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Published in: Osteoporosis International 12/2006

01-12-2006 | Review

Sacral insufficiency fractures: current concepts of management

Authors: E. Tsiridis, N. Upadhyay, P. V. Giannoudis

Published in: Osteoporosis International | Issue 12/2006

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Abstract

Background

Sacral insufficiency fractures (SIFs) are often overlooked in elderly patients presenting with low back and pelvic pain following no or minimal trauma.

Objective

The aim of this review is to raise awareness and outline the clinical presentation, methods of diagnosis and treatment of SIFs.

Discussion

Insufficiency fractures represent a special category of stress fractures that occur in bones with reduced mineral content and elastic resistance. SIFs, a well-defined subgroup of the latter group, are not uncommon, but lack of clinical suspicion results in many being undiagnosed. SIFs are set to become an important clinical entity of both social and economic significance as the Western population ages. Subtle clinical presentations and signs coupled with radiographic findings that can mimic other unrelated or overlapping conditions, such as sacroiliac joint infection, spinal stenosis and metastatic bone disease, often make SIF diagnosis a challenge. The aim of this review is to increase awareness among clinicians, highlighting SIFs as an important differential diagnosis to be considered when patients present with low back and pelvic pain and subsequently allow prompt management. The paper provides an overview of epidemiology, anatomical considerations, relevant pathophysiology and risk factors, presenting symptoms and signs, investigations and imaging techniques, differential diagnoses and current treatment methods available for the management of SIFs.
Literature
1.
go back to reference Kannus P, Palvanen M, Niemi S et al (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 11:443–448PubMedCrossRef Kannus P, Palvanen M, Niemi S et al (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 11:443–448PubMedCrossRef
2.
go back to reference Kannus P, Palvanen M, Parkkari J et al (2005) Osteoporotic pelvic fractures in elderly women. Osteoporos Int 16:1304–1305PubMedCrossRef Kannus P, Palvanen M, Parkkari J et al (2005) Osteoporotic pelvic fractures in elderly women. Osteoporos Int 16:1304–1305PubMedCrossRef
3.
go back to reference Lourie H (1982) Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA 248:715–717PubMedCrossRef Lourie H (1982) Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA 248:715–717PubMedCrossRef
4.
go back to reference Ries T (1983) Detection of osteoporotic sacral fractures with radionuclides. Radiology 146:783–785PubMed Ries T (1983) Detection of osteoporotic sacral fractures with radionuclides. Radiology 146:783–785PubMed
5.
go back to reference Gacetta DJ, Yandow DR (1984) Computed tomography of spontaneous osteoporotic sacral fractures. J Comput Assist Tomogr 8:1190–1191PubMedCrossRef Gacetta DJ, Yandow DR (1984) Computed tomography of spontaneous osteoporotic sacral fractures. J Comput Assist Tomogr 8:1190–1191PubMedCrossRef
6.
go back to reference De Smet AA, Neff JR (1985) Pubic and sacral insufficiency fractures: clinical course and radiologic findings. AJR Am J Roentgenol 145:601–606PubMed De Smet AA, Neff JR (1985) Pubic and sacral insufficiency fractures: clinical course and radiologic findings. AJR Am J Roentgenol 145:601–606PubMed
7.
go back to reference Schneider R, Yacovone J, Ghelman B (1985) Unsuspected sacral fractures: detection by radionuclide bone scanning. AJR Am J Roentgenol 144:337–341PubMed Schneider R, Yacovone J, Ghelman B (1985) Unsuspected sacral fractures: detection by radionuclide bone scanning. AJR Am J Roentgenol 144:337–341PubMed
