ArticleRMD open2023
A rare side effect of methotrexate therapy: drug-induced osteopathy with multiple fractures of the lower limb.
Article in RMD open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Unsuspected Adverse Drug Reactions to Dermatologic Medications: An Epidemiological Hypothesis-Free Screening Study of Real-World Data in Denmark.Drug safety · 2026Article
- [Methotrexate osteopathy-a critical review].Zeitschrift fur Rheumatologie · 2026Review
- Stress fractures of the lower extremity in methotrexate-induced osteopathy: A case report.Radiology case reports · 2025Article
- Talus insufficiency fracture due to long-term methotrexate therapy in a patient with rheumatoid arthritis.Journal of surgical case reports · 2025Article
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Authors and funding
4 authors.
Funding
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Abstract
Methotrexate is associated with bone lesions that are rare and, although presenting with a typical localisation to the lower extremities and appearing with a characteristic radiologic morphology, largely unknown and often misdiagnosed as osteoporotic insufficiency fractures. The correct and early diagnosis, however, is key for treatment and prevention of further osteopathology. Here, we present a patient with rheumatoid arthritis who developed multiple painful insufficiency fractures in the left foot (processus anterior calcanei, tuber calcanei) and in the right lower leg and foot (anterior and dorsal calcaneus and at the cuboid and distal tibia) during therapy with methotrexate, which were all misdiagnosed as osteoporotic. The fractures occurred between 8 months and 35 months after starting methotrexate. Discontinuation of methotrexate resulted in rapid pain relief and no further fractures have occurred. This case powerfully demonstrates the importance of raising awareness of methotrexate osteopathy in order to take appropriate therapeutic measures, including and perniciously discontinuing methotrexate.
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