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METHOFRACT, a methotrexate osteopathy multicentre cohort study.

François Robin1,2, Roba Ghossan3, Nadia Mehsen-Cetre4

  • 1Univ Rennes, INSERM, INRAE, CHU Rennes, UMR 1317 1341, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France francois.robin@chu-rennes.fr.

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Summary
This summary is machine-generated.

Methotrexate-induced osteopathy (MTX-IO) fractures are rare, often affecting postmenopausal women with RA or PsA. Discontinuing methotrexate significantly improves fracture healing and pain relief.

Keywords:
MethotrexateOsteoporosisPain

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Area of Science:

  • Rheumatology
  • Orthopedics
  • Pharmacovigilance

Background:

  • Methotrexate-induced osteopathy (MTX-IO) is a rare complication affecting patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA).
  • It typically presents as lower limb fractures, particularly in the tibia and foot.
  • Understanding the affected population and risk factors is crucial for management.

Purpose of the Study:

  • To identify the demographic and clinical characteristics of patients with MTX-IO.
  • To describe the fracture patterns and identify risk factors for poor outcomes.
  • To evaluate the effectiveness of methotrexate discontinuation on clinical outcomes.

Main Methods:

  • A multicentre retrospective study involving 92 patients diagnosed with MTX-IO.
  • Data collection included clinical presentation, imaging (MRI, bone scintigraphy), bone mineral density, and biochemical markers.
  • Analysis focused on fracture characteristics, patient demographics, and treatment outcomes.

Main Results:

  • The study predominantly included postmenopausal women with seropositive RA (92 patients, 2012-2024).
  • Common fracture sites were the tibial metaphysis (88%) and foot bones (49%), with frequent multiple and recurrent fractures.
  • Osteoporosis was present in 56% of patients at diagnosis.
  • Discontinuing methotrexate led to significantly better fracture healing and pain relief (91% vs. 29%, p<0.001).

Conclusions:

  • MTX-IO is a significant condition, particularly in postmenopausal women with RA or PsA.
  • Early diagnosis using MRI or bone scintigraphy is recommended.
  • Discontinuation of methotrexate is critical for improving outcomes and preventing further fractures.