Which factor described below would most clearly increase osteoporosis risk in an older male?

• A. Low body weight, age 60 years
• B. Regular exercise, age 60 years
• C. Chronic glucocorticoid therapy, age 70 years
• D. High calcium intake, age 70 years

Answer: (C)

Chronic glucocorticoid therapy is a major trigger for osteoporosis because it directly disrupts bone remodeling at multiple levels. These drugs suppress osteoblast formation and promote osteoblast and osteocyte death, leading to a sharp drop in bone formation. They also tilt the balance toward resorption by increasing RANKL and decreasing osteoprotegerin, so osteoclast activity rises. In addition, glucocorticoids reduce calcium absorption from the gut and increase calcium loss in the urine, lowering the calcium available for bone. This combination accelerates bone loss, especially in older individuals whose bone density is already declining with age. While low body weight, age, and lack of activity are risk factors, the effect of long-term glucocorticoid therapy is a direct and potent driver of osteoporosis, making it the factor most clearly increasing risk in an older male. Regular exercise and adequate calcium intake help reduce risk, whereas chronic steroid exposure drives it up.