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“Introduction Approved therapies for treating osteoporosis in Canada include bisphosphonates (alendronate, etidronate, risedronate, and zoledronic acid), calcitonin, denosumab, raloxifene, and Resveratrol teriparatide [1]. Each drug is effective in reducing vertebral fracture risk; however, only selected bisphosphonates (alendronate,

risedronate, and zoledronic acid), denosumab, and teriparatide have demonstrated significant reductions in nonvertebral fracture risk compared to placebo [2, 3]. Consequently, Canadian osteoporosis practice guidelines recommend etidronate, calcitonin, and raloxifene in a list of second-line options [1]. In contrast to practice guidelines, many publicly funded drug plans across Canada limit coverage for first-line therapies, yet provide unrestricted coverage for etidronate—a second-line therapy [4]. We used data from British Columbia (BC) and Ontario to compare osteoporosis treatment prescribing practices between provinces. In BC, etidronate is the only osteoporosis medication listed under general benefits on its provincial drug formulary (PharmaCare). In Ontario, etidronate has been available without restriction since 1996, while alendronate and risedronate were initially subject to limited access criteria until 2007, when coverage broadened to include all three oral bisphosphonates without restriction. Other osteoporosis therapies are not listed on either public formulary or are only available under restricted conditions.

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