Fractures of the Proximal Tibia Associated with Longterm Use of Methotrexate: 3 Case Reports and a Review of Literature

Meier, L.; Sersooskerken, Anne-Moon van Tuyll van; Liberton, Ellen; Kleijn, Lucas; Westgeest, Toon; Polák, Martin; Nijs, Ron de

doi:10.3899/jrheum.100385

Cited by 15 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, the negative impact of high dose MTX on bone has also been described in the long-term treatment of inflammatory diseases such as rheumatoid arthritis [57].…”

Section: Methotrexatementioning

confidence: 99%

Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications

D’Oronzo

Stucci

Tucci

et al. 2015

Cancer Treatment Reviews

View full text Add to dashboard Cite

“…Moreover, the negative impact of high dose MTX on bone has also been described in the long-term treatment of inflammatory diseases such as rheumatoid arthritis [57].…”

Section: Methotrexatementioning

confidence: 99%

Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications

D’Oronzo

Stucci

Tucci

et al. 2015

Cancer Treatment Reviews

View full text Add to dashboard Cite

“…Stress fractures of the medial tibial plateau are well known to be caused by repetitive mechanical stress in runners and in military personnel (12,13). Other factors such as surgery for anterior cruciate ligament reconstruction (14) and unicompartmental knee arthroplasty (15,16), drug-induced osteoporosis (17,18), and even primary and postpartum osteoporosis without BP use (19,20) can also cause these fractures. Generally, medial tibial plateau stress fractures can be managed conservatively simply by the cessation of sports activity, and symptoms usually resolve within two months (12,13,21).…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

et al. 2021

View full text Add to dashboard Cite

Objective : Only a few cases of insufficiency fractures of the tibial plateau following bisphosphonate use have been reported. The authors report a case with bisphosphonate (BP) -related atypical insufficiency fracture of tibial plateau, which developed delayed union. Patient : A 65-year-old Japanese woman presented with left knee pain without any trauma. She had a 5-year history of risedronate use for primary osteoporosis. Initial X-rays were unremarkable, but magnetic resonance imaging (MRI) confirmed an insufficiency fracture at the left tibial plateau at 3 weeks after the initial visit. Risedronate treatment was stopped because we diagnosed her with a BP-related atypical insufficiency fracture of the tibial plateau. She was treated with rest, a lateral wedge insole and protective weight-bearing with a T-cane for 3 months. Result : At 3-month follow-up, the patient still had a pain and a delayed healing on radiographs. Six months later, X-rays showed that the fracture site had a sclerotic change, but MRI revealed delayed union. At 8-month follow-up, the fracture was healed without any symptoms. Conclusion : All clinicians need to be aware of the delayed healing of atypical insufficiency fracture related with prolonged BP use.

show abstract

“…It has been suggested that one such cause in this patient could be methotrexate which is known to cause osteopathy at high doses [16]. Nonetheless, stress fractures, particularly of the tibial plateau [17] but also of the femur and ulna [18], have recently been described in patients treated for inflammatory rheumatism. However, the deleterious impact of methotrexate on bone density and metabolism is controversial [19].…”

Section: Discussionmentioning

confidence: 99%

Atypical Insufficiency Fractures Associated with Long-Term Bisphosphonate Therapy: 3 Case Reports

Guinamand

2015

Journal of Bone Biology and Osteoporosis

View full text Add to dashboard Cite

Atypical femoral fractures as defined by the American Society for Bone and Mineral Research (ASBMR) are linked with long-term bisphosphonate therapy. We report the cases of 3 patients treated with bisphosphonates, and presenting non femoral atypical fracture. Our first patient presented with a series of fractures after being treated with risedronate: the left tibia, bilateral tibial plateau successively, the left femoral and tibial metaphysis, the right tibia and calcaneus, the left talus, and the left talar dome. The second patient had been taking alendronate and presented with a spontaneous fracture of the spine of the left scapula. The third patient had been treated with alendronate and presented with a fracture of the upper right tibial diaphysis with an unusual oblique orientation. These fractures could be suggestive of bisphosphonate therapy failure or stress fractures. However, the number of fractures in our first case, the fracture site in the second and the fracture line orientation in the third brings to mind the hypothesis of atypical non femoral fractures associated with bisphosphonate therapy. We therefore suggest the possibility of a new type of atypical fracture in patients treated with bisphosphonates, and whose causal relationship with bisphosphonates is even more difficult to demonstrate.

show abstract

Fractures of the Proximal Tibia Associated with Longterm Use of Methotrexate: 3 Case Reports and a Review of Literature

Cited by 15 publications

References 21 publications

Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications

Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

Atypical Insufficiency Fractures Associated with Long-Term Bisphosphonate Therapy: 3 Case Reports

Contact Info

Product

Resources

About