Background: Osteoporosis is an extra-articular complication of rheumatoid arthritis that results in increased risk of fractures and associated morbidity, mortality, and healthcare costs. Objective: To evaluate changes in bone mineral density in a sample of rheumatoid arthritis (RA) patients on biological (anti tumor necrosis factor (TNF) alpha) and non-biological agent disease modifying antirheumatic drugs (DMARDs). Patients and Methods: A cross sectional study enrolled 60 RA patients diagnosed by rheumatologist according to the 2010 American College of Rheumatology/European League Against Rheumatism (2010 ACR/EULAR) classification criteria for RA. Thirty patient on biological agent (anti TNF alpha) and 30 patient on non-biological agent (DMARD). RA disease-related data wincluded disease duration, disease activity score index of 28 joints (DAS 28) and clinical disease activity index (CDAI), functional class, body mass index and treatment history. vitamin D level were measured in both groups. Bone mineral density was measured by dual energy x-ray absorptiometry of hip and lumber spines for patients. AT–score of equal or less than-2.5 standard deviation that of young healthy adults were taken as osteoporotic and scores between-1 to-2.5 standard deviation was taken as osteopenic. Results: Prevalence of RA patients on biological agent (anti TNF alpha) who had osteoporosis was 1 (3%) and 12 (40%) were osteopenic, and in patients on non biological (DMARD), Osteoporosis was present in 8 (26%) and osteopenia in 13 (43%, p= 0.019). Vitamin D level in patient on biological agent (anti TNF alpha) was low in 24 (80%) and normal …