8.
go back to reference Guilbeau JC, Arrive L, Maurice F et al (1986) Spontaneous fracture of the sacrum due to “insufficiency”. An overlooked cause of low lumbago in elderly women. J Radiol 67:741–744PubMed Guilbeau JC, Arrive L, Maurice F et al (1986) Spontaneous fracture of the sacrum due to “insufficiency”. An overlooked cause of low lumbago in elderly women. J Radiol 67:741–744PubMed
9.
go back to reference Balseiro J, Brower AC, Ziessman HA (1987) Scintigraphic diagnosis of sacral fractures. AJR Am J Roentgenol 148:111–113PubMed Balseiro J, Brower AC, Ziessman HA (1987) Scintigraphic diagnosis of sacral fractures. AJR Am J Roentgenol 148:111–113PubMed
10.
go back to reference Carter SR (1987) Stress fracture of the sacrum: brief report. J Bone Joint Surg Br 69:843–844PubMed Carter SR (1987) Stress fracture of the sacrum: brief report. J Bone Joint Surg Br 69:843–844PubMed
11.
go back to reference Gaucher A, Regent D, Paul JP et al (1987) Fractures caused by bony insufficiency of the sacrum. Clinical, radiographic, scintigraphic and x-ray computed tomographic symptomatology. J Radiol 68:433–440PubMed Gaucher A, Regent D, Paul JP et al (1987) Fractures caused by bony insufficiency of the sacrum. Clinical, radiographic, scintigraphic and x-ray computed tomographic symptomatology. J Radiol 68:433–440PubMed
12.
go back to reference Pere P, Gaucher A, Pourel J (1987) Fractures caused by osseous insufficiency of the sacrum. Incidence, complications and pathogenesis. Rev Rhum Mal Osteoartic 54:311–313PubMed Pere P, Gaucher A, Pourel J (1987) Fractures caused by osseous insufficiency of the sacrum. Incidence, complications and pathogenesis. Rev Rhum Mal Osteoartic 54:311–313PubMed
13.
go back to reference Davies AM, Evans NS, Struthers GR (1988) Parasymphyseal and associated insufficiency fractures of the pelvis and sacrum. Br J Radiol 61:103–108PubMedCrossRef Davies AM, Evans NS, Struthers GR (1988) Parasymphyseal and associated insufficiency fractures of the pelvis and sacrum. Br J Radiol 61:103–108PubMedCrossRef
14.
go back to reference Hauge MD, Cooper KL, Litin SC (1988) Insufficiency fractures of the pelvis that simulate metastatic disease. Mayo Clin Proc 63:807–812PubMed Hauge MD, Cooper KL, Litin SC (1988) Insufficiency fractures of the pelvis that simulate metastatic disease. Mayo Clin Proc 63:807–812PubMed
15.
go back to reference Rawlings CE 3rd, Wilkins RH, Martinez S et al (1988) Osteoporotic sacral fractures: a clinical study. Neurosurgery 22:72–76PubMed Rawlings CE 3rd, Wilkins RH, Martinez S et al (1988) Osteoporotic sacral fractures: a clinical study. Neurosurgery 22:72–76PubMed
16.
go back to reference Brahme SK, Cervilla V, Vint V et al (1990) Magnetic resonance appearance of sacral insufficiency fractures. Skeletal Radiol 19:489–493PubMedCrossRef Brahme SK, Cervilla V, Vint V et al (1990) Magnetic resonance appearance of sacral insufficiency fractures. Skeletal Radiol 19:489–493PubMedCrossRef
17.
go back to reference Guttner B, Freyschmidt J, Hohlweg-Majert P (1990) Stress fracture of the sacral bone. Rofo 152:236–237PubMed Guttner B, Freyschmidt J, Hohlweg-Majert P (1990) Stress fracture of the sacral bone. Rofo 152:236–237PubMed
18.
go back to reference Jones JW (1991) Insufficiency fracture of the sacrum with displacement and neurologic damage: a case report and review of the literature. J Am Geriatr Soc 39:280–283PubMed Jones JW (1991) Insufficiency fracture of the sacrum with displacement and neurologic damage: a case report and review of the literature. J Am Geriatr Soc 39:280–283PubMed
