Previous research has produced mixed results regarding the link between rheumatoid arthritis (RA) disease activity and bone mineral density (BMD). It was yet unclear whether cumulative RA disease activity was linked to BMD. The data came from the RA Cohort at the University of California, San Francisco, from 2006 to 2018. The study comprised those who had BMD measurements and at least 2 study visits before the BMD measurement. Multivariable linear regression was used to examine the relationship between low cumulative disease activity index (CDAI), as evaluated by DAS28ESR, and the primary outcome of femoral neck BMD. Sensitivity analyses were conducted using CDAI as the disease activity measure and total hip and lumbar spine BMD as outcomes instead of CDAI. A total of 161 people with RA were studied. The cohort was somewhere between 62.4 ± 10.2 years old, with 88% of the participants being female. The most common racial/ethnic groups in the cohort were Hispanic/Latino (N=73, 45%) and Asian (N=59, 37%). The average duration of RA was somewhere between 10.5 ± 7.3 years, and 83% of patients tested positive for ACPA. In comparison to the moderate/high disease activity group, low disease activity was related to increased femoral neck BMD (β=0.071 [95% CI: 0.021 to 0.122], p=0.020). When CDAI and additional BMD sites were substituted in multivariable models, the link between low cumulative disease activity remained consistent. In a unique RA population, less cumulative disease activity as defined by DAS28ESR was linked to increased femoral neck BMD, regardless of typical osteoporosis risk variables (e.g., age, sex, BMI). The results were similar when comparing cumulative low CDAI and other BMD sites.