Over the past two years, Canada has undergone a significant and coordinated transition in osteoporosis care: the shift to biosimilar denosumab. At Osteoporosis Canada, we have closely followed this evolution, recognizing both its challenges and its potential to improve access to treatment for Canadians living with osteoporosis.
A biosimilar medication is a biologic drug that is highly similar (but not identical) to an existing biologic medication and works the same way in the body. It goes through very strict testing to prove it is just as safe and effective. A biosimilar medication is not a generic medication which is identical to the originator molecule.
The transition began in British Columbia, which became the first province to implement a biosimilar switching policy for denosumab. Since then, provinces and territories across the country have followed suit in a staged approach. As of February 2026, Saskatchewan became the final province to initiate its transition, marking the completion of a nationwide effort. This coordinated shift reflects a growing confidence in biosimilar medications and their role in strengthening the sustainability of our healthcare system.
Central to this transition has been PrJubbonti®, the first denosumab biosimilar introduced to the Canadian market. Notably, this transition has occurred without any reported supply interruptions—an important achievement given the critical nature of maintaining consistent osteoporosis treatment. To date, more than 200,000 patients across Canada have successfully transitioned to PrJubbonti®, demonstrating both the scale and effectiveness of this initiative.
From a health system perspective, the economic impact has been substantial. Biosimilars are typically offered at a lower cost than their reference biologics, and the widespread adoption of denosumab biosimilars is generating meaningful savings for both public and private payers. These savings can be reinvested into the healthcare system, improving access to therapies, supporting innovation, and ensuring long-term sustainability. At a time when healthcare resources are under increasing pressure, this represents a critical step forward.
Equally important is the evidence supporting the efficacy and safety of biosimilars. Biosimilar medications undergo rigorous evaluation to ensure they are highly similar to their reference products, with no clinically meaningful differences in effectiveness or safety. For patients with osteoporosis, this means they can expect the same therapeutic benefits—namely, reduced bone loss and a lower risk of fractures—when using a biosimilar.
Continuity of care remains essential in osteoporosis management. Denosumab is a treatment that requires consistent dosing to maintain its protective effects on bone density. Interruptions or delays in therapy can increase the risk of rebound bone loss and fractures, particularly in the spine. Denosumab discontinuation is associated with rapid bone loss and increased risk of vertebral fractures if dosing is delayed or stopped.1 The successful, uninterrupted transition to biosimilars across Canada underscores the importance of careful planning, patient education, and collaboration among healthcare providers, pharmacists, and policymakers.
At Osteoporosis Canada, we believe this transition highlights a broader opportunity: to improve awareness and treatment of osteoporosis nationwide. While advances in medication access are encouraging, there remains a significant gap in diagnosis and treatment. Many individuals at high risk of fracture are still not receiving appropriate care.
Biosimilars are an important part of the solution. By reducing costs and expanding access, they help ensure that more Canadians can receive the treatment they need to protect their bone health. As we look ahead, our focus remains on supporting patients through these changes, advocating for equitable access to care, and continuing to promote evidence-based treatment for osteoporosis.
Strong bones require consistent care—and with the successful adoption of biosimilars, Canada is taking an important step toward a more sustainable and accessible future for osteoporosis treatment.
Supported by an unrestricted educational grant from:
1Anastasilakis AD, Polyzos SA, Makras P. Warning of an increased risk of vertebral fracture after stopping denosumab. CMAJ. 2018;190(15):E485–E486.
