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Altaf Abdulkhaliq,1 Mohamed Cheikh,2,3 Fahad Almuntashri,4 Haneen Alzahrani,4 Huda Nadwi,4 Eithar Kadi,4 Mutasem Abed,4 Murad Janaini,4 Alaa Monjed,4 Nahed Janoudi,2 Hani Almoallim4,5 1Department of Clinical Biochemistry, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia; 2Internal Medicine Department, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 3Department of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia; 4Department of Medicine, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia; 5Alzaidi Chair of Research in Rheumatic Diseases, Umm Al Qura University, Makkah, Saudi ArabiaCorrespondence: Fahad Almuntashri Tel +966 542626003Email fahadalmuntashri@gmail.comIntroduction: Osteoporosis (OP) is one of the most common comorbidities associated with rheumatoid arthritis (RA). Literatures reported that the risk for developing OP was strongly associated with duration and severity of RA. We aim to elaborate on the consequences of OP on disease activity and management plan in patients with RA.Patients and Methods: A retrospective cohort study recruited 408 patients, including those with RA alone and with RA plus OP. The RA disease activity in the patients was assessed using disease activity score in 28 joints (DAS28-CRP). A statistical analysis was performed to compare data between the two groups of patients and determine any significant risk factor associated with the development of OP in RA patients.Results: Of 408 patients who were included in this study, 353 patients (86.5%) had only RA, while 55 patients (13.5%) had RA with OP and showed significant difference (P = 0.04) concerning age categories. Patients diagnosed with RA and OP had RA duration longer than RA-only patients (independent t-test, P = 0.01). The two groups had almost similar disease activity at the three clinical visits, as well, had nearly similar disability at their first visit, whereas RA with OP patients had significant greater disability at their 2nd and 3rd visits (independent t-test, P = 0.001). Both groups were treated with the same biologic and non-biologic medication of similar frequency, although RA patients with OP received steroid more frequently than patients had RA only (61.7% vs. 41.7%, chi square test, P = 0.03).Conclusion: There was no significant difference in disease activity at both groups of patients. However, RA with OP group had longer duration of RA, were more frequently treated with steroids, and had greater disability. We recommend physicians focus on controlling RA disease activity, early screening for and treating of OP.Keywords: rheumatoid arthritis, osteoporosis, disease activity, biologic, disease modifying antirheumatic drugs, effects, RA OP