Osteoporosis Differential Diagnoses

Updated: Aug 27, 2020
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Diagnostic Considerations

The differential diagnosis of osteoporosis is very extensive. When dealing with reduced bone density, always rule out the other possible causes of symptoms before treating the patient for osteoporosis. Many patients have a coexisting cause of bone loss.

The differential diagnosis of an atraumatic compression fracture may include osteomalacia, tumor, osteonecrosis, infection, and other bone-softening metabolic disorders. Metastatic bone disease should always be ruled out when a patient incurs multiple fractures.

Osteoporosis may be confused with osteomalacia, but in osteoporosis, the bones are porous and brittle, whereas in osteomalacia the bones are soft. This difference in bone consistency is related to the ratio of mineral to organic material (principally, collagen). In osteoporosis, the mineral-to-collagen ratio is within the reference range, whereas in osteomalacia, the proportion of mineral composition is reduced relative to organic matrix content.

Often, the presence of a fracture is not only a marker for decreased bone mass but also potentially a symptom of failing health in general and one or more primary disorders in particular. Failure to diagnose and/or make appropriate referrals may create potential legal issues.

Other conditions to be considered include the following:

  • Leukemia
  • Lymphoma
  • Metastases (bony and other)
  • Pathologic fractures secondary to bone metastases from cancer
  • Renal osteodystrophy

Differential Diagnoses