Rheumatoid Arthritis and Bone Health: The Osteoporosis Connection

Does rheumatoid arthritis increase your risk of osteoporosis?

Yes — having rheumatoid arthritis (RA) raises your chance of developing osteoporosis and of breaking a bone, and that risk increases the longer you have had the condition. The Royal Osteoporosis Society states plainly that people with RA have a higher chance of osteoporosis and broken bones than those who do not have RA, and that this chance increases the longer you have had RA (Royal Osteoporosis Society, 2026).

The scale of that extra risk is meaningful. The National Rheumatoid Arthritis Society reports that several studies have shown a two-fold increase in osteoporosis in people with RA compared with people of the same age and sex who do not have RA (National Rheumatoid Arthritis Society, 2019). A 2020 review in the Journal of Clinical Medicine likewise found that the incidence of osteoporotic fractures in RA exceeds that of the general population by roughly 1.5- to 2-fold (Journal of Clinical Medicine, 2020). None of these figures describe any single person's risk — they describe groups — but the direction is consistent across sources.

Why does rheumatoid arthritis cause bone loss?

The biggest driver is the chronic inflammation of RA itself, which directly activates the cells that break bone down. RA is an inflammatory disease, and the inflamed joint lining releases pro-inflammatory cytokines — signalling molecules such as TNF, IL-1, IL-6 and IL-17. These, together with a master signal called RANKL, activate osteoclasts, the cells that resorb (break down) bone. A 2020 review describes TNF stimulating RANKL to activate osteoclasts and promote resorption while also inhibiting bone formation, producing a systemic effect that leads to generalised bone loss alongside the localised joint destruction (Journal of Clinical Medicine, 2020).

A 2022 review reached the same conclusion from the molecular angle, describing a systemic upregulation of osteoclastogenic cytokines with RANKL as the master driver of bone-density loss, and IL-6 and IL-17 contributing further (International Journal of Molecular Sciences, 2022). In other words, the same inflammation that damages joints also weakens bone throughout the body.

But inflammation is not the only route. NRAS lists additional contributing factors, including difficulty taking exercise and long-term corticosteroid use (National Rheumatoid Arthritis Society, 2019), and the Royal Osteoporosis Society names reduced physical activity, steroid use, poor disease control and an increased risk of falls as factors that raise the risk in RA (Royal Osteoporosis Society, 2026). Understanding what causes osteoporosis more broadly helps put these overlapping factors in context.

Where does RA cause bone loss — around the joints or throughout the body?

Both. RA produces two distinct patterns of bone loss. NRAS notes that osteoporosis in RA can present either as generalised bone loss or as periarticular osteoporosis — thinning of the bone immediately around the affected joints (National Rheumatoid Arthritis Society, 2019). A 2021 review in Cureus describes the same split, explaining that RA can result in local periarticular and generalised bone loss, with the inflammatory reaction in the joint synovium producing cytokines (TNF, IL-1, IL-6) that activate osteoclasts and mediate bone destruction (Cureus, 2021).

The generalised loss is what raises your overall fracture risk at sites such as the hip and spine — which is why bone health in RA is not only about the joints you can feel.

Do the steroids used for rheumatoid arthritis weaken bones?

They can — glucocorticoid (steroid) treatment is a well-recognised cause of secondary osteoporosis, and RA is one of the conditions steroids are commonly used for. The Royal Osteoporosis Society explains that steroid medicines can cause bone to break down faster than it is made — by activating bone-breakdown cells, slowing bone-building cells and reducing calcium absorption — and lists rheumatoid arthritis among the conditions treated with steroids (Royal Osteoporosis Society, 2022).

The same source notes that the risk from steroid tablets increases if they are taken for more than three months, and that even relatively low doses may increase risk (Royal Osteoporosis Society, 2022). The Cureus review similarly flags both systemic and intra-articular corticosteroids as risk factors for secondary osteoporosis in RA (Cureus, 2021). These thresholds are general information for context, not a reason to change anything yourself — our guide to steroids and bone loss explains the mechanism in more depth.

How much does rheumatoid arthritis raise fracture risk?

Studies consistently show a raised, though not enormous, increase in fracture risk — commonly in the region of 1.5- to 2-fold. The 2020 Journal of Clinical Medicine review put the excess incidence of osteoporotic fractures at roughly 1.5 to 2 times that of the general population (Journal of Clinical Medicine, 2020). The 2022 International Journal of Molecular Sciences review reported an increased risk of fragility fractures with a relative risk of about 1.61, and around 20% prevalence of vertebral (spinal) fractures in the RA populations it examined (International Journal of Molecular Sciences, 2022).

Prevalence of osteoporosis itself can look high in some cohorts. The Cureus review cites one large observational study (Ozen and colleagues, 2017, covering 11,669 people with RA) that reported osteoporosis in 67.4% of participants (Cureus, 2021). That is a single-cohort finding, not a universal rate for everyone with RA — but it underlines why bone health deserves attention in this group. The high-dose glucocorticoids sometimes used in RA add a further layer of secondary osteoporosis risk on top of the disease itself (Journal of Clinical Medicine, 2020).

Is rheumatoid arthritis included in fracture-risk tools like FRAX?

Yes — RA is a specific input in FRAX, the fracture-risk tool clinicians use. FRAX, developed at the University of Sheffield, includes rheumatoid arthritis as an explicit clinical risk factor, instructing the clinician to "enter yes where the patient has a confirmed diagnosis of rheumatoid arthritis" (FRAX, University of Sheffield, 2026). A confirmed RA diagnosis therefore directly raises the calculated 10-year fracture risk. The 2020 review notes that FRAX helps set a treatment threshold in people with RA (Journal of Clinical Medicine, 2020).

FRAX is not a scan — it is a calculator that your clinician interprets alongside a bone-density result and your other risk factors. Our explainer on fracture risk and FRAX walks through how the score is built and what it means.

What can help protect my bones if I have rheumatoid arthritis?

The most useful steps are controlling your RA well, staying active within your limits, getting enough calcium and vitamin D, not smoking — and having your bone density assessed and monitored, especially if you take steroids. NRAS advises that a healthy diet rich in calcium and vitamin D, weight-bearing exercise and sunlight all help to maintain bone mass, and that bone density is measured by a DEXA scan (National Rheumatoid Arthritis Society, 2019). Because reduced activity and poor disease control both add to the risk, keeping your RA well managed with your rheumatology team is itself a bone-protecting move (Royal Osteoporosis Society, 2026). The Royal Osteoporosis Society also emphasises that enough calcium and vitamin D, plus weight-bearing exercise, are important when steroids are involved (Royal Osteoporosis Society, 2022).

Because RA raises fracture risk silently — bone loss has no symptoms until something breaks — knowing where your bones stand matters. A baseline measurement, followed by monitoring over time, lets you and your clinicians see whether your bone density is holding steady or drifting, so any change can be acted on early. This is especially relevant if you are on long-term steroids.

A radiation-free REMS scan is one way to establish that baseline and monitor bone density over time, without the small X-ray dose that limits how often a conventional scan can be repeated. It complements — rather than replaces — the care from your rheumatology team and GP, who remain the people to decide on any diagnosis or treatment. You can read more about our bone health assessment or book a radiation-free bone health assessment if you would like a baseline to monitor alongside your RA care.

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This article is part of our bone health series. To understand the treatments involved, see our guide to steroids and bone loss.