Patients at highest risk for the adverse effects of glucocorticoid-induced bone loss are those with initially low levels of bone mass. However, although glucocorticoids are the most common cause of secondary osteoporosis, diagnostic thresholds in glucocorticoid-induced osteoporosis using BMD have not been established. The diagnostic guidelines for postmenopausal women do not apply to glucocorticoid-induced osteoporosis. Patients exposed to glucocorticoids are at increased risk of fractures. At similar BMD levels, patients on glucocorticoids appear to have a higher risk of fracture. This higher risk of fracture at comparable BMD suggests that the quality of the bone tissue is affected by glucocorticoid therapy.⁹