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Matters arising
Is methotrexate osteopathy a form of bone idiosyncrasy?
  1. A P Rozin
  1. Bat Galim, Rambam Medical Centre, PO Box 9602, Haifa, Israel
  1. Correspondence to:
    Dr A P Rozin, B Shine Department of Rheumatology, Rambam Medical Centre, PO Box 9602, Haifa 31096, Israel;
    arozinrambam.health.gov.il

https://doi.org/10.1136/ard.62.11.1123

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    We read the letter about low dose methotrexate (MTX) osteopathy with mixed feelings.1 On the one hand, it is not unusual for a woman to develop insufficiency bone fracture after 25 years of prednisone treatment. Longstanding inflammatory joint disease also affects bone. The patient had an active disease that is associated with osteoclast activation mediated by tumour necrosis factor-osteoprotegerin. However, the authors underestimated other possible factors which might have had an influence on bone density. Menstrual cycle status was not discussed. Results of bone density assessment were not described despite long term steroid treatment. Risk factors such as family history, smoking, diet, and physical activity were not analysed.

    Of note, besides pelvic fracture, increased technetium-99m uptake was seen …

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