OBJECTIVES: The primary objective was to estimate the proportion of patients suffering from osteoporosis among postmenopausal women who could benefit from therapeutic recommendations according to the French guidelines after performing a BMD diagnosis measurement. METHODS: Cross sectional observational study was performed of postmenopausal women, not treated for osteoporosis for at least one year and who could benefit from therapeutic recommendations according to the French guidelines after performing a BMD. RESULTS: A total of 647 postmenopausal women were enrolled (646 analyzed) by 78 rheumatologists performing BMD measurement between May 2007 and January 2008. The BMD measurement were prescribed by rheumatologists (42.6%), GPs (34.1%), Ob/Gynecologist (18.1%) or other physicians (5.1%). The mean age was 66±9 years. According to the WHO definition, densitometry osteoporosis diagnosis was made in 57.6% patients (IC95%  53.7; 61.4), osteopenia diagnosis in 38.7% patients (IC95% 34.9; 42.6); and a normal BMD was established in 3.7% patients. A total of 39.7% of patients had at least a prevalent fracture and a treatment other than calcium and vitamin D supplementation was recommended in 93.0% cases of osteoporosis, in 44.8% in case of osteopenia and 8.3% in case of normal BMD. In a logistic regression model, the factors influencing the therapeutic decision making in this population were the osteoporosis diagnosis versus osteopenia diagnosis OR = 21.0 (IC95% 12.5; 35.3), past or current glucocorticoids use OR = 2.7 (IC95% 1.3; 5.7). The fracture type was also important in decision making; existing vertebral fracture versus none OR = 17.2 (IC95% 5.8; 51.4), existing non vertebral fracture versus none OR = 4.7 (IC95% 2.7; 8.4). CONCLUSIONS: In a real setting, osteoporosis was diagnosed in approximately 60% of the women who underwent a BMD diagnosis and who complied with the French therapeutic guidelines. Therapeutic recommendations decision making was influenced mainly by BMD results, followed by prevalent fracture and fracture types and glucocorticoids use.