Ocular inflammatory reactions have been described in patients on bisphosphonate treatment. We estimated the incidence rate of ocular inflammation at 3 and 12 months in patients treated for osteoporosis using a register based cohort linked to prescription data (hospitals and private practice) and hospital data. Between Jan 1, 1997 and Dec 31, 2007, a total of 88,202 patients beginning osteoporosis therapy were identified. Of those patients, 82,404 (93%) began oral bisphosphonates and 5798 (7%) non-bisphosphonates. Topical eye steroids (TES) Within the first year of treatment, 4,769 (5.4%) of patients on osteoporosis therapy filled one or more prescriptions for TES. TES treatment rates (per 1000 patient years) in the first year of osteoporosis treatment were 44 (95% confidence interval (CI) 42-46) for alendronate, 40 (95% CI 38-43) for etidronate, 45 (95% CI 35-57) for risedronate, 32 (95% CI 27-37) for raloxifene and 64 (95% CI 49-83) for strontium ranelate. After adjustment for age, Charlson index, and the number of co-medications, pulmonary disease in men was associated with an increased use of TES (odds ratio (OR) 1.48; 95% CI 1.17-1.86, p=0.001). In women, malignant disease (OR 1.27; 1.02-1.60, p=0.04) and pulmonary disease (OR 1.32; 95% CI 1.07-1.62, p=0.01) were significant predictors at 3 months and rheumatic diseases at 12 months (OR 1.20; 1.10-1.31, p