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The effect of low dose methotrexate on bone density.
A B Cranney1, R J McKendry, G A Wells
1Division of Rheumatology, Ottawa Hospital, Ontario, Canada.
The Journal of Rheumatology
|November 16, 2001
Summary
Low-dose methotrexate (MTX) does not negatively impact bone density in patients with rheumatoid arthritis or psoriatic arthritis. This study found no significant bone loss associated with long-term MTX use in these inflammatory conditions.
Area of Science:
- Rheumatology
- Osteoporosis Research
- Pharmacology
Background:
- High-dose methotrexate (MTX) is associated with bone loss in cancer patients.
- The effect of long-term, low-dose MTX on bone density in inflammatory arthritis is not well-established.
Purpose of the Study:
- To investigate the association between low-dose MTX and bone mineral density (BMD) in patients with rheumatoid arthritis (RA) and psoriasis/psoriatic arthritis (Ps/PsA).
Main Methods:
- Prospective study comparing 30 RA and 30 Ps/PsA patients on MTX with control groups (30 RA, 27 Ps/PsA) not on MTX.
- Bone mineral density (BMD) measured at the radius, lumbar spine, trochanter, and femoral neck using dual-energy x-ray absorptiometry.
- Statistical analysis included Student t tests and analysis of covariance to assess differences and control for confounders.
Main Results:
- No significant differences in BMD (Z scores) at the radius, femoral neck, or trochanter between MTX-treated groups and controls.
- The RA MTX group showed higher absolute BMD at the lumbar spine (L2-L4) compared to controls.
- Analysis of covariance indicated no effect of MTX treatment group on bone density after adjusting for confounders.
Conclusions:
- Low-dose methotrexate (MTX) does not appear to negatively affect bone density at cortical or trabecular sites in patients with RA or Ps/PsA.
- Findings suggest MTX is safe for bone health in the context of long-term inflammatory arthritis treatment.