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Dexamethasone is now replacing prednisolone as the drug of choice because of its greater lymphocytotoxicity and higher CNS penetration. Recent studies have shown that bone mineralisation status as assessed by bone mineral density, corrected as well as uncorrected for body size, may be adversely affected immediately after completion of treatment. Older age, pubertal age, the male sex, and dexamethasone have been shown to be independent risk factors for fractures and reduced bone mineralisation. A number of childhood conditions that require chronic GC therapy may themselves predispose the child to abnormalities of growth and bone health. For instance, poor linear growth and osteoporosis may be presenting features in a child with inflammatory bowel disease. The interaction with other factors such as inflammatory cytokine production, diminished physical activity, alterations in nutritional status, and the use of other immunomodulatory agents that may also have bone adverse effects greatly increase the risks posed to the growth and bone health of the child on chronic GC therapy. The clinical effects on bone health can be divided into those occurring in the short term (fractures and avascular necrosis) and those that may occur over the longer term’that is, increased predisposition for osteoporosis and skeletal deformity. Current studies and clinical observations suggest that children who require long term systemic GC therapy (for more than three months) have a higher incidence of fractures during therapy. For adults, the Royal College of Physicians has issued guidelines on indications for assessing and managing bone health. Bone mineral status can be assessed by a number of methods and DEXA is by far the most popular method. Unlike adults where a single assessment of bone mineral density by DEXA can predict likelihood of fracture in age related osteoporosis, this relation is not so clear in children with GC induced osteoporosis. Children at risk of GC induced osteoporosis and those displaying growth failure should, therefore have serial bone mineral density assessment to assess a change in status; results need to be carefully interpreted in relation to their sex, age, height, and weight, as well as their disease and its treatment. Current studies of long term follow up of children treated with chemotherapy only regimens for ALL do not show disturbances in final height or bone mineral status, and there are no data to support or refute the claim that prolonged GC therapy in childhood may lead to early osteoporosis in adulthood. Skeletal disproportion has been reported as a possible long term effect of ALL chemotherapy; it is not clear whether this phenomenon of skeletal disproportion is observed in other groups of children requiring chronic GC therapy. Failure to acquire peak bone mass should prompt longer term monitoring. Prevention of GC induced growth retardation and adverse bone health could be addressed in a number of cases by judicious use of GC therapy coupled with improved nutrition and promotion of weight bearing activities. In addition, alternate day GC regimens and consideration of GC sparing drugs at an earlier stage than before may be possible preventive measures but need further evaluation. For reasons mentioned earlier, calcium and vitamin D supplementation is generally recommended in patients on GC therapy, although there is little objective clinical evidence to suggest that this practice prevents GC induced osteoporosis in adults or children. As hypogonadism may contribute both to poor growth and impaired bone mineral accretion, addressing hypogonadism in pubertal children on GC therapy should be an important consideration, nebido 1000mg review. Recent studies show that recombinant GH treatment may be of benefit in halting the growth retardation and bone loss observed in children on chronic GC therapy. In children, the role of the antiresorptive group of drugs, bisphosphonates has been mostly studied in the field of osteogenesis imperfecta where their use is associated with a reduction in the frequency of fractures, improved bone mass, and mobility. An early resumption of aerobic as well as weight bearing activity, with good analgesic control will require the support of a child oriented physiotherapy and pain relief service. GC are an effective and necessary form of therapy for a large number of children. 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