Osteoporosis is a condition characterized by a spectrum of compromised skeletal microarchitecture, with clinical manifestations related to decreasing levels of bone mineral density (BMD). Spinal cord injuries (SCIs) vary significantly in terms of the range of clinical impact and overall compromise to a patient’s functional outcomes and quality of life. SCIs have long been recognized as a clinical culprit that ultimately leads to osteoporosis. Clinicians are encouraged to recognize and appreciate the similarities and subtle nuances that differentiate SCI-induced osteoporosis as a separate and distinct clinical entity within the broader diagnosis of osteoporosis.