Three hundred ninety-five patients with rheumatoid arthritis (mean age 49 years) were followed for an average of 6.7 years, and their baseline variables from the initial visit were examined for prediction of time to first fracture. Multivariate analyses identified use of corticosteroids in women and prior diagnosis of osteoporosis as important risk factors. Among patients taking 5 mg or more of prednisone, female sex strongly predicted fractures: the 5-year probability of having a fracture was 34%. Low risk groups were nonosteoporotic and consisted of men and patients taking less than 5 mg prednisone.