The Cost of Osteoporosis Care — Treatment Costs and Japan's Insurance System

• Rough out-of-pocket costs for osteoporosis treatment (tablets versus injections)
• How to use the High-Cost Medical Expense Benefit (高額療養費制度)
• How medical costs work if you are 70 or older
• How generic medicines can save you money
• Typical costs for tests (DXA scans and blood tests)

Osteoporosis costs fall into three main categories.

All the figures on this page are approximate. They vary by hospital or clinic, by how many days' supply you are prescribed, and by which dispensing pharmacy (調剤薬局, chōzai yakkyoku) you use.

Most people under 70 pay 30% of the cost at the counter. This is the 30% co-payment (3割負担, sanwari futan), with the remaining 70% covered by insurance. What osteoporosis treatment costs you varies widely depending on the type of medication and how it is used (tablet or injection, and how often). In general, tablets are relatively inexpensive and injectable treatments tend to cost more. Ask your doctor or pharmacist about the specific medication and price in your case.

The figures above are estimates only, and they differ by medication, days of supply, and pharmacy. Injectable treatments can cost more than tablets, but do not choose on price alone. Talk it through with your doctor and pick the treatment that suits you. If your monthly costs do run high, the High-Cost Medical Expense Benefit described below will cap what you pay.

Saving money with generics

Many medications have a generic version (後発品／ジェネリック, kōhatsuhin), and where one exists it typically costs around 40–70% of the price of the original brand. Tablets in particular have a good range of generics, and it is not unusual to be treated for a few hundred yen a month.

Generics contain the same active ingredient, but the way they are used can differ: how you take them, how an injection is given, or how often you need to come in. Convenience and fit with your daily life matter too, so always talk to your doctor before switching.

Try asking: "Doctor, is there a generic version of this medication?" With injections, though, the injection method or visit frequency may change as well, so it is worth discussing the effect on your daily life and not just the price.

Bone density scan (DXA)

Insurance generally covers a bone density scan once a year (when the purpose is monitoring your response to treatment). Our DXA Guide explains what the scan involves and how to read the results.

Blood tests (bone turnover markers)

For routine follow-up, medication plus consultation plus tests comes to roughly ¥2,000–5,000 a month if you are on tablets. For more on what these blood tests show, see Bone Turnover Markers.

From age 70, the share you pay at the counter changes according to your income.

From October 2022, the share paid by some people aged 75 and over rose from 10% to 20%. You can check your own share on your health insurance card (保険証, hokenshō).

If you are on one of the more expensive injectable treatments, your medical costs in a given month can climb. The High-Cost Medical Expense Benefit (高額療養費制度, kōgaku ryōyōhi seido) sets a monthly ceiling on your out-of-pocket costs and refunds anything above it.

What the scheme is

Japan's public health insurance places an upper limit (限度額, gendogaku) on how much you pay out of pocket in a single calendar month. Anything above that limit is refunded to you when you apply. That is the High-Cost Medical Expense Benefit.

The limit depends on your age and income. Most people with osteoporosis are 70 or older, so the explanation below focuses on the scheme as it applies from age 70.

Monthly out-of-pocket caps for people aged 70 and over — the system from August 2026

The High-Cost Medical Expense Benefit was revised from August 2026 (stage 1). In August 2027 the income categories will be subdivided further (stage 2, described below). The caps below apply from August 2026 through July 2027.

"Outpatient (per person)" is the cap that applies if you have only outpatient visits. In a month that includes a hospital stay, the "household total" cap applies instead. The reduced cap for frequent users (多数回該当: from the fourth month in any twelve in which you reach the cap) is unchanged at ¥44,400 for the general and working-age-equivalent I categories and ¥24,600 for those exempt from resident tax.

For reference, through July 2026 the general category paid ¥18,000 outpatient (¥144,000 a year) and ¥57,600 household total; those exempt from resident tax paid ¥8,000 outpatient and ¥24,600 household total (¥15,000 if income was below the set level).

What changed in the August 2026 revision

The amounts changed, but the way you use the scheme stays the same: the eligibility certificate or your My Number health insurance card still works. Here is what changed.

