𝐆𝐥𝐮𝐜𝐨𝐜𝐨𝐫𝐭𝐢𝐜𝐨𝐢𝐝-𝐈𝐧𝐝𝐮𝐜𝐞𝐝 𝐎𝐬𝐭𝐞𝐨𝐩𝐨𝐫𝐨𝐬𝐢𝐬: 𝐑𝐢𝐬𝐤 𝐀𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭 𝐚𝐧𝐝 𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐨𝐧 Long-term glucocorticoids: assess fracture risk when prednisone equivalent dose is ≥2.5 mg/day for >3 months. Perform fracture-risk assessment as early as possible after starting or continuing long-term glucocorticoids. Adults ≥40 years: Assess fracture risk using: -GC-adjusted FRAX -BMD measurement by DXA -Vertebral fracture assessment (VFA) or spinal imaging, when appropriate. 𝐅𝐑𝐀𝐗 𝐢𝐬 𝐧𝐨𝐭 𝐯𝐚𝐥𝐢𝐝𝐚𝐭𝐞𝐝 𝐢𝐧 𝐚𝐝𝐮𝐥𝐭𝐬 <𝟒𝟎 𝐲𝐞𝐚𝐫𝐬. Fracture-Risk Categories Low risk -MOF: <10% -Hip fracture: <1% Moderate risk -MOF: 10–<20% -Hip fracture: 1–<3% -BMD T-score: >−2.5 to <−1 High risk -MOF: 20–<30% -Hip fracture: 3–<4.5% -BMD T-score: ≤−2.5 to >−3.5 Very high risk -Prior osteoporotic fracture -BMD T-score: ≤−3.5 -MOF: ≥30% -Hip fracture: ≥4.5% -Very high glucocorticoid exposure Very high glucocorticoid exposure includes approximately prednisone ≥30 mg/day for >30 days or cumulative ≥5 g/year. Moderate, high, and very-high risk: osteoporosis pharmacotherapy is recommended in addition to calcium, vitamin D and lifestyle measures. Oral bisphosphonates are a common first-line pharmacologic option, particularly in high-risk adults. 𝐀𝐧𝐚𝐛𝐨𝐥𝐢𝐜 𝐓𝐡𝐞𝐫𝐚𝐩𝐲 𝐟𝐨𝐫 𝐕𝐞𝐫𝐲-𝐇𝐢𝐠𝐡-𝐑𝐢𝐬𝐤 𝐎𝐬𝐭𝐞𝐨𝐩𝐨𝐫𝐨𝐬𝐢𝐬 Very-high fracture risk: Anabolic therapy may be preferred as initial treatment in appropriate patients. 𝐓𝐞𝐫𝐢𝐩𝐚𝐫𝐚𝐭𝐢𝐝𝐞: 20 micrograms SC once daily, generally for up to 2 years. 𝐀𝐛𝐚𝐥𝐨𝐩𝐚𝐫𝐚𝐭𝐢𝐝𝐞: 80 micrograms SC once daily, generally for up to 2 years. 𝐑𝐨𝐦𝐨𝐬𝐨𝐳𝐮𝐦𝐚𝐛: 210 mg SC once monthly for 12 months. It has both bone-forming and antiresorptive effects. All patients should receive adequate calcium and vitamin D, weight-bearing/resistance exercise, smoking cessation, limitation of excessive alcohol and attention to fall prevention.