Continuing methotrexate raises fracture risk in patients

A recent study found that continuing treatment with methotrexate (MTX) significantly raises the risk of future fractures in patients with certain bone injuries. This study focused on people who had insufficiency fractures in their lower limbs, a condition known as methotrexate osteopathy (MTXO). Researchers reviewed the medical records of 33 patients, mostly women, who had experienced these fractures. The average age of the patients was about 67 years, and they had been receiving MTX for an average of 10.7 years. The study tracked their health for about 5.7 years. The results showed that almost all patients who continued taking MTX after their first fracture ended up having more fractures. Specifically, 95% experienced either additional insufficiency fractures or major osteoporotic fractures. In comparison, only 36% of patients who stopped taking MTX had more fractures. Patients who discontinued MTX also reported less pain and were more able to bear weight. The study indicated that stopping MTX could lower fracture risk and help speed up recovery from the first fracture. The authors suggested that doctors should reconsider MTX treatment for patients with this condition. However, the study does have some limitations, such as gaps in the data collected and the way fractures were identified. This research was led by Dr. Barbara Hauser and was published in February 2025.