Patients rely on their primary care physician to manage multiple, often chronic medical conditions that require prescription medications. Balancing the risk to benefit of treatments can be challenging and requires that the primary care physician stay abreast of new information regarding risks and benefits. The number of medications with reported adverse effects on skeletal health is expanding. This review focuses on medications recently added to the list of "bad to the bone" drugs and on recent advances in management of glucocorticoid-induced osteoporosis. A practical approach to assessing and managing the skeletal risks is outlined.Mayo Clin Proc. 2011;86(4):338-343 BMD = bone mineral density; GnRH = gonadotropin-releasing hormone; 5HTT = 5-hydroxytryptamine transporter; PPARγ = peroxisome proliferator-activated receptor gamma; PPI = proton pump inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant © 2011 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) identify prescription medications associated with increased risk of fractures, (2) recognize the importance of assessing baseline fracture risk in patients initiating and continuing these medications, and (3) recognize the role of teriparatide in patients at high risk of fracture who must take glucocorticoids.