In this scenario, which factor most likely contributed to osteoporosis progression?

• A. Long-term corticosteroid use
• B. Regular exercise
• C. Adequate calcium intake
• D. Vitamin D sufficiency

Answer: (A)

Long-term corticosteroid use is a major driver of osteoporosis progression because glucocorticoids directly disrupt bone remodeling and calcium balance. They suppress osteoblast activity, promote osteoclast survival, and reduce the production of new bone matrix, leading to accelerated bone loss. They also decrease intestinal calcium absorption and increase calcium excretion by the kidneys, creating a negative calcium balance that further weakens bone. Over time, this combination rapidly reduces bone density and raises fracture risk, especially in the spine and hips.

In contrast, regular exercise strengthens bone by stimulating formation and improving mechanical strength, while adequate calcium intake and vitamin D sufficiency support mineralization and calcium absorption. These factors tend to protect against bone loss rather than drive it, so they do not contribute to progression the way chronic corticosteroid exposure does.