**2.4 Osteoporosis**

Another feature of RA is secondary osteoporosis. RA patients have greater incidence of osteoporosis and osteoporotic fractures than matched non-RA controls (e.g. Frank & Gottwalt, 2009; Huusko et al., 2001; Sinigaglia et al., 2006); with this increase attributed to the disease itself (systemic inflammation), treatment with high dose oral glucocorticoids, and sedentary lifestyle (Cantley et al., 2009; Frank & Gottwalt, 2009; Huusko et al., 2001; Sinigaglia et al., 2006; ). Interestingly, after high-dose steroid therapy, the reduced bone mineral density (BMD) in RA patients has been found to be most strongly associated with low strength (quadriceps and handgrip) and poor physical function (Huusko et al., 2001; Madsen et al., 1998, 2001).
