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Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy

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Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy. / Rolvien, Tim; Jandl, Nico Maximilian; Stürznickel, Julian; Beil, Frank Timo; Kötter, Ina; Oheim, Ralf; Lohse, Ansgar W; Barvencik, Florian; Amling, Michael.

In: CALCIFIED TISSUE INT, Vol. 108, No. 2, 02.2021, p. 219-230.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Rolvien, T, Jandl, NM, Stürznickel, J, Beil, FT, Kötter, I, Oheim, R, Lohse, AW, Barvencik, F & Amling, M 2021, 'Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy', CALCIFIED TISSUE INT, vol. 108, no. 2, pp. 219-230. https://doi.org/10.1007/s00223-020-00765-5

APA

Rolvien, T., Jandl, N. M., Stürznickel, J., Beil, F. T., Kötter, I., Oheim, R., Lohse, A. W., Barvencik, F., & Amling, M. (2021). Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy. CALCIFIED TISSUE INT, 108(2), 219-230. https://doi.org/10.1007/s00223-020-00765-5

Vancouver

Rolvien T, Jandl NM, Stürznickel J, Beil FT, Kötter I, Oheim R et al. Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy. CALCIFIED TISSUE INT. 2021 Feb;108(2):219-230. https://doi.org/10.1007/s00223-020-00765-5

Bibtex

@article{1b892055741d472ca1a0aeef8725a831,
title = "Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy",
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.",
author = "Tim Rolvien and Jandl, {Nico Maximilian} and Julian St{\"u}rznickel and Beil, {Frank Timo} and Ina K{\"o}tter and Ralf Oheim and Lohse, {Ansgar W} and Florian Barvencik and Michael Amling",
year = "2021",
month = feb,
doi = "10.1007/s00223-020-00765-5",
language = "English",
volume = "108",
pages = "219--230",
journal = "CALCIFIED TISSUE INT",
issn = "0171-967X",
publisher = "Springer New York",
number = "2",

}

RIS

TY - JOUR

T1 - Clinical and Radiological Characterization of Patients with Immobilizing and Progressive Stress Fractures in Methotrexate Osteopathy

AU - Rolvien, Tim

AU - Jandl, Nico Maximilian

AU - Stürznickel, Julian

AU - Beil, Frank Timo

AU - Kötter, Ina

AU - Oheim, Ralf

AU - Lohse, Ansgar W

AU - Barvencik, Florian

AU - Amling, Michael

PY - 2021/2

Y1 - 2021/2

N2 - 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.

AB - 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.

U2 - 10.1007/s00223-020-00765-5

DO - 10.1007/s00223-020-00765-5

M3 - SCORING: Journal article

C2 - 33064170

VL - 108

SP - 219

EP - 230

JO - CALCIFIED TISSUE INT

JF - CALCIFIED TISSUE INT

SN - 0171-967X

IS - 2

ER -