Does anyone know if methotrexate can cause bone density loss? The leaflet in metoject box re side effects says1/100 chance but no information. I’ve had horrific spiral comminuted open fractures of my tibia and fibula following low impact missed my foot/fell to the ground that shouldn’t cause those injuries. I cannot get a dexa/bone density scan thanks to Covid. Ortho dr hasn’t a clue if methotrexate causes bone loss and can’t get to speak to rheumy till end of this month unless it’s cancelled yet again. I’ve had triamcinalone/Kenalog IM injections a handful of times in past 3 years but no oral steroids. After methotrexate being withheld 4 weeks whilst in Ortho ward, I’m struggling big time with flare and trying to use crutches. Very concerned continued methotrexate use might cause bone density loss and increased fracture risk. Sorry for long post but I can’t find answers on google or HU posts. Thanks
Bone density loss with methotrexate?: Does anyone know... - NRAS
Bone density loss with methotrexate?
There's an article here:
pubmed.ncbi.nlm.nih.gov/117...
which concludes that there was no risk with the low dose regime used in Rheumatoid Arthritis.
The risk was reported from high doses used for treating cancer patients.
There are several other similar articles with the same conclusion.
I would think that you have no reason to stop methotrexate on that basis.
But I don't know why you can't have a bone density scan now - I had one in July - suitably distanced and wearing a mask.
Thanks oldtimer That’s incredibly helpful. I’m in Scotland/Glasgow and was unable to get a scan even when in hospital for 4 weeks, they’ve stopped doing them due to Covid and I came home to a letter saying the same and stating no idea when the service will be reinstated. I’m going on the basis I likely have osteoporosis but puzzled as to why my leg bones splintered like dry twigs. I will continue with my weekly injections knowing I’m not putting myself risk re the bones. 😊
I shouldn’t think so...I took 25mg Mtx for 7 years.
I am in my 70’s & fell recently ....a really heavy fall...knew I had done damage straight away. I fractured a couple of vertebrae I had a Dexa scan last month & no osteoporosis...in fact “good for my age”.
But all steroids do contribute to loss of bone mass.
I phoned the hospital & asked if they were doing Dexa scans as my rheumy nurse said they weren’t....but they were! Try that.
I don’t know if MTX does but Steroids have caused my osteoporosis I think. This site lists other drugs that cause bone loss.
osteoporosis.ca/about-the-d...
Thanks Lolabridge, I know or heard about the roids risks and have luckily not had oral ones for years. Maybe it’s just bad luck on my part but family asking if inflammatory arthritis causes osteoporosis?
I notice that PPIs like Omeprazole can cause bone loss. I’m on that too ☹️
😱 GP did not tell me that!
Out of date info I'm afraid. Latest studies show that's not the case.
It is a big risk with steroids, so usually prescribed things like adcal alongside is on them long term.
But MTX is rare at our doses. Here’s another article which suggests it’s not an issue.
jrheum.org/content/31/7/130...
Thanks for the reassurance and article, this site is a font of knowledge (I mean the members) 😀
Yes very true and I take Ad Cal D3.
Thanks
I hope not, I have osteoporosis - was diagnosed 2004.
Hi, Are you taking any meds for Osteoporosis? I have it, but not taking any meds. I only take Calcium and Vit D3 at present. I am 62 now and was diagnosed 10 years ago. Have not had any meds in my life, yet!
Not any more, I stopped it about eight years ago after eight years on intravenous bisphosphonates. I have a couple of teeth that may have to come out within the next year and I'm terrified of what the outcome might be. If it had been explained to me before I was put on them, I would not have agreed to it in the first place. I have taken D3 for about eight years now but no calcium, I was using diet for that. Is yours bad?
Unfortunately my Osteoporosis is bad, my back! And I am a slim petite person and everyone says I am losing weight, but I am not and eat well and healthy, no smoking and very very little wine! Therefore it must be due to Menopause because when I was 48 I went into Menopause and from then Osteopenia and now porosis. I am too scared to take the meds because I get stomach issues. So at present just taking Calcium and Vit D3. Hoping not to have a fall really?? But you can see that I am a small boned person.
My mum had Osteoporosis its the worst disease and I take Ad calD3 if it helps the tablets did give me an upset stomach but the chewy ones don't. I only knew about the chewy ones as prescribed by Nephrologist and as a kidney patient its a definite no to Alendronic Acid. I had Dexa scan my bones are great luckily.
Great! at what age did you start taking the AdCal? Is it because your Mum had porosis? Was there a particular reason why she ended up with porosis?
Oct 2018 when the kidney injury occurred. And my mum got diagnosed with it at 60'ish she shrunk to 4'9" from being tall in horrific pain so had morphine patches but she didn't have RA. I had Dexa scan as RA consultant asked for one last year. I had the AKI aged 64 through a medication so an wary of meds but Ad Cal does work.
I am so sorry to hear that. I used to be 5ft 1inch 10 years ago and now I am approx 4ft 11, therefore lost those inches in 10 years. But my back is very straight, definitely in my back area. No pain yet.... hoping not to have. I wish I knew of a good exercise to do to keep muscle strong in that area?
