Bone damage in active rheumatoid arthritis (RA) includes accelerated bone loss and joint destruction, which are both associated with increased osteoclast activity. Glucocorticoids suppress the signs and symptoms of inflammation in RA and reduce the rate of bony joint destruction, but it is not clear whether glucocorticoids will reduce or increase disease-related bone loss. In a 2-year, double-blind, randomized study in patients with early RA, Haugeberg et al demonstrate that disease-related loss of hand bone mass is reduced by treatment with prednisolone, 7.5 mg/d, compared with placebo. This observation strengthens the argument for a common cellular mechanism for bone loss in osteoporosis and joint damage in RA. The results also suggest that quantitative bone mass measurement could be a useful outcome marker of response to treatment.