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 from 2023 describe it differently, and both are legitimate; you are not expected to adjudicate between them.

Osteoporosis Canada (2023) 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 (2023) 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 (1-888-579-6707) can help you find one. See No family doctor?.

Ontario funding for bone-density testing (separate from clinical need)

OHIP rules for bone-density measurement were clarified effective April 1, 2026 (Ministry Bulletin 260804, issued August 18, 2026). In summary: a baseline BMD is insured once per lifetime after age 50 in line with guideline screening recommendations, or earlier for clinical scenarios outside guideline scope; after a baseline, repeat testing is insured at intervals of three or more years for therapy monitoring and high-risk patients, five or more years for non-high-risk patients, and 12–36 months for secondary osteoporosis, a new fragility fracture or a risk factor for rapid bone loss; under 50, testing is not routine unless specific comorbidities or fragility fractures are present. These are payment rules, not clinical recommendations, and the schedule contains further conditions — your clinician confirms whether a particular test is insured. Checked 2026-09-15.

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 is a conversation and a calculation (FRAX or CAROC) using your age, sex and risk factors; it may include checking for height loss or signs of a spine fracture. 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 and when they were checked

• R18 — Quick Reference Guide — Clinical Practice Guideline 2023, Osteoporosis Canada.
• R19 — Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update, CMAJ 2023;195:E1333.
• R20 — Recommendations on screening for primary prevention of fragility fractures (2023), Canadian Task Force on Preventive Health Care.
• R21 — Bulletin 260804 — Additional Schedule of Benefits changes effective April 2026 (Bone Mineral Density), Ontario Ministry of Health, issued August 18, 2026. Full text retrieved and read 2026-09-15.
• R22 — Osteoporosis, Public Health Agency of Canada.

Sources checked 2026-09-15. Page built 2026-09-15. Independent qualified clinical review: not yet completed. Found a problem? How to report a correction.