19.
go back to reference Kayes K, Coscia M, Braunstein E (1991) Radiologic case study. Sacral insufficiency fracture. Orthopedics 14:817–818PubMed Kayes K, Coscia M, Braunstein E (1991) Radiologic case study. Sacral insufficiency fracture. Orthopedics 14:817–818PubMed
20.
go back to reference Khorasani R, Nagel JS, Tumeh SS (1991) Radiologic vignette. Sacral insufficiency fracture. Arthritis Rheum 34:1387–1390PubMedCrossRef Khorasani R, Nagel JS, Tumeh SS (1991) Radiologic vignette. Sacral insufficiency fracture. Arthritis Rheum 34:1387–1390PubMedCrossRef
21.
go back to reference Nokes SR, Boyd CM, Kovaleski TM (1991) Radiological case of the month. Insufficiency fractures of the sacrum and left pubis. J Ark Med Soc 87:345–346PubMed Nokes SR, Boyd CM, Kovaleski TM (1991) Radiological case of the month. Insufficiency fractures of the sacrum and left pubis. J Ark Med Soc 87:345–346PubMed
22.
go back to reference Stroebel RJ, Ginsburg WW, McLeod RA (1991) Sacral insufficiency fractures: an often-unsuspected cause of low back pain. J Rheumatol 18:117–119PubMed Stroebel RJ, Ginsburg WW, McLeod RA (1991) Sacral insufficiency fractures: an often-unsuspected cause of low back pain. J Rheumatol 18:117–119PubMed
23.
go back to reference Abe H, Nakamura M, Takahashi S et al (1992) Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol 158:599–602PubMed Abe H, Nakamura M, Takahashi S et al (1992) Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol 158:599–602PubMed
24.
go back to reference Newhouse KE, el-Khoury GY, Buckwalter JA (1992) Occult sacral fractures in osteopenic patients. J Bone Joint Surg Am 74:1472–1477PubMed Newhouse KE, el-Khoury GY, Buckwalter JA (1992) Occult sacral fractures in osteopenic patients. J Bone Joint Surg Am 74:1472–1477PubMed
25.
go back to reference Lien HH, Blomlie V, Talle K et al (1992) Radiation-induced fracture of the sacrum: findings on MR. AJR Am J Roentgenol 159:227PubMed Lien HH, Blomlie V, Talle K et al (1992) Radiation-induced fracture of the sacrum: findings on MR. AJR Am J Roentgenol 159:227PubMed
26.
go back to reference Weber M, Hasler P, Gerber H (1993) Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine 18:2507–2512PubMedCrossRef Weber M, Hasler P, Gerber H (1993) Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine 18:2507–2512PubMedCrossRef
27.
go back to reference Peris P, Guanabens N, Pons F et al (1993) Clinical evolution of sacral stress fractures: influence of additional pelvic fractures. Ann Rheum Dis 52:545–547PubMed Peris P, Guanabens N, Pons F et al (1993) Clinical evolution of sacral stress fractures: influence of additional pelvic fractures. Ann Rheum Dis 52:545–547PubMed
28.
go back to reference Blomlie V, Lien HH, Iversen T et al (1993) Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology 188:241–244PubMed Blomlie V, Lien HH, Iversen T et al (1993) Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology 188:241–244PubMed
29.
go back to reference Peh WC, Gough AK, Sheeran T et al (1993) Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol 32:319–324PubMed Peh WC, Gough AK, Sheeran T et al (1993) Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol 32:319–324PubMed
30.
go back to reference Leroux JL, Denat B, Thomas E et al (1993) Sacral insufficiency fractures presenting as acute low-back pain. Biomechanical aspects. Spine 18:2502–2506PubMedCrossRef Leroux JL, Denat B, Thomas E et al (1993) Sacral insufficiency fractures presenting as acute low-back pain. Biomechanical aspects. Spine 18:2502–2506PubMedCrossRef
31.
go back to reference West SG, Troutner JL, Baker MR et al (1994) Sacral insufficiency fractures in rheumatoid arthritis. Spine 15:2117–2121 West SG, Troutner JL, Baker MR et al (1994) Sacral insufficiency fractures in rheumatoid arthritis. Spine 15:2117–2121
