Bone loss not related to age, referred to as secondary osteoporosis, presents a significant potential for morbidity and mortality in patients with chronic or life-threatening illnesses. Increasingly, as palliative care aims to evaluate and treat patients with serious illness earlier in the course of their illness, when disease-directed therapies are still ongoing, palliative medicine professionals may encounter patients who are potential candidates for bonedirected therapies. The goal remains prevention; dramatic consequences of untreated bone loss are often fracture, pain, accelerated and ultimately irreversible debility, hospitalization, rehabilitation, and sometimes death. Secondary osteoporosis accounts for almost half ofall cases of bone loss in the United States. 1 Bone loss may result from chronic medications, diseases that directly impair bone integrity or cause an imbalance between bone production and resorption, or a combination of both. Medications used long term that may cause bone loss include corticosteroids (technically glucocorticoids), heparin, anticonvulsants, and immunosuppressants. Medical conditions that may cause decreased bone density include endocrine dysfunction (e.g., hyperparathyroidism, hypogonadism), gastrointestinal malabsorption syndromes (e.g., gastric bypass, celiac disease), rheumatoid arthritis, cystic fibrosis, posttransplantation states, severe liver disease, and long-term immobility. A comprehensive list of medical conditions involving loss of bone density is presented in Table 13-1.