Rheumatoid arthritis (RA) is characterised by synovitis, cartilage destruction in the joints, erosions in the subchondral bone at the joint margins and by periarticular osteopenia1 and also by generalised osteoporosis affecting the axial and appendicular bones.2 Conventional radiographs are the standard method for detection and quantification of joint destruction in RA, but its sensitivity is limited. Bone loss less than around 30% cannot be detected on plain radiographs.3 Radiogrammetry assessing cortical bone width as a measure of bone strength and bone loss was proposed in 1960.4 In RA localised bone involvement in the hands can be measured by digital x-ray radiogrammetry (DXR), which gives an estimate of cortical hand bone mineral density (BMD) in the metacarpal joints two …