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In active RA, bone resorption is increased and bone formation is normal or reduced in comparison to healthy controls. This uncoupling of bone formation and resorption with a negative remodelling balance leads to generalized bone loss. The pathogenesis of this altered bone metabolism is multifactorial, involving non-disease-specific factors (such as age, female sex and postmenopausal status) and disease-specific factors.fatcat:vfxgzvaf4reyrmh62xfu5jn6oy