32.
go back to reference Gotis-Graham I, McGuigan L, Diamond T et al (1994) Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br 76:882–886PubMed Gotis-Graham I, McGuigan L, Diamond T et al (1994) Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br 76:882–886PubMed
33.
go back to reference Stabler A, Beck R, Bartl R et al (1995) Vacuum phenomena in insufficiency fractures of the sacrum. Skeletal Radiol 24:31–35PubMedCrossRef Stabler A, Beck R, Bartl R et al (1995) Vacuum phenomena in insufficiency fractures of the sacrum. Skeletal Radiol 24:31–35PubMedCrossRef
34.
go back to reference Peh WC, Khong PL, Ho WY (1996) Insufficiency fractures of the sacrum and os pubis. Br J Hosp Med 54:15–19 Peh WC, Khong PL, Ho WY (1996) Insufficiency fractures of the sacrum and os pubis. Br J Hosp Med 54:15–19
35.
go back to reference Grasland A, Pouchot J, Mathieu A et al (1996) Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med 156:668–674PubMedCrossRef Grasland A, Pouchot J, Mathieu A et al (1996) Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med 156:668–674PubMedCrossRef
36.
go back to reference Peh WC, Khong PL, Ho WY (1997) Case report: sacral insufficiency fractures masking malignancy. Clin Radiol 52:71–72PubMedCrossRef Peh WC, Khong PL, Ho WY (1997) Case report: sacral insufficiency fractures masking malignancy. Clin Radiol 52:71–72PubMedCrossRef
37.
go back to reference Breuil V, Brocq O, Euller-Ziegler L et al (1997) Insufficiency fracture of the sacrum revealing a pregnancy associated osteoporosis. First case report. Ann Rheum Dis 56:278–279PubMed Breuil V, Brocq O, Euller-Ziegler L et al (1997) Insufficiency fracture of the sacrum revealing a pregnancy associated osteoporosis. First case report. Ann Rheum Dis 56:278–279PubMed
38.
go back to reference Grimaud A, Oddo F, Thibaud I et al (1997) Fracture of the sacrum caused by bone insufficiency in a pregnant woman. J Radiol 78:511–512PubMed Grimaud A, Oddo F, Thibaud I et al (1997) Fracture of the sacrum caused by bone insufficiency in a pregnant woman. J Radiol 78:511–512PubMed
39.
go back to reference Schulman LL, Addesso V, Staron RB et al (1997) Insufficiency fractures of the sacrum: a cause of low back pain after lung transplantation. J Heart Lung Transplant 16:1081–1085PubMed Schulman LL, Addesso V, Staron RB et al (1997) Insufficiency fractures of the sacrum: a cause of low back pain after lung transplantation. J Heart Lung Transplant 16:1081–1085PubMed
40.
go back to reference Parikh VA, Edlund JW (1998) Sacral insufficiency fractures-rare complication of pelvic radiation for rectal carcinoma: report of a case. Dis Colon Rectum 41:254–257PubMedCrossRef Parikh VA, Edlund JW (1998) Sacral insufficiency fractures-rare complication of pelvic radiation for rectal carcinoma: report of a case. Dis Colon Rectum 41:254–257PubMedCrossRef
41.
go back to reference Verhaegen MJ, Sauter AJ (1999) Insufficiency fractures, an often unrecognized diagnosis. Arch Orthop Trauma Surg 119:115–116PubMedCrossRef Verhaegen MJ, Sauter AJ (1999) Insufficiency fractures, an often unrecognized diagnosis. Arch Orthop Trauma Surg 119:115–116PubMedCrossRef
42.
go back to reference Weber M, Hasler P, Gerber H (1999) Sacral insufficiency fractures as an unsuspected cause of low back pain. Rheumatology 38:90–91PubMedCrossRef Weber M, Hasler P, Gerber H (1999) Sacral insufficiency fractures as an unsuspected cause of low back pain. Rheumatology 38:90–91PubMedCrossRef
43.
