Multiple stress fractures in a scleroderma patient on methotrexate therapy

A patient on methotrexate therapy for scleroderma developed four stress fractures within a period of 13 months. She was not on steroid therapy and had no risk factors for osteoporosis. A review of the literature found 13 cases of stress fractures under methotrexate therapy. Whether methotrexate can induce bone changes remains controversial.