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.
journal_name
Calcif Tissue Intjournal_title
Calcified tissue internationalauthors
Rolvien T,Jandl NM,Stürznickel J,Beil FT,Kötter I,Oheim R,Lohse AW,Barvencik F,Amling Mdoi
10.1007/s00223-020-00765-5subject
Has Abstractpub_date
2021-02-01 00:00:00pages
219-230issue
2eissn
0171-967Xissn
1432-0827pii
10.1007/s00223-020-00765-5journal_volume
108pub_type
杂志文章abstract::The purpose of the present work was to investigate the appearance of ossification centers in human femur by Dual-energy X-ray Absorptiometry (DXA), comparing densitometric data with morphogenetic events. Posteroanterior scans were performed on 31 dried femora (from 11.5 weeks of conceptual age to 1 year of postnatal l...
journal_title:Calcified tissue international
pub_type: 杂志文章
doi:10.1007/pl00005841
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abstract::Human osteoblasts were obtained by migration and proliferation of cells from embryonic membranous bone on glass fragments. Light and electron microscopy analyses revealed a typical osteoblast-like appearance with high protein synthesis activity. The cells showed high alkaline phosphatase activity that was associated w...
journal_title:Calcified tissue international
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journal_title:Calcified tissue international
pub_type: 杂志文章
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
pub_type: 杂志文章
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journal_title:Calcified tissue international
pub_type: 杂志文章,随机对照试验
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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journal_title:Calcified tissue international
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