Background: Bone health can be seriously affected by the leprosy reaction itself and steroids used in its treatment. Objective: To assess the bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) scan and fracture risk by the fracture risk assessment tool (FRAX) in steroid treated patients with leprosy reaction. Methods: This study involved 25 patients with leprosy reaction treated with steroids (prednisolone) and 22 healthy family members attending the urban leprosy clinics of The Leprosy Mission International -Bangladesh (TLMI-B) Dhaka program in January-March, 2018. Socio-demographic and clinical information was recorded and BMD was measured in the spine, femur neck and forearm by DXA. Fracture risk was calculated by FRAX. Results: Both the T-score and Z-score of the spine were lower in the leprosy group in relation to those of the control group [leprosy vs. control: T-score −1.7 (−3.2-1.3) vs. −1.2 (−2.5-0.8), p =0.030 and Z-score −1.9 (−3.3 to −1.4) vs. −1.2 (−2.3 to −0.2), p =0.038; median (interquartile range). In other regions (femur neck, forearm) both scores were similar between the two groups, except for Z-score of the left femur neck which was lower in the leprosy group (p =0.036). Although the frequency of osteopenia and osteoporosis in different sites was similar between groups, the 10-year probability of major osteoporotic fracture [leprosy vs. control: 2.2% (1.6-4.7) vs. 1.1% (0.9-2.0); p <0.001] or hip fracture [leprosy vs. control: 0.4% (0.1-1.7) vs. 0.1% (0.0-0.2); p =0.001] by FRAX was higher in the leprosy group. Conclusions: Participants with leprosy reactions and steroid treatment had lower BMD related parameters in lumber spine and higher risk of osteoporotic fracture.