Continuing Drug Ups Fracture Risk

TOPLINE:

In patients with methotrexate osteopathy (MTXO) insufficiency fractures, continuing MTX led to a significantly higher risk for subsequent fractures, with nearly all patients who continued MTX experiencing either further insufficiency fractures or major osteoporotic fractures.

METHODOLOGY:

• Researchers conducted a retrospective case note review to assess whether the continuation of MTX after MTX-associated insufficiency fractures, also called MTXO, affects the risk for future fractures.
• A total of 33 patients (mean age, 67.3 years; 97% women) with MTXO insufficiency fractures of the lower limbs were included.
• The mean MTX dose was 20 mg/week, with an average treatment duration of 10.7 years.
• Demographic data as well as clinical data, including information on disease activity, MTX treatment, concomitant treatments, and bone health parameters at the time of the first insufficiency fracture, were collected. T he mean follow-up duration was 5.7 years.
• Methotrexate was continued in 21 of 32 patients following the initial insufficiency fracture.

TAKEAWAY:

• Nearly all (95.2%) patients who continued MTX after the initial insufficiency fracture sustained either further insufficiency (67%) or major osteoporotic (33%) fractures.
• Subsequent fractures occurred in significantly fewer patients who discontinued MTX than those who continued it (36% vs 95%; P = .001).
• A higher proportion of patients who discontinued MTX than those who continued it experienced clinical improvement in pain (77.8% vs 36.4%, P = .036) and full weight-bearing tolerance (71.4% vs 22.7%, P = .030).
• Patients who continued MTX had a significantly higher incidence of further fractures over time than those who discontinued it (P = .042).

IN PRACTICE:

“Discontinuation of MTX after an initial insufficiency fracture reduces fracture risk and likely improves fracture healing. These findings underscore the need to re-evaluate MTX therapy in patients with MTXO,” the authors wrote.

SOURCE:

The study was led by Barbara Hauser, MD, PhD, Rheumatic Diseases Unit, NHS Lothian, Western General Hospital, Edinburgh, United Kingdom, and was published online on February 22, 2025, in Annals of the Rheumatic Diseases. 

LIMITATIONS:

The study was limited by the quality and completeness of existing records because of its retrospective nature. Disease activity scores were not consistently recorded, which may have affected the assessment of the association between disease activity and fracture risk. The identification of insufficiency fractures was limited to MRI scans requested by rheumatologists, potentially excluding cases investigated by orthopedic teams. 

DISCLOSURES:

This study did not receive any specific funding. Some authors reported receiving personal and institutional funding from various pharmaceutical companies, outside the submitted work. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.