I have osteopenia ( less severe than osteoporosis) and my rheumatologist put me on Fosamax to prevent bone loss as soon as I started the prednisone. While on Fosamax my bone density increased 10%. You might talk to your doctor about whether this medication would be appropriate for you. Also, Kevzara is a newer medication for people who have PMR but cannot tolerate prednisone or cannot taper off it. As far as flares, my rheumatologist told me that I could increase my dose up to 25%, then taper back to where I was. My experience is that waiting to increase prednisone during a flare just makes it harder to get the pain under control. I reduced my previous activities ( uphill hiking, biking, yard work etc. ) . What I do now seems pretty whimpy but I stay active.