For patients <65 with significant intermittent steroid exposure who otherwise do not have risk factors for osteoporosis, when, if ever, do you recommend considering DEXA screening?

The FRAX guidelines recommend answering "Yes" for glucocorticoid use when a patient has received the equivalent of prednisone ≥5 mg daily for more than 3 months. However, many patients with rheumatoid arthritis have been treated with intermittent courses of corticosteroids over several years, which ...

Great question, and one that I think deserves a broader framing than just "when to get a DXA."

Bone health should be on the table anytime we prescribe steroids. Regardless of age, dose, or anticipated duration, every visit where steroids are discussed should include counseling on calcium (800–1000 mg...