Stage 1 (from August 2026)

1. The monthly caps rose in every income category (for example, for people aged 70 and over in the general category, outpatient ¥18,000 → ¥22,000 and household total ¥57,600 → ¥61,500). The only cap left unchanged is the ¥8,000 outpatient cap for people exempt from resident tax with income below the set level.
2. The reduced cap for frequent users is frozen, so people who have been in treatment for a long time do not pay more.
3. A new annual cap was introduced. Once your out-of-pocket total for the year (August to the following July) reaches the annual cap (¥530,000 in the general category), anything beyond it is refunded by your insurer. This also covers people whose monthly bills never reach the monthly cap.
4. An outpatient annual cap of ¥96,000 now applies to people exempt from resident tax, so someone who pays up to the monthly cap every month pays no more over the year than before.

Stage 2 (planned for August 2027)

• The five income categories become thirteen. For people aged 70 and over in the general category, the outpatient cap stays at ¥22,000 up to approx. ¥2 million of annual income and becomes ¥28,000 for approx. ¥2–3.7 million (the ¥216,000 outpatient annual cap is shared). The household total becomes three steps: ¥61,500, ¥65,400 and ¥69,600.
• The reduced cap for frequent users falls from ¥44,400 to ¥34,500 for people with annual income under approx. ¥2 million.
• The outpatient cap for people exempt from resident tax becomes ¥13,000 (annual cap ¥96,000).

For people with a long-term condition like osteoporosis, where treatment continues for years, the new annual cap and the frozen frequent-user cap are the parts that matter most when you look at a whole year at a time.

What to do is unchanged

Even with the revisions, the steps are the same:

1. Get an eligibility certificate in advance (or use your My Number health insurance card)
2. Read the notices from your insurer. A refund under the annual cap may require an application
3. Talk to your doctor if you are worried about cost

The figures above are taken from the Ministry of Health, Labour and Welfare's published materials (updated July 2026). Check your own category and amounts in the notices from the insurer you are enrolled with: National Health Insurance (国民健康保険, kokumin kenkō hoken), your employer's health insurance society (健康保険組合, kenkō hoken kumiai), or the regional association for late-stage elderly medical care (後⁠期⁠高⁠齢⁠者⁠医⁠療⁠広⁠域⁠連⁠合, kōki kōreisha iryō kōiki rengō).

How to use the High-Cost Medical Expense Benefit

Option 1: Apply after the fact (pay in full first, get refunded later)

1. Pay as usual at the medical institution
2. Later, your insurer (health insurance society, National Health Insurance, and so on) sends you information about applying for the benefit
3. Once you apply, the amount above your cap is transferred to your bank account (in two to three months)

Option 2: Certificate of Eligibility for the Ceiling Amount (never pay more than the cap in the first place). We recommend this option.

The certificate is called the 限度額適用認定証 (gendogaku tekiyō ninteishō). It is a card you show at the counter so you are only ever billed up to your monthly cap.

1. Apply to your insurer for the certificate in advance
2. Show the certificate at the billing counter (会計窓口, kaikei madoguchi) of the hospital or clinic
3. You pay only up to your cap from the start

Our recommendation: get the certificate before you start an expensive medication, and you will have one less thing to worry about. If you have a My Number health insurance card (マイナ保険証, maina hokenshō: your My Number card registered for use as a health insurance card), the cap is often applied automatically without any certificate.

When the benefit helps most

• A month in which you receive a higher-cost injectable treatment: this can come to about ¥25,000–30,000 at the 30% rate → anything above your cap comes back
• A month in which you are admitted for surgery: surgery plus hospital stay can run to several hundred thousand yen → you pay only up to your cap
• A month in which you are treated at more than one hospital or clinic: the costs are combined, and if the total exceeds your cap it qualifies

If you do need admission or surgery for a fracture, the High-Cost Medical Expense Benefit applies there too. For reference, here are rough figures for hospital costs.

These are estimates before the High-Cost Medical Expense Benefit is applied. With the Certificate of Eligibility for the Ceiling Amount, what you actually pay at the counter is capped at the limit for your income category. If admission is planned, getting the certificate beforehand takes one worry off your mind.

[!note] For reference: the full picture of medical costs The table above shows what you pay at the counter (at the 30% rate, before the High-Cost Medical Expense Benefit is applied). The total medical cost is far larger: national data report that for an admission with a hip fracture, the total cost of acute inpatient care is about ¥1.87 million per case (2021; an analysis of 830,000 cases nationwide).

The difference is borne by health insurance. Staying on osteoporosis treatment protects your own life and independence, and it also helps prevent the kind of event that costs this much.

Medical expense deduction on your tax return (医療費控除)

If your medical costs for the year exceed ¥100,000 (or 5% of income for those with income under ¥2 million), you can claim the medical expense deduction (医療費控除, iryōhi kōjo) on your annual tax return (確定申告, kakutei shinkoku).

