Abstract
Estrogen deprivation reduces bone mass, accelerates bone remodeling, and weakens bone structure. Under current guidelines, the diagnosis of osteoporosis rests heavily upon bone mass, measured as BMD. This approach can be questioned, however, by the facts that fracture resistance is more dependent on age than BMD, and treatment agents with antifracture efficacy have little effect on bone mass. We outline a comprehensive set of considerations to exclude other possibilities and support a diagnosis of osteoporosis.