Most countries have guidelines on long-term glucocorticoid therapy and secondary osteoporosis prevention, but none have guidelines for the treatment of patients with COPD with osteoporosis (with or without glucocorticoids), so this topic will be one of the future research directions of the new guideline development working group. Referring to the GINA guideline pathway for asthma management, clinical research data, combined with long-term clinical practice, for the prevention and treatment of osteoporosis in patients with COPD, the overall goal is to improve delay the progression of osteoporosis and prevent the occurrence of fractures; long-term goals should start from relieving COPD symptoms and reducing risk, including relieving symptoms, stopping disease progression, preventing exacerbations, improving The long-term goals should be to relieve COPD symptoms and reduce risk, including relieving symptoms, stopping disease progression, preventing disease exacerbation, improving activity tolerance, improving health status, and reducing mortality. Prevention and treatment strategies include smoking cessation, exercise, minimizing glucocorticoid use, and adequate nutrition. Since patients with COPD with osteoporosis often do not have significant osteoporotic symptoms, all patients with progressive COPD should be screened for combined osteoporosis. The GINA guidelines recommend that people at high risk for osteoporosis should have their bone mineral density assessed by dual-energy X-ray absorptiometry (DXA), such as those taking oral hormones (prednisone or prednisolone 7.5 mg daily and above) for more than 6 months; postmenopausal women taking 5 mg of oral prednisone or prednisolone daily for more than 3 months; and patients with a history of vertebral or other fractures associated with osteoporosis Patients with a history of vertebral or other fractures associated with osteoporosis. Osteoporosis risk can be assessed using the One-Minute Questionnaire recommended by the International Osteoporosis Foundation or the Osteoporosis Self-Screening Tool for Asians. Both the GOLD guidelines and the Guidelines for the diagnosis and management of primary osteoporosis indicate that certain preventive measures can be taken for osteoporosis: 1. Control infection and improve the patient’s ventilation while actively treating chronic obstructive pulmonary disease; 2. Apply glucocorticoids for as short a time as possible and use inhaled hormones as much as possible; 3. Eat a reasonable diet and enhance nutrition, which should be supplemented with adequate calcium (1000 mg/day) and Vitamin D (800-1200IU/day); 4. Quit smoking; 5. Improve hypoxemia; 6. Strengthen physical exercise and outdoor activities. The 2015 GOLD guidelines state that the treatment of osteoporosis in patients with COPD should follow the conventional osteoporosis guidelines. The main drugs currently available for the treatment of osteoporosis are calcium, vitamin D, calcitonin, bisphosphonates, sex hormone supplementation and anti-osteoporosis monoclonal antibodies that have emerged in recent years. A randomized, double-blind, placebo-controlled study in the United States found that calcium supplementation with vitamin D reversed glucocorticoid-induced bone loss. The major orthopedic and osteoporosis societies unanimously recommend that calcium in combination with vitamin D is the basic medication for osteoporosis. The anti-osteoporosis effect of bisphosphonates has been widely recognized. One study included 701 healthy women with low bone mineral density to compare the effects of alendronate with calcium supplementation. Study endpoints included bone mineral density, bone turnover markers, and adverse events. It was found that alendronate significantly reduced the incidence of fractures; it was also found that the combination of alendronate and calcium reduced the incidence of fractures better than alendronate alone. Our guidelines for the management of primary osteoporosis state that adequate calcium (1000 mg/day) and vitamin D (800-1200 IU/day) are the basis of osteoporosis management and should be implemented into all anti-osteoporosis treatment regimens to achieve the best outcome. Continuous monitoring to maintain bone health The GOLD guidelines state that continuous monitoring of COPD should ensure that treatment goals are met and that risk factors are continuously assessed. Even if the patient’s osteoporosis is alleviated or cured by treatment, the complexity of COPD itself requires continued attention to the secondary prevention of osteoporosis. A healthy lifestyle, such as a balanced diet rich in calcium, low salt and moderate protein, avoidance of smoking, appropriate outdoor activities and sun exposure, and adequate calcium and vitamin D supplements, not only contribute to bone health but also to recovery from COPD. Since there are many factors affecting bone metabolism in patients with COPD, leading to the development of osteoporosis, which seriously threatens the physical and mental health of patients, it is important to draw clinicians’ attention to osteoporosis in COPD by elucidating the interplay between the two. Regular testing, timely detection and early treatment can reduce complications, alleviate patient suffering and better improve the quality of life of patients with chronic obstructive pulmonary disease.