Osteoporosis is a major health concern and treatment of primary osteoporosis with anti-osteoporosis medications is needed to reduce fracture risk and burden. Before initiating anti-osteoporosis medications, secondary causes of osteoporosis should be considered and satisfactorily excluded. However, it can be challenging to differentiate primary osteoporosis from secondary osteoporosis, especially in patients with paucity of symptoms or who have less common clinical presentation. Hence, practical tips like Appropriate Care Guide on Osteoporosis forms the basis of initial secondary osteoporosis workup for primary care physicians. Snapshots of secondary osteoporosis are briefly discussed to facilitate “pattern recognition”.