This study aimed to investigate the relationship between interstitial lung disease (ILD) severity and bone mineral density (BMD) and osteoporotic vertebral fractures (OVFs) in patients with rheumatoid arthritis (RA) and determine whether ILD independently affects skeletal health. This retrospective cross-sectional study included 150 RA patients treated between January 2021 and December 2024. Based on high-resolution chest computed tomography, patients were classified as RA-ILD (n = 62) or RA wit