Objectives To analyze the clinical and radiographic features of focal osteoporotic marrow defect (FOMD) from 2 Brazilian oral pathology services and to discuss these findings in light of the literature. Study Design Data regarding age, sex, anatomic location, symptoms, radiographic features, size of lesion, and diagnostic hypotheses from cases of FOMD were collected. Additionally, an electronic search was undertaken in April 2018, including cases reports and cases series of FOMD. Results Among 61,754 oral biopsies, 28 (0.04%) were FOMD. The mean age was 39.6 years and 20 (74.1%) cases occurred in females. An asymptomatic (75.0%) radiolucent (87.5%) lesion, with a mean size of 1.3 cm in the posterior mandible (77.8%) was the most common characteristic found. Fifteen cases were obtained on systematic review. The mean age was 50.1 years—with a predilection for females (73.3%). Asymptomatic (66.7%) lesions on the posterior mandible (80.0%), with a radiolucent aspect (93.3%) and a mean size of 2.3 cm were more observed. FOMDs were present in diagnostic hypotheses in 15.8% and 14.3% of multicenter cases and systematic reviews, respectively. Conclusions The features presented in this study have more similarities than differences when compared to those reported in the literature. Support: FAPEMIG.