SynopsisCodesDifferential Diagnosis & PitfallsDrug Reaction DataReferences

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Other Resources UpToDate PubMed


Contributors: Benjamin L. Mazer MD, MBA
Other Resources UpToDate PubMed


Osteoporosis is a metabolic bone disease characterized by progressively declining bone density with decreasing bone strength and structure, resulting in increased fracture risk, especially vertebral and hip fractures. Fracture is the only clinical manifestation. The condition begins when osteoclast function (bone resorption) occurs more than osteoblast function (bone formation). This results in increased and irreversible bone porosity in the cortical and cancellous (trabeculae) osseous tissue. Risk factors include advancing age, female sex, and postmenopausal status. Corticosteroid use, especially long-term use, can be an important predisposing factor for osteoporosis.

Osteoporosis is classified into two categories, primary and secondary. Primary is the most common and includes postmenopausal, age-related, and idiopathic osteoporosis. Secondary refers to bone loss caused by an underlying condition such as cancer, chronic obstructive pulmonary disease, certain drugs, chronic kidney disease, and endocrine disorders.

Treatment attempts to maintain function, current bone mass, and prevent fractures and pain. It includes calcium and vitamin D supplementation, prescription therapy, and lifestyle changes.

Prevention of fractures with bisphosphonates has been shown most clearly in patients with osteoporosis, which is defined either by a bone-density T score of less than −2.5 or by the presence of prevalent vertebral fractures. The efficacy of continuation of bisphosphonate therapy after 5 years is still under consideration. Whether bisphosphonates are efficacious in patients with osteopenia alone is uncertain.


M81.0 – Age-related osteoporosis without current pathological fracture
M81.8 – Other osteoporosis without current pathological fracture

64859006 – Osteoporosis

Differential Diagnosis & Pitfalls

  • Drug-induced bone mineral loss (eg, antiestrogens)
  • Hyperthyroidism
  • Hypercalcemia
  • Nutritional deficiency (eg, calcium or Vitamin D deficiency)
  • Anorexia nervosa
  • Renal osteodystrophy
  • Aromatase deficiency
  • Primary hyperparathyroidism
  • Alcohol use disorder
  • Paget disease of bone
  • Osteogenesis imperfecta
  • Collagen disorders (eg, Ehlers-Danlos syndrome)
  • Pathologic fracture
  • Malignancy (particularly primary bone, hematopoietic, metastasis to bone, neuroendocrine)
  • Marfan syndrome
  • Rheumatoid arthritis
  • Osteoarthritis
  • Mastocytosis in adults
  • Cushing syndrome
  • Trauma
  • Avascular necrosis

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:07/18/2023
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Imaging Studies image of Osteoporosis - imageId=7923513. Click to open in gallery.  caption: '<span>Diffuse osteopenia of the foot  with marked demineralization and decreased cortical thickness of all the bones. These are radiographic findings, which can be seen in the  setting of osteoporosis.</span>'
Diffuse osteopenia of the foot with marked demineralization and decreased cortical thickness of all the bones. These are radiographic findings, which can be seen in the setting of osteoporosis.
Copyright © 2024 VisualDx®. All rights reserved.