To investigate the effects of Tofacitinib citrate tablets combined with Xianling Gubao capsule on serum inflammatory cytokines, bone strength and bone metabolism levels in patients with rheumatoid arthritis (RA) complicated with osteoporosis. 80 patients with RA complicated with osteoporosis who were diagnosed and treated in Lianyungang Hospital Affiliated to Xuzhou Medical University from August 2021 to August 2022 were included.The patients were divided into the control group (Tripterygium wilfordii polyglycosides tablets combined with Xianling Gubao capsule) and the experimental group (Tofacitinib citrate tablets combined with Xianling Gubao capsule) according to the random number table method, with 40 cases each. The efficacy, inflammatory cytokines, bone strength and bone metabolism indexes were compared in the two groups, and the incidence of adverse reactions was observed in the two groups. The total clinical effective rate in the experimental group was higher than that in the control group (P<0.05). Macrophage colony-stimulating factor (M-CSF), interleukin-1β(IL-1β) and cyclooxygenase-2 (COX-2) in the experimental group after treatment were lower than those in the control group (P<0.05). The cross sectional area (CSA), cross sectional moment of inertia (CSMI), cross sectional coefficient (Z) and cortical thickness (CT) in the experimental group after treatment were higher than those in the control group (P<0.05). After treatment, the N-terminal intermediate molecule of osteocalcin (N-MID), the amino terminal extension peptide(T-PINP), osteocalcin (BGP) and carboxyterminal propeptide of type I procollagen (PICP) in the experimental group were higher than those in the control group at the same period, and the β-collagen degradation products (β-CTX) was lower than that in the control group at the same period (P<0.05). Lumbar spine BMD and femoral neck BMD increased after treatment in both groups compared with before treatment, and were higher in the experimental group than in the control group during the same period (P<0.05). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid arthritis patient condition (DAS28) scores decreased in both treatment groups, and were lower in the experimental group than in the control group during the same period (P<0.05). There was no significant difference in the incidence of adverse reactions in the two groups (P>0.05). Tofacitinib citrate tablets combined with Xianling Gubao capsule is applied to the patients with RA with osteoporosis, which can effectively regulate the bone metabolism level, enhance bone strength and reduce the serum inflammatory cytokines level. [ABSTRACT FROM AUTHOR]