I do walk and use a Nordic cross trainer during lockdown but don't do as much as I used too due to the AKI, my mum was very active and strong so I think it might be down to a bit of luck. She had a widows hump and a lot of spinal fractures and so I do take the Ad Cal as prescribed as RA is one thing, but in my experience with mum Osteoporosis is much worse. Your GP might be able to help but I definitely think the Ad Cal helps. No doubt its more expensive than the tablets but Kowa make a good chewy one, my GP didn't mind changing the prescription at all. I'll just add you can't buy this stuff in the same strength OTC so don't bother with anything not on a prescription its a food stuff not a medication. Steroids can cause spontaneous hip fractures and I thought I had one last year but it was Shingles pain and was admitted to hospital for pain relief by veinous route.
Thanks. Do you think that the prescribed Kowa Ad Cal will help with actual Osteoporosis because I have gone from Osteopenia to porosis now.
I don't know but it won't make it worse. So I suppose it must make a difference or they wouldn't prescribe it.
Thank you, which make Ad Cal do you take please?
Kowa and its big tablet tastes like fruit flavoured chalk but much easier on my tummy.
But does it actually work, do you get good results from Doctor?
I don't think it's really possible to be certain as I may never get Osteoporosis because a lot don't, but so far I don't have it. I don't think it would have been prescribed if it didn't help so just trust the Consultant who prescribed it. Trouble is there is not really any certainty in a lot of these types of issues. So what harm can be done by chewing the tablets. ? In my view not much, but the risk of Osteoporosis is frightening and I saw how much pain my mum endured. I'll chew the Ad cal and pray I don't get it.
Positive is key. Thanks
Mine is in my lumbar spine and femur neck and I think I have a little bit in my hip somewhere (I can't remember what the letter said after my last DEXA). I started my menopause at about 42, that's why they think I have it. I also have stomach issues and that's the reason the consultant thought I would be better off on intravenous infusions. A little wine is good for you in that way I understand, so you're doing the right thing there. There are weight bearing exercises you can do to increase bone density and I've just tried to have a look at the ROS site but whatever I click on comes up with a load of DOS gobbledygook. I know that Tai Chi helps to build bones so that may help if you're interested. Don't worry about what people say, let them say it as you know yourself better than they do. Good luck. xx
I meant to say that you could always sign up to the Bone Health forum here. It's a good site with nice people and a lot of info. If you type in the search box top right Bone Health forum, it should bring it up and then you click on Communities and it brings up the ones you can sign up for - if you want to of course. x
Thanks very much
Hi you should have bone density scan - my rheumatologist organised this for me when newly diagnosed and I had it in middle of lockdown
It showed I had osteopenia/ not related to methotrexate and I was prescribed 1000mg calciD every day and also alendronic acid once week as precaution because of meds.
Alendronic acid can cause problems with teeth and jaw - but we just can’t win can we ?!!😳😳
No DEXA scans being done in Glasgow nhs hospitals at all and I would need to pay £250 to have one done privately in Edinburgh. Sounds like postcode lottery
It’s not fair we should all be getting the same support my understanding was that my rheumatologist
was following the guidelines of National Early Inflammatory Arthritis audit NEIAA) – (details are on the British society for Rheumaltolgy website)perhaps a question of individual hospital rheumatology department participating. Definitely not right we get different levels of support.
Rheumatologist prescribed alendronic acid and CaliciD for me and requested GP include on repeat prescription - not sure how that went down at surgery! 🤣🤣
I’m taking Vit D K2 B12 Calcium, iron and multivitamin with omega 3, mostly under tongue sprays but not been offered anything by GP for bones
And it must not be given to people with low kidney function as it's not licensed.
I’ve never been told that but it seems I’ve not been told alot of things. My bones are ok despite mtx and long term steroids though 😊
I have taken mxt for 18 years and my last dexa scan showed a small loss in my back. I have never been told that mxt can cause loss but as I was referred by rheumatologist I presume it could be. Personally, I think it is more likely to be RA that is responsible rather than mxt. On saying that, I don't know, Iam just assuming.
MTX not affected me in that way, after 40+ years use.
I've been on MTX 11 years & as has been said I've always understood that bone density reduction is only a possible concern in the high doses & greater regularity used in cancer treatment. Steroids of course are the meds most associated with bone issues, I've been on them a good while now but always been prescribed daily (at times twice daily) Adcal-D3 for ages now & my biennial DEXA scans have shown me to have osteopenia with my frax score (fracture risk) not increased. I've never broken a bone so that seems to be holding good. I do hope that your recovery is a good one & you can be reassured by a scan soon.
The latest info/large studies on PPI's is that they aren't associated with bone structure or strength medpagetoday.com/resource-c...
Just saw your post. I too just experienced a fracture of knee and tibia with no significant cause. I have been taking 20mg of Methotrexate now for over 2 years to treat my Psoriatic Arthritis. I am concerned about this possibly being a side effect. Anyone have any knowledge about bone problems on MTX.
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