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Background The diagnosis and treatment level of osteoporosis in Shanghai community health service institutions are still unclear, and systematic evaluation and monitoring are lacking. Objective To understand the current status of osteoporosis diagnosis and management in community health service in Shanghai, to evaluate their diagnosis and treatment capacity, and to explore their problems and improvement measures. Methods A questionnaire was distributed to 248 community health service centers and 1 873 community general practitioners (GPs) in 16 administrative districts of Shanghai in December 2023 to investigate the current status, knowledge and competence of community health service center and GPs in urban and suburban areas regarding osteoporosis diagnosis and management. Results Of the 248 community health centers in the 16 administrative districts of Shanghai, 79 (31.9%) were in the urban area and 169 (68.1%) in the suburbs, and of the 1 873 GPs, 497 (26.5%) were in the urban area and 1 376 (73.5%) in the suburbs. In terms of inspection and testing equipment, the proportion of bone mineral density (BMD) in urban and suburban areas was 92.4% and 50.9%, and the proportion of bone turnover markers was 50.6% and 12.4%, respectively (P<0.05). In terms of drugs, the proportion of bisphosphonates in urban and suburban areas was 73.4% and 45.0%, and the proportion of active vitamin D and its analogues was 69.9% and 53.3%, respectively (P<0.05). In terms of non-drug treatment, the proportion of traditional Chinese medicine suitable technology in urban area and suburban area was 79.7% and 80.5% respectively (P>0.05). Exercise therapy, physical factor therapy and occupational therapy in urban areas were higher than those in suburban areas, 73.4% versus 50.3%, 73.4% versus 37.9%, 65.8% versus 38.5% (P<0.05). The difficulties of disease management mainly included insufficient examination equipment, inadequate treatment drugs, and limited doctors' diagnosis and treatment ability, especially in the suburbs. Regarding the cognition of GPs in community health centers on osteoporosis high-risk groups and screening, the proportion of urban and suburban GPs' cognition on postmenopausal women was 99.2% versus 97.8% (P<0.05), and the proportion of their cognition on the Osteoporosis Self-Screening Tool for Asians (OSTA) was 88.3% versus 84.4% (P<0.05). Regarding the cognition of common symptoms and examinations of osteoporosis, the proportion of urban and suburban GPs' cognition of compression fracture was 97.0% and 92.2% respectively (P<0.05), and the proportion of cognition of bone transformation markers was 67.6% and 45.2% respectively (P<0.05). Regarding the perception of osteoporosis treatment modalities, the proportion of urban and suburban GPs' perception of physical factor therapy and occupational therapy was 89.3% versus 84.7% and 86.3% versus 81.2%, respectively (P<0.05). The difficulties in diagnosis and treatment mainly included: insufficient experience in the use of new drugs, insufficient ability to identify high-risk groups, insufficient ability to assess the risk of osteoporosis, insufficient confidence in diagnosis, and insufficient ability to choose and mix drugs, especially among rural doctors. Conclusion All community health service institutions in Shanghai, especially those in the suburbs, need to strengthen the equipment of osteoporosis related examinations and tests such as bone mineral density and bone turnover markers, improve the types of therapeutic drugs such as bisphosphonates, active vitamins and their analogues, and strengthen the development of relevant appropriate technologies including exercise, physiotherapy and work. As for the systematic and comprehensive management of osteoporosis, it is suggested to improve the relevant information construction, coordinate and integrate multidisciplinary teams and multi-party resources.