What you can include:

• Osteoporosis medication, tests, and consultation fees
• Transport costs for getting to appointments (public transport)
• Medical costs for other conditions (all of it can be combined)
• Costs for everyone in the household can be added together

Public subsidy for outpatient care (自立支援医療) — in specific situations

Osteoporosis on its own does not qualify, but the Medical Care for Persons with Disabilities scheme (自立支援医療, jiritsu shien iryō) may be available if you need long-term outpatient care and meet the other conditions. Check with your municipal office (市区町村, shikuchōson).

Long-Term Care Insurance (介護保険) after a fracture

If you need rehabilitation or care services after a fracture, people aged 65 and over can use Long-Term Care Insurance (介護保険, kaigo hoken). Fractures caused by osteoporosis are one of the leading reasons people come to need long-term care.

There is nothing embarrassing about telling your doctor "the cost of my medication is hard to manage." Doctors have many treatment options.

When you raise it with your doctor:

• They can suggest switching to a generic
• They can work with you to find a medication or schedule that costs less
• Adjusting the days of supply can sometimes reduce how often you need to come in
• They may be able to refer you to a medical social worker (医療ソーシャルワーカー, iryō sōsharu wākā)

Stopping treatment on your own because of cost raises your fracture risk. Always talk to your doctor before making that decision.

1. Check the co-payment share on your health insurance card (10%? 20%? 30%?)
2. Ask at the pharmacy whether your medication has a generic version
3. Apply for the Certificate of Eligibility for the Ceiling Amount before starting an expensive treatment
4. Keep your medical receipts so you are ready to claim the medical expense deduction
5. Be honest with your doctor about your concerns over cost

Q. Are tablets the cheapest option?

Generally, tablets, especially those with a generic version, tend to be the least expensive option, and treatment can sometimes cost only a few hundred yen a month at the 30% rate. But medication is chosen on more than price. How high your fracture risk is and how well a treatment suits your body also matter, so the cheapest medication is not necessarily the best one for you. Discuss the specific choice with your doctor.

Q. Are there generic versions of injectable treatments?

For some medications, yes. Where a generic is available, it can be around 20–30% cheaper than the original brand. Ask your doctor or pharmacist whether one exists for your treatment and whether switching makes sense.

Q. The injection given every six months: what does one dose cost?

It depends on the medication, but for one example of a longer-interval clinic injection, a typical figure at the 30% rate is about ¥8,000–10,000 per dose (the drug itself plus the injection procedure fee). At once every six months, that works out to roughly ¥1,500–1,700 a month. If you pay 20%, it is lower still. Check the exact figure with your doctor or pharmacist.

Q. Do I have to apply for the High-Cost Medical Expense Benefit every month?

Once you have applied, most insurers will assess and pay it automatically from the following month onward (with National Health Insurance, some municipalities require an application each time). Using the Certificate of Eligibility for the Ceiling Amount is simpler still, because your payment at the counter is capped from the outset.

Q. If I have a My Number health insurance card, do I still need the eligibility certificate?

At most medical institutions, simply presenting your My Number health insurance card (マイナ保険証) means the High-Cost Medical Expense Benefit is applied automatically, with no certificate needed. Some institutions are not yet set up for this, however, so either check in advance or obtain the certificate anyway for peace of mind.

• DXA Scans Explained: What the bone density test involves and how often it is covered
• Bone Turnover Markers: What the blood tests show and why they are repeated
• The Fracture Cascade: Why staying on treatment matters so much
• Fracture Treatment Options: Conservative care, surgery, and what admission involves
• How Families Can Help: Practical support, including with appointments and medication

• Ministry of Health, Labour and Welfare. For Those Using the High-Cost Medical Expense Benefit and Revision of the High-Cost Medical Expense Benefit (from August 2026 treatment) (updated July 2026).
• Japan Health Insurance Association (協会けんぽ). When Medical Costs Become High.
• Japan Osteoporosis Society et al. Guidelines for Prevention and Treatment of Osteoporosis, 2025 edition.
• Hatano M, et al. Temporal trends in acute care costs of hip fracture treatment from 2011 to 2021 in Japan. Arch Osteoporos. 2025;20(1):124. PMID 40938461

This article provides general medical information and is not a substitute for professional medical advice. Costs vary by medical institution, region, and period. For the exact figures in your case, please check with the billing counter (会計窓口) at your hospital or clinic, or with the insurer you are enrolled with.