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Glucocorticoids Selective serotonin reuptake inhibitors Aromatase inhibitors Hypoglycemic agents (thiazolidinediones) Proton pump inhibitors Antiepileptics Anticoagulants (heparin and oral agents) Loop diuretics Antiretroviral agents Calcineurin inhibitors Androgen deprivation therapy Depot medroxyprogesterone acetate General recommendations Reassess need for medication Use lowest dosage and shortest duration needed Counsel patients on lifestyle changes: encourage weight-bearing exercise, cessation of tobacco use, and limiting alcohol use Supplement calcium and vitamin D Consider screening and monitoring bone density with dual-energy absorptiometry (DXA) Initiate osteoporosis treatment if indicated Oral glucocorticoids Therapy anticipated for ≥ 3 months at any dose: get baseline DXA scan Follow American College of Rheumatology recommendations for initiating osteoporosis prevention treatment Proton pump inhibitors Supplement calcium with calcium citrate Consider alternative therapy such as a histamine-2 receptor blocker Aromatase inhibitors Consider bisphosphonate treatment for postmenopausal women with T scores < –2.0 or with other risk factors