Osteoporosis refers to premature bone loss and inadequate bone formation resulting in low bone mass, microscopic deterioration of bone tissue, and increased bone fragility which then results in an increased risk of fracture. The loss interferes with the mechanical support structure function of bone.

The cause of the condition is related to a number of risk factors including: advanced age (geriatric); positive family history; low calcium intake; hormone deficiency; hormone excess; immobilization; tobacco use; malignancy; and genetic disorders. Other causes include: diabetes mellitus; liver disease; rheumatoid arthritis; or alcoholism-induced.

The condition is usually without symptoms when it is uncomplicated. However, signs and symptoms may include: severe backache; spontaneous fractures, often discovered incidentally on x-ray; and loss of height. Compressed vertebrae may be found. The primary areas of demineralization are the spine and pelvis; however, the condition can affect any bone.

Tests include complete blood work and computed tomography (CT) scan. Bone density (densitometry), and dual energy x-ray absorptiometry (DEXA) are done to determine the density of bone. A bone biopsy may be required because the condition may coexist with other conditions such as metastatic bone disease or myeloma.

The treatment is tailored to meet the needs of the person. The goals of treatment are to prevent fractures, decrease pain, and to maintain function. Treatment may include: hormone replacement in men and women; supplemental bisphosphonates; and estrogen receptor modulators (SERMS). A calcium supplement nasal spray may be used to increase bone density, reduce the number of new fractures, and reduce pain. An increase in calcium is needed. Treatment also focuses on preventing postmenopausal osteoporosis by starting estrogen therapy early. Maintenance of adequate body weight, increased walking, and avoidance of long-acting tranquilizers are encouraged.

Residuals may include pain which may last longer than three months, long periods of drug therapy, and proneness to spontaneous fractures. There may be curvatures in the spine resulting from multiple compression fractures. Long-term therapy with calcium supplements may reverse osteoporosis and decrease fracture risk. Measures to prevent progressive loss of bone mass are more effective than treatment of the clinical aspects of the disease.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• The provisions for 10 and 20 percent evaluations for arthritis with multiple joint involvement without limitation of motion do not apply to these conditions as is reflected in Note (2) under DC 5003.

• On or after October 10, 2008, if a veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of § 3.307 are also satisfied and the Secretary determines that the Veteran has posttraumatic stress disorder (PTSD). 38 CFR 3.309(c)(1).

• On or after September 28, 2009, if a veteran is a former prisoner of war and was interned or detained for not less than 30 days, this disease shall be service connected if manifest to a degree of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of § 3.307 are also satisfied. 38 CFR 3.309(c)(2).

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.