Symptoms such as low bone mass or bone pain and fractures are seen not only in osteoporosis but also in other metabolic bone diseases such as rickets/osteochondrosis and need to be differentiated by relevant tests. Osteoporosis can also be due to a variety of etiologies. Before diagnosing primary osteoporosis, attention must be paid to exclude other diseases or medications that affect bone metabolism (i.e., secondary osteoporosis) to avoid missed or misdiagnosis. Diseases that need to be identified include: 1, endocrine diseases cortisolism, hypogonadism, hyperparathyroidism, hyperthyroidism, type 1 diabetes, etc. 2, rheumatic diseases rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, seronegative spondyloarthropathy, etc. 3, malignant tumors and hematological system diseases multiple myeloma, leukemia, tumor bone metastases, etc. 4, drugs long-term supraphysiological doses of glucocorticoids, thyroid hormone overdose, anti-epileptic drugs, lithium, aluminum poisoning, cytotoxic or immunosuppressive drugs (cyclosporine A, tacrolimus), heparin, drugs that cause hypogonadism (aromatase inhibitors, gonadotropin-releasing hormone analogues), proton pump inhibitors, anti-hepatitis B virus drug adefovir, etc. 5, gastrointestinal diseases chronic liver disease (especially primary biliary cirrhosis), inflammatory bowel disease (especially Crohn’s disease), major gastrectomy, gastrointestinal malabsorption diseases, etc. 6, kidney disease various etiologies leading to renal insufficiency or failure. 7, hereditary diseases osteogenesis imperfecta, Marfan’s syndrome, hemochromatosis, homocystinuria, porphyria, etc. 8, any other causes of vitamin D deficiency, alcoholism, anorexia nervosa, malnutrition, prolonged bed rest, pregnancy and lactation, chronic obstructive pulmonary disease, cerebrovascular accident, organ transplantation, amyloidosis, multiple sclerosis, acquired immunodeficiency syndrome, etc.