Patients with a chronic pulmonary disease often require long-term treatment with oral steroids. Prolonged use of glucocorticoids is associated with increased risk of bone loss and osteoporosis. The American College of Rheumatology (ACR) has published guidelines to prevent steroid-induced osteoporosis. The aim of this study was to investigate adherence to these guidelines in clinical practice. Medical records of 87 patients receiving oral steroids (prednisolone >10 mg/day) for at least 6 months were reviewed. Of these, 57 patients were treated by a rheumatology specialist, and 30 by a pulmonology specialist. Differences between the two groups were examined using Chi-square test. Altogether 33 patients (35%) received prophylactic treatment. Examination of between-groups variation revealed that 46% of patients treated by a rheumatologist received prophylaxis, while the respective percentage in those treated by a pulmonologist was only 23% (p<0.05). Our data suggest that only a relatively small proportion of patients receiving corticosteroid treatment are offered prophylaxis for steroid-induced osteoporosis, and this proportion is significantly lower in patients attended by pulmonary medicine specialists. Pneumon 2004, 17(3):297-303.