Background <p>Osteoporosis (OP) is a condition characterized by systemic degenerative bone disease. Recent studies have suggested a potential association between diffuse panfine bronchiectasis and osteoporosis. In this case report, we present a patient with severe osteoporosis and diffuse panfine bronchiectasis. The patient's medical history, clinical presentation, and diagnostic tests are discussed in detail.</p> Case presentation <p>A 72-year-old postmenopausal woman with a 30-year history of chronic cough and sputum production presented with severe back pain and height reduction (10 cm over 10 years). Imaging revealed multiple spinal compression fractures and severe osteoporosis (lumbar spine T-score: -4.4). CT confirmed diffuse panbronchiolitis with diffuse bilateral micronodular lung lesions.After ruling out secondary factors and common pathogenic factors, it was suspected that her severe osteoporosis might be closely related to diffuse panbronchiolitis. The patient was treated with anti-osteoporosis and anti-inflammatory medications. Currently, her pain has alleviated, and she can perform daily activities.</p> Conclusion <p>Clinicians should be aware of this possible association when evaluating patients with osteoporosis.Early identification and active treatment can effectively slow down the progression of osteoporosis. Identifying high-risk patients is also an important measure.</p>