To minimize osteoporosis risk during long-term glucocorticoid therapy, which measure is most appropriate?

• A. Calcium and vitamin D supplements.
• B. Estrogen replacement therapy.
• C. High-protein diet only.
• D. Routine bone X-rays.

Answer: (A)

Preventing glucocorticoid-induced bone loss is best addressed by ensuring adequate calcium and vitamin D to support bone mineralization and calcium balance. Calcium and vitamin D supplements help maintain bone density and reduce fracture risk during long-term steroid therapy by supplying the essential nutrients the bone relies on when corticosteroids impair bone formation and increase resorption.

Estrogen replacement therapy is not routinely used for this purpose due to significant risks and it does not specifically counter the bone-killing effects of glucocorticoids. A high-protein diet alone does not prevent osteoporosis, as protein without the essential minerals and vitamins doesn’t reliably protect bone. Routine bone X-rays are diagnostic tools, not preventive measures, and radiation exposure isn’t a preventive strategy. For comprehensive prevention, clinicians may also consider weight-bearing exercise, fall prevention, and, in higher-risk patients, pharmacologic agents like bisphosphonates.