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Osteoporosis is a disease that is increasingly prevalent worldwide, affecting aging individuals especially. Likewise, the use of medications such as corticosteroids and the constant rise in the survival of patients suffering from chronic medical diseases has placed more patients at risk for osteoporosis than in the past. Chronic obstructive pulmonary disease (COPD) is a chronic condition characterized by progressive dyspnea and frequent exacerbation that often leads to hospital admission. Data from the National Health and Nutrition Examination Survey (NHANES) III suggests an osteoporosis prevalence of 21%, which is higher in severe compared to mild COPD. Several potential factors are related to the risk of osteoporosis in these patients, including corticosteroid use, vitamin D deficiency, immobilizations, hypogonadism, and others. Despite new advances in understanding the mechanism of osteoporosis in patients with COPD, the relative contribution of each factor is unknown. Moreover these patients are undertreated and, even worse, the main international guidelines are focused on postmenopausal osteoporosis or corticoid-induced osteoporosis. In this review we update new advances in prevalence and risk factors, explain how to evaluate a patient with COPD with suspected osteoporosis, and list what the pulmonologist needs to know about treatment.