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Background Psoriatic disease has a complex effect on bone metabolism, resulting in both pathological bone formation and bone resorption. However, microstructural changes in cortical and trabecular compartments remain poorly understood. The aim of this study was to investigate the prevalence and determinants of bone microarchitectural damage in patients with psoriatic disease.Methods We performed a cross-sectional study in patients with psoriasis (PsO), psoriatic arthritis (PsA) and age-matched healthy controls (HCs) recruited into the Department of Dermatology and Rheumatology of Verona centre. We conducted high-resolution peripheral quantitative CT of the radius and finger joints of the non-dominant hand. Bone microstructure parameters and finite element analysis (uFEA) were calculated.Results 51 patients with PsO and 39 patients with PsA were consecutively enrolled in the study. 24 age-matched HCs were enrolled. Distal radius total and cortical volumetric bone mineral density (Ct.BMD) levels were lower in patients with PsA and PsO compared with HC. On distal radius uFEA analysis, we found a significant reduction of stiffness in PsA compared with both HC and PsO. At the distal interphalangeal (DIP) joints, Ct.BMD and trabecular volumetric bone mineral density were lower in PsA and PsO compared with HC. Nail involvement in psoriatic disease was negatively associated with bone stiffness at the proximal and distal region of the DIPs.Conclusion Psoriatic disease negatively impacted bone integrity. Patients with psoriatic disease seemed to have lower bone density and more microarchitectural alteration that impacted on biomechanics properties. Nail involvement was associated with decreased bone stiffness in psoriatic disease.