I was diagnosed with PsA over ten years ago, and over the course of that period, I've been on and off of Prednisone, mostly for flares, but sometimes low dose for maintenance. Late last spring I fractured my sacrum. I'm a distance runner, and the constant pounding probably had been causing stress fractures, and then at the start of a half marathon it just gave way while running down the first big hill. After a MRI confirmed a "non displaced fracture" of my sacrum, my rheumatologist ordered a BMD scan, and referred me to endocrinology. The scan came back showing osteopenia, and osteoporosis in the lumbar vertabrae and the greater trochanter triangle of the femur (-2.7😎. My endocrinologist (I've got a lot of ologists now) told me that rheumatoid diseases in and of themselves can contribute to a loss in bone density, and when treated with steroids, that is greatly accelerated. My osteoporosis has been diagnosed as steroid induced, and I was put on alendronate, until it cause GI complications, and then a Reclast infusion. The best thing to do when saddled with a disease that can contribute so significantly to bone loss is to avoid anything that may contribute further; i.e. caffeine (possible culprit), tobacco, alcohol. Additionally, try to consume as much calcium from your diet as possible, supplemented with magnesium, D3, and K2. Even NSAIDs can contribute to bone loss when taken in large doses over long periods of time. Also, PPI's for GERD can interfere with calcium absorption, so try to avoid foods that may cause you to have to use PPI's (omeprazole, esomeprazole, etc.). Eating a diet rich in low fat dairy, whole grains, and lots of fresh vegetables and fruits has been shown to be effective in slowing bone loss. And now for the difficult part: proper exercises to increase bone density. Eccentric exercises are supposed to be the best, as they cause the muscles to pull against (or away from?) the bones in such a way as to stimulate bone growth. Since my fracture, and my osteoporosis diagnosis, I'v been under the care of a physical rehabilitation specialist who has been prescribing these types of exercises for me. I'm a long distance runner, so am at particular risk for fractures as it is, and my doctors have all been very good at guiding me through the past (nearly) year of rehabilitation.