Table 1.

Risk Factors for Glucocorticoid-Induced Osteoporosis.

Risk Factor	Explanation
Advancing age	Elderly patients receiving glucocorticoid therapy have a 26-    fold higher risk of vertebral fractures than younger    patients and a shorter interval between initiation of    treatment and the occurrence of fracture (14)
Low body mass index	Significant risk factor for GIO and probably fractures as well    (13).
Underlying disease	Rheumatoid arthritis, polymyalgia rheumatica, inflammatory    bowel disease, chronic pulmonary disease, and     transplantation are independent risk factors (7)
Family history of hip fracture, prevalent fractures, smoking, excessive alcohol consumption, frequent falls.	All are independent risk factors for osteoporosis but have not    been well studied in patients receiving glucocorticoids.
Glucocorticoid receptor genotype	Individual glucocorticoid sensitivity may be regulated by    polymorphisms in the glucocorticoid receptor gene (16).
11β-HSD isoenzymes	11β-HSD1 expression increases with aging and    glucocorticoid administration and thereby enhances    glucocorticoid activation (17)
Glucocorticoid dose (peak, current, or cumulative, duration of therapy, interval)	There may be no safe dose, although this is somewhat    controversial. However, the risk of fracture unarguably    escalates with increased doses and duration of therapy.    Alternate day or inhalation therapy does not spare the    skeleton (7,15).
LowBMD	Glucocorticoid-induced fractures occur independently of a    decline in bone mass but patients with very low bone    density may be at higher risk (7,13).

11β-HSD, 11β-hydroxysteroid dehydrogenase; BMD, bone mineral density.