TY - JOUR T1 - An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 277 LP - 279 DO - 10.1136/ard.62.3.277 VL - 62 IS - 3 AU - J Vanhoof AU - S Landewe AU - J Vandevenne AU - P Geusens Y1 - 2003/03/01 UR - http://ard.bmj.com/content/62/3/277.abstract N2 - We report an exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a 67 year old women with rheumatoid arthritis (RA). The patient developed RA at the age of 55. She was consecutively treated with several disease modifying drugs : parenteral gold (1989–90), sulfasalazine (1990–91), and methotrexate (MTX; started in 1991 and discontinued in 2001 because of bone marrow suppression); chloroquine was added from 1993 until 1999. Oral corticosteroids (prednisone 5 mg/day) were started in 1990. Because of persistent hydrops of both knees a bilateral chemical synovectomy (osmium acid) was undertaken in 1990. Afterwards three intra-articular infiltrations with depot corticosteroids were given, and the arthritis of the knees resolved. Bone mineral densitometry (BMD) in 1994 showed a T score (compared with young adults) at the lumbar spine of −2.6 standard deviation (SD) and at the femoral neck of −2.7SD, compatible with osteoporosis. Treatment with calcium supplements and alfacalcidol (50 μg/day) was started as this was the only treatment for glucocorticoid osteoporosis which was reimbursed. Because of further bone loss (follow up BMD still showed a … ER -