Back pain is a common medical and social problem requiring a thorough differential diagnosis and appropriate treatment from physicians of all specialties. Both physicians and patients often underestimate the role of metabolic skeletal diseases in the development of acute and chronic pain. This article presents a clinical case of primary (postmenopausal) osteoporosis in a 66-year-old female patient with clinically manifest primary generalized osteoarthritis. A detailed analysis of the algorithm of standard and additional diagnostic procedures is provided, along with indications for use and the selection of a drug for pathogenetic therapy. The presence of metabolic skeletal disease was suspected based on back pain in this elderly patient, which began at a late age (over 50 years), and a height loss of more than 4 cm compared to her height at age 25. The diagnosis was made clinically based on radiographic data (lumbar vertebral fracture) and confirmed by laboratory testing. When determining the treatment tactics, the risk of fracture was taken into account, in particular, which in the presented observation was assessed as high.