Methotrexate osteopathy in rheumatic disease

Abstract

Objective-To determine whether two adults with stress fractures receiving low weekly doses of methotrexate had methotrexate osteopathy. Case reports-Two adult patients developed features consistent with methotrexate osteopathy while receiving low weekly doses of methotrexate. Methods-Iliac crest biopsy samples were taken and bone histomorphometry carried out. Results-Symptoms resolved when the methotrexate was discontinued. Bone histology showed changes consistent with osteoblast inhibition by methotrexate. Conclusions-When given in low doses for prolonged periods, methotrexate may have adverse effects on bone, particularly in post-menopausal women.