Fig. 2. Initial fracture risk assessment. A clinical fracture risk assessment includes obtaining a history with the details of GC use (dose, duration, pattern of use), an evaluation for falls, fractures, frailty, and other OP risk factors (malnutrition, significant weight loss or low body weight, hypogonadism, secondary hyperparathyroidism, thyroid disease, family history of hip fracture, history of alcohol use [at ≥3 units/day] or smoking) and other clinical comorbidities, and a physical examination including measurement of weight and height (without shoes), testing of muscle strength, and assessment for other clinical findings of undiagnosed fracture (i.e., spinal tenderness, deformity, and reduced space between lower ribs and upper pelvis) as appropriate given the patient's age. The risk of major osteoporotic fracture calculated with the fracture-risk assessment tool (FRAX) should be increased by 1.15, and the risk of hip fracture by 1.20, if the prednisone dose is 7.5 mg/day (i.e., if the calculated hip fracture risk is 2.0%, increase to 2.4%). It is recognized that in some cases, BMD testing may not be available. GC, glucocorticoid; OP, osteoporosis; BMD, bone mineral density. [Reprinted from “2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.”, by Buckley L, et al., 2017, Arthritis Care Res (Hoboken), 69, pp.1095–1110. Copyright 2017 by the Wiley. Reprinted with permission].