Methotrexate osteopathy demonstrated by technetium-99m HDP bone scintigraphy

The authors report a case of methotrexate osteopathy as revealed by Tc-99m HDP bone scintigraphy in a patient with rheumatoid arthritis, Methotrexate is used widely in high doses as a chemotherapeutic agent. Lower doses are g iven in rheumatoid and psoriatric arthritis. Methotrexate affects bone meta bolism, resulting in methotrexate osteopathy, characterized by osteoporosis , osseus pain, and even spontaneous (micro)fractures, Radiographic visualiz ation of microfractures is difficult. Tc-99m HDP bone scans have been shown to be very sensitive in the visualization of changes in bone metabolism as a result of methotrexate osteopathy.