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We describe 2 postmenopausal women with rheumatoid arthritis (RA). They developed fractures during their treatment with weekly low dose methotrexate (MTX). The adverse effect of longterm low dose regimens of MTX on bone metabolism has been described as "methotrexate osteopathy," an analogy of the syndrome known in pediatric oncology. MTX may be an additional risk factor for osteoporosis and fractures in RA. This therapy should be relatively contraindicated in patients with multiple risk factors for osteoporosis.
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