Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: Health Canada approves Celltrion's Stoboclo (denosumab bi… 2025 · sources last checked 2026-08-20

Reference tool — not medical advice. Thresholds, targets, and first-line agents differ by guideline body and change over time — switch the lens to compare. Clinician judgement, dosing/monitoring, contraindications, and live coverage always required. Runs entirely in your browser — no data is collected.

Osteoporosis selector

Choose the guideline lens, enter fracture history, T-score, FRAX and renal function — get whether to treat, the risk tier, and a sequenced drug recommendation (bisphosphonate → denosumab; anabolic-first for very-high risk), with each guideline’s year shown. Societies disagree on thresholds and anabolic-first — switch the lens to compare.

Guideline lens

Patientchoose one

Agechoose one

Prior fragility fracturechoose one

Lowest T-score (hip or spine)choose one

10-year major osteoporotic fracture risk (FRAX)choose one

FRAX-Canada is preferred in Canada; thresholds are age-dependent under NOGG

FRAX / clinical risk factors

Renal function (eGFR)choose one

Treatment context & cautions

Treatment recommendation

Reassess / lifestyle

Risk tier

Below treatment threshold

Notes

  • • Below the treatment threshold under this guideline: optimize calcium/vitamin D, weight-bearing exercise and falls reduction, and reassess fracture risk periodically.

Suggested drug classesPer Osteoporosis Canada 2023.

Enter fracture history, T-score and FRAX to begin.

Switch the guideline lens to see fixed (US / Canada 20%) vs age-dependent (NOGG) thresholds, and how broadly each body defines very-high risk (anabolic-first).

Guidelines

References

  1. [1]Morin SN, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ 2023;195:E1333. link
  2. [2]Camacho PM, et al. AACE/ACE Clinical Practice Guidelines for Diagnosis and Treatment of Postmenopausal Osteoporosis — 2020 Update. Endocr Pract 2020;26(Suppl 1):1. link
  3. [3]Eastell R, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women. J Clin Endocrinol Metab 2019;104:1595 (2020 update adds romosozumab). link
  4. [4]Gregson CL, et al. UK clinical guideline for the prevention and treatment of osteoporosis (NOGG 2024; age-dependent FRAX thresholds). link
  5. [5]Cummings SR, et al. Vertebral fractures after discontinuation of denosumab (FREEDOM/Extension analysis). J Bone Miner Res 2018;33:190. link
  6. [6]FDA Drug Safety Communication (Jan 2024): boxed warning for severe hypocalcemia with denosumab in advanced CKD / dialysis. link
  7. [7]Ontario Drug Benefit / EAP — teriparatide (LU) and romosozumab (EAP) funding criteria are narrower than the guideline anabolic indication; verify live. link
  8. [8]Saag KG, et al. ARCH: Romosozumab then alendronate vs alendronate in postmenopausal osteoporosis (CV signal source). NEJM 2017;377:1417. link
  9. [9]Qaseem A, et al. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass: ACP Living Clinical Guideline. Ann Intern Med 2023;176:224. link
  10. [10]Health Canada approves Celltrion's Stoboclo (denosumab biosimilar, referencing Prolia) and Osenvelt (referencing Xgeva) for all reference-product indications, Sept 2025. A Prolia/osteoporosis biosimilar (60 mg SC q6 months) alongside Sandoz's Jubbonti; interchangeable with reference denosumab, typically payer-preferred. link