Osteoporosis is a multifactorial disease resulting in reduced bone strength and increased bone fragility. The cause of osteoporosis is underexplored. The manifestation of osteoporosis makes a significant contribution to the development of bone fractures. In the medical assessment, the question arises to what extent osteoporosis is considered to be a previous disability or in particular as a contributory factor. In particular, there are some uncertainties relating to the degree of possible participation, as there are only insufficient scientific evaluation systems. From the authors' point of view no valid assessment of the degree of participation exists on the basis of technical examinations or even the severity of the trauma. At the current time there is no possibility to indicate the level of contribution in 10% or 20% steps. Taking the total picture, including clinical and radiological findings into consideration, it seems possible to assess the contribution only in larger percentage steps (e.g. 0%, 50% or ≥80%). The mere diagnosis of osteoporosis does not justify a participation rate unless its effects can be pathomorphologically proven.