Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population receives those medications. With the increased survival of patients with rheumatologic diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. The risk of fracture depends on the GC dose. The use of prednisone up to 2.5 mg/day leads to a relative risk (RR) of 1.55; at the dose of 2.5-7.5 mg/day the RR is 2.59, and at doses greater than 7.5 mg/day the RR reaches 5.18, all risks having statistical significance Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, based on the WHO Fracture Risk Assessment Tool (FRAXR) to evaluate the risk for each individual, this is also endorsed by Taiwan Osteoporosis Association.

　　The ACR Recommendations for the Prevention and Treatment of GIO have suggested performing densitometry in patients who will use GC (prevention) for over three months, at doses >5 mg/day, and in patients already on GC (treatment). New ACR recommendations have suggested performing densitometry in any patient who will use GC (prevention) and in patients already on GC (treatment), regardless of the dose and duration of GC use.
Non-pharmacological interventions, such as regular physical activity, and to avoid tobacco and alcohol use, should be recommended, even with no confirmed evidence of GIO. Calcium and vitamin D supplementation should be considered because of the reduction in intestinal calcium resorption due to GC use.

　　The positive effects of bisphosphonates (oral,IV) on bone mass of patients treated with GC have been demonstrated in some clinical studies, teriparatide are also considered as alternative choice.