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<p>Methotrexate-associated osteopathy (MTX osteopathy) is a&#xa0;rare and likely underrecognized complication of long-term low-dose methotrexate therapy in patients with inflammatory rheumatic diseases. It typically presents with atraumatic insufficiency fractures of the lower extremities, particularly the tibia and foot bones, often occurring bilaterally and at multiple sites. Pathophysiological mechanisms include impaired osteoblast function and increased osteoclast activity. Clinically, patients present with weight-bearing pain in the affected region and reduced mobility. Imaging, especially MRI, reveals characteristic band-like stress fractures. Recent studies demonstrate that continuation of methotrexate after an initial insufficiency fracture significantly increases the risk of subsequent fractures, whereas discontinuation is associated with improved outcomes. Differentiation from osteoporosis is crucial, as management strategies differ. Treatment primarily involves discontinuation of methotrexate and initiation of bone-specific therapy. Due to limited evidence, further research is needed to improve diagnostic criteria, risk stratification, and therapeutic strategies.</p>

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Methotrexatassoziierte Osteopathie (MTX-Osteopathie): Pathophysiologie, klinische Symptomatik und Management

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Judith Haschka

摘要

Methotrexate-associated osteopathy (MTX osteopathy) is a rare and likely underrecognized complication of long-term low-dose methotrexate therapy in patients with inflammatory rheumatic diseases. It typically presents with atraumatic insufficiency fractures of the lower extremities, particularly the tibia and foot bones, often occurring bilaterally and at multiple sites. Pathophysiological mechanisms include impaired osteoblast function and increased osteoclast activity. Clinically, patients present with weight-bearing pain in the affected region and reduced mobility. Imaging, especially MRI, reveals characteristic band-like stress fractures. Recent studies demonstrate that continuation of methotrexate after an initial insufficiency fracture significantly increases the risk of subsequent fractures, whereas discontinuation is associated with improved outcomes. Differentiation from osteoporosis is crucial, as management strategies differ. Treatment primarily involves discontinuation of methotrexate and initiation of bone-specific therapy. Due to limited evidence, further research is needed to improve diagnostic criteria, risk stratification, and therapeutic strategies.