ArticleCalcified tissue international2021
Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy.
Article in Calcified tissue international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 32 citations in OpenAlex.
- [Methotrexate osteopathy-a critical review].Zeitschrift fur Rheumatologie · 2026Review
- Low-Dose Methotrexate and Bone Health: Pathophysiological and Clinical Perspectives.Journal of clinical medicine · 2026Review
- Mechanisms of osteoclast activation in inflammatory bone loss in rheumatoid arthritis.Nature reviews. Rheumatology · 2026Review
- Methotrexate osteopathy in rheumatoid arthritis.Rheumatology international · 2025Review
- Stress fractures of the lower extremity in methotrexate-induced osteopathy: A case report.Radiology case reports · 2025Article
- [Osteoporosis and inflammation : A surgical challenge in orthopedics and trauma surgery].Orthopadie (Heidelberg, Germany) · 2025Review
- Article
- ["Paradoxical fractures": pathological fractures under anti-osteoporotic and antirheumatic treatment].Zeitschrift fur Rheumatologie · 2025Review
- Methotrexate use in juvenile idiopathic arthritis and its impact on growth plate development: A prospective observational cohort study.Bioinformation · 2025Article
- MTX Osteopathy Versus Osteoporosis Including Response to Treatment Data-A Retrospective Single Center Study Including 172 Patients.Calcified tissue international · 2024Article
- Bone marrow edema in children: chronic nonbacterial osteomyelitis and its mimickers.Therapeutic advances in musculoskeletal disease · 2024Review
- Osteomalacia in Adults: A Practical Insight for Clinicians.Journal of clinical medicine · 2023Review
- The Effect of Anti-rheumatic Drugs on the Skeleton.Calcified tissue international · 2022Review
- Case Report of an Unusual Differential Diagnosis of a Red and Atraumatic Swollen Foot Charcot Arthropathy in Rheumatoid Arthritis.Journal of orthopaedic case reports · 2022Article
- Bone stress injuries.Nature reviews. Disease primers · 2022Review
- [Drug-induced osteopathy in rheumatology].Zeitschrift fur Rheumatologie · 2022Review
- [Clavicle stress fracture following reverse shoulder arthroplasty].Der Orthopade · 2022Article
- Influence of X-rays and gamma-rays on the mechanical performance of human bone factoring out intraindividual bone structure and composition indices.Materials today. Bio · 2022Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Methotrexate (MTX) is one of the most commonly prescribed drugs for autoimmune rheumatic diseases. As there is no consensus on its negative effects on bone, the purpose of this investigation was to determine the clinical spectrum of patients with stress fractures due to long-term MTX treatment (i.e., MTX osteopathy). We have retrospectively analyzed data from 34 patients with MTX treatment, severe lower extremity pain and immobilization. MRI scans, bone turnover markers, bone mineral density (DXA) and bone microarchitecture (HR-pQCT) were evaluated. Stress fractures were also imaged with cone beam CT. While the time between clinical onset and diagnosis was prolonged (17.4 ± 8.6 months), the stress fractures had a pathognomonic appearance (i.e., band-/meander-shaped, along the growth plate) and were diagnosed in the distal tibia (53%), the calcaneus (53%), around the knee (62%) and at multiple sites (68%). Skeletal deterioration was expressed by osteoporosis (62%) along with dissociation of low bone formation and increased bone resorption. MTX treatment was discontinued in 27/34 patients, and a combined denosumab-teriparatide treatment initiated. Ten patients re-evaluated at follow-up (2.6 ± 1.5 years) had improved clinically in terms of successful remobilization. Taken together, our findings provide the first in-depth skeletal characterization of patients with pathognomonic stress fractures after long-term MTX treatment.
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