Osteoporosis is defined as “low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and consequent increase in fracture risk.”1 It is a major public health concern, with 50 000 hip and an estimated 50 000 vertebral osteoporosis related fractures occurring annually in the United Kingdom, with an annual cost of more than £500 million.2 Until recently the condition was widely seen as an inevitable and untreatable consequence of aging. However, the introduction of dual energy xray absorptiometry (DXA) scanning as an investigative tool, and the emergence of effective treatments have led to an explosion of clinical, academic, and commercial interest in the field. This editorial reviews its relevance within neurology and presents recent guidelines for the management of steroid induced osteoporosis.