Fig. 3. Reassessment of fracture risk. 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. Very high-dose GC treatment was defined as treatment with prednisone ≥30 mg/day and a cumulative dose of 5 g in the past year. Reliability of fracture-risk assessment tool (FRAX) after OP treatment is debated, but FRAX calculation can be repeated in adults age ≥40 years who have not received treatment. 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].