Glucocorticoid-induced osteoporosis is the leading cause of medication-induced osteoporosis. The fracture incidence after 1 yr of glucocorticoid therapy has been found to be 17% and observational studies suggest that fractures eventually occur in 30 to 50% of chronic glucocorticoid-treated patients. An increased risk of fracture develops within as quickly as 3 mo, and with doses of prednisone as low as 2.5 mg daily. Despite effective methods of prevention and treatment, only 50% of chronic glucocoriticoid-treated patients undergo any evaluation for osteoporosis and less than one in four receives treatment. This article addresses the various issues the clinician faces in managing patients receiving chronic glucocorticoids. It begins and ends with a case perspective. Evidence-based information is used to outline the current best strategy for the prevention and treatment of glucocorticoid-induced osteoporosis.