Fig. 4. Initial pharmacologic treatment for adults. Recommended doses of calcium and vitamin D are 1,000 to 1,200 mg/day and 600 to 800 IU/day (serum level ≥20 ng/mL), respectively. Lifestyle modifications include a balanced diet, maintaining weight in the recommended range, smoking cessation, regular weight-bearing and resistance training exercise, and limiting alcohol intake to 1 to 2 alcoholic beverages/day. 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. The risk of major OP fracture calculated with the fracture-risk assessment tool (FRAX) should be increased by 1.15, and the risk of hip fracture by 1.2, 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. BMD, bone mineral density; OP, osteoporosis; GC, glucocorticoid; SERM, selective estrogen receptor modulating agent. [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].