Which characteristic below would increase the risk of osteoporosis in an older adult male patient?

• A. Low body weight, age 60 years
• B. Smoker, age 65 years
• C. Chronic glucocorticoid therapy, age 70 years
• D. Family history of hypothyroidism, age 65 years

Answer: (C)

Long-term glucocorticoid therapy is a major risk factor for osteoporosis because it directly alters bone remodeling. It suppresses osteoblast activity, increases osteoclast survival, and reduces calcium absorption while increasing calcium excretion by the kidneys. The net effect is accelerated bone loss and a higher risk of fractures. In an older man, who already has lower peak bone mass and greater bone turnover with aging, this effect is especially pronounced. While low body weight and smoking also contribute to fracture risk, the impact of chronic glucocorticoids is the strongest single factor among the options. A family history of hypothyroidism is less directly tied to osteoporosis unless thyroid function is abnormal.