go back to reference Schmid L, Pfirrmann C, Hess T et al (1999) Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int 10:91–93PubMedCrossRef Schmid L, Pfirrmann C, Hess T et al (1999) Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int 10:91–93PubMedCrossRef
44.
go back to reference Peh WC (2000) Intrafracture fluid: a new diagnostic sign of insufficiency fractures of the sacrum and ilium. Br J Radiol 73:895–898PubMed Peh WC (2000) Intrafracture fluid: a new diagnostic sign of insufficiency fractures of the sacrum and ilium. Br J Radiol 73:895–898PubMed
45.
go back to reference Aretxabala I, Fraiz E, Perez-Ruiz F et al (2000) Sacral insufficiency fractures. High association with pubic rami fractures. Clin Rheumatol 19:399–401PubMedCrossRef Aretxabala I, Fraiz E, Perez-Ruiz F et al (2000) Sacral insufficiency fractures. High association with pubic rami fractures. Clin Rheumatol 19:399–401PubMedCrossRef
46.
go back to reference Peh WC (2001) Clinics in diagnostic imaging (60). Insufficiency fractures of the pelvis. Singapore Med J 42:183–186PubMed Peh WC (2001) Clinics in diagnostic imaging (60). Insufficiency fractures of the pelvis. Singapore Med J 42:183–186PubMed
47.
go back to reference Wild A, Jaeger M, Haak H et al (2002) Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg 122:58–60PubMed Wild A, Jaeger M, Haak H et al (2002) Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg 122:58–60PubMed
48.
go back to reference Garant M (2002) Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol 13:1265–1267PubMed Garant M (2002) Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol 13:1265–1267PubMed
49.
go back to reference Pommersheim W, Huang-Hellinger F, Baker M et al (2003) Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol 24:1003–1007PubMed Pommersheim W, Huang-Hellinger F, Baker M et al (2003) Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol 24:1003–1007PubMed
50.
go back to reference Hoshino Y, Doita M, Yoshikawa M et al (2004) Unstable pelvic insufficiency fracture in a patient with rheumatoid arthritis. Rheumatol Int 24:46–49PubMedCrossRef Hoshino Y, Doita M, Yoshikawa M et al (2004) Unstable pelvic insufficiency fracture in a patient with rheumatoid arthritis. Rheumatol Int 24:46–49PubMedCrossRef
51.
go back to reference Khanna AJ, Kebaish KM, Ozdemir HM et al (2004) Sacral insufficiency fracture surgically treated by fibular allograft. J Spinal Disord Tech 17:167–173PubMedCrossRef Khanna AJ, Kebaish KM, Ozdemir HM et al (2004) Sacral insufficiency fracture surgically treated by fibular allograft. J Spinal Disord Tech 17:167–173PubMedCrossRef
52.
go back to reference Fujii M, Abe K, Hayashi K et al (2005) Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med 30:165–169PubMedCrossRef Fujii M, Abe K, Hayashi K et al (2005) Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med 30:165–169PubMedCrossRef
53.
go back to reference Butler CL, Given CA 2nd, Michel SJ et al (2005) Percutaneous sacroplasty for the treatment of sacral insufficiency fractures. AJR Am J Roentgenol 184:1956–1959PubMed Butler CL, Given CA 2nd, Michel SJ et al (2005) Percutaneous sacroplasty for the treatment of sacral insufficiency fractures. AJR Am J Roentgenol 184:1956–1959PubMed
54.
go back to reference Brook AL, Mirsky DM, Bello JA (2005) Computerized tomography guided sacroplasty: a practical treatment for sacral insufficiency fracture: case report. Spine 30:E450–E454PubMedCrossRef Brook AL, Mirsky DM, Bello JA (2005) Computerized tomography guided sacroplasty: a practical treatment for sacral insufficiency fracture: case report. Spine 30:E450–E454PubMedCrossRef
55.
go back to reference Dasgupta B, Shah N, Brown H et al (1998) Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol 37:789–793PubMedCrossRef Dasgupta B, