Osteoporosis, defined as an inappropriate decrease in bone mass, is a common disease. Osteoporosis is a silent disease. If bone pain is present, there may be associated conditions present such as osteoarthritis, or small fractures responsible for the pain. There is considerable misinformation regarding the relationship between osteoporosis susceptibility and thyroid hormone replacement. A brief review of the current medical facts is appropriate. First, patients taking thyroid hormone for prolonged periods of time, who maintain their TSH in the normal range, have no increased risk for the development of osteoporosis. It must be remembered that both thyroid disease and osteoporosis are both common diseases, especially in women, and hence many patients will have independently developed both osteoporosis and thyroid disease. This does not imply a causal relationship between the two. Even in patients with thyroid cancer who need to take higher than normal doses of thyroxine for decades, there is little convincing evidence that the risk of osteoporosis is significantly increased. See Bone mineral density in well-differentiated thyroid cancer patients treated with suppressive thyroxine: A systematic overview of the literature. J Surg Oncol. 2002 Jan;79(1):62-70.