Objective <p>This meta-analysis aims to assess the efficacy and safety of denosumab in treating osteoporosis (OP) in patients with rheumatoid arthritis (RA).</p> Methods <p>We conducted a comprehensive search in databases including PubMed, Embase and Cochrane Library for studies on denosumab's effectiveness in treating OP in RA patients from their inception until 2023. Two researchers independently screened the retrieved literature, and the methodological quality of the included studies was evaluated using the Cochrane 5.1 bias risk assessment tool. Statistical analysis was performed using STATA 15.1.</p> Results <p>A total of 1441 patients from 9 articles, meeting the specified criteria, were included, with 762 in the experimental group and 679 in the control group. The pooled results suggest that following the treatment of osteoporosis in patients with rheumatoid arthritis, both bone mineral density (BMD) and bone erosion score (BES) exhibit notable increases with denosumab in comparison to biological agent therapy. Moreover, the modified total Sharp score (mTSS), joint space narrowing (JSN), and BES demonstrate significantly higher improvements subsequent to denosumab therapy for osteoporosis in rheumatoid arthritis patients, as opposed to receiving a placebo. However, there is no significant difference between denosumab and placebo treatment for osteoporosis in patients with RA in terms of serious adverse events.</p> Conclusion <p>In conclusion, compared to the control group, denosumab treatment significantly increased lumbar spine BMD in RA patients who had not received BPs treatment. Additionally, it reduced joint mTSS, JSN, and BES, alleviated joint space narrowing, and inhibited bone erosion, providing maximal joint protection and maintaining joint function.</p>