OBJECTIVE: To evaluate the economic efficiency of management guidelines for corticosteroid-induced osteoporosis and establish whether it is more economically efficient to modify the guidelines when targeting respiratory patients. METHODS: Data were collected from GP medical records related to osteoporosis risk factors and corticosteroid use in the previous year. Sample data were used for economic modelling based on population data and costs from literature. Three strategies were evaluated: the existing guidelines; modified guidelines; treatment without reference to guidelines. Main outcome measures: net discounted cost per fracture averted and net discounted cost per quality adjusted life year (QALY) saved. RESULTS: A cohort of 110 (71 women) adult patients prescribed oral and / or inhaled corticosteroids was identified. Following existing guidelines averted 0.5 fractures and saved 0.1 QALYs at a net total cost of £5,943. The resultant cost per fracture averted is £12,506 and cost per QALY saved is £40,356. When modified, to include intermittent oral and inhaled corticosteroid use as risk factors, the net total costs increased to £30,190; 3.6 fractures averted and 1.1 QALYs are saved resulting in a cost per fracture averted of £8,419 and cost per QALY saved of £27,854, representing greater economic efficiency. Further reductions in costs with no detriment to benefits were seen when modified risk criteria were in the guidelines were not followed and bone mass density measurements and diagnostic testing were excluded. Sensitivity analysis of the results identified sex as a major influence on cost effectiveness. When men were excluded favourable reductions were seen in the cost per fracture averted and cost per QALY saved. CONCLUSION: When managing corticosteroid-induced osteoporosis in respiratory patients, this study showed that it was more cost-effective to use modified guidelines than existing guidelines. The modifications proposed are to include risk assessment criteria for sex, and use of intermittent oral and inhaled corticosteroids.