provider, Health811 (811) or Health Care Connect (811) can help you find one. See Getting screened.

OHIP coverage for bone-density testing

Ontario’s OHIP payment rules are separate from clinical recommendations. Coverage for a bone-density scan depends on the reason for testing and the time since any previous scan. Exceptions can apply, including for younger people and when earlier repeat testing is medically necessary.

Your ordering clinician and imaging clinic can confirm the applicable rules for you. Do not delay or cancel a recommended scan solely because of a general age or timing summary on this website.

Potential benefits and limitations

Assessment can identify people at high enough risk that treatment meaningfully reduces hip and spine fractures, which threaten independence. Limitations: a bone-density number alone does not predict who will fracture; a scan can prompt treatment in some people who would never have fractured; and being labelled "osteopenia" can cause worry without changing management. Falls prevention, exercise and nutrition matter for everyone regardless of testing.

What the assessment and scan involve

A fracture-risk assessment considers your age, sex, fracture history and other risk factors, and may include checking for height loss or signs of a spine fracture. FRAX can estimate risk with or without bone-density information; CAROC uses a bone-density result. Your provider chooses an appropriate approach. A DXA scan is a quick, low-radiation X-ray of the hip and spine, lying on a table for about 10 minutes, with no injections.

What happens after an abnormal result

A low bone-density result is combined with your fracture risk to decide next steps: lifestyle measures, falls prevention, sometimes medication, and a plan for monitoring. Some people are referred to a specialist, particularly when a secondary cause is suspected. This page does not interpret results or advise on medication, calcium or vitamin D doses.

Bone health at any age

Regular weight-bearing and resistance activity, plus balance training, supports bone strength and reduces falls; if you have had a fracture or significant osteoporosis, ask for an individualized exercise plan rather than high-impact activity. Aim for adequate calcium (mainly from food) and vitamin D in line with Health Canada recommendations — ask a provider or dietitian about your needs. Avoid smoking, limit alcohol, and reduce fall hazards at home.

Questions to ask your provider

• Based on my age and history, what is my fracture risk, and would a FRAX calculation or DXA scan help?
• I take steroids / have a condition that affects bone — should I be assessed?
• I broke a bone after 40 — what follow-up is available?
• Is a bone-density test insured for me right now, and when would a repeat be appropriate?
• What can I do to reduce my risk of falls and fractures?

Conversation guide

Sources

• Quick Reference Guide — Clinical Practice Guideline — Osteoporosis Canada
• Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: guideline update — CMAJ
• Recommendations on screening for primary prevention of fragility fractures — Canadian Task Force on Preventive Health Care
• OHIP Bulletin 260804 — Schedule of Benefits changes for bone mineral density testing — Ontario Ministry of Health
• Osteoporosis — Public Health Agency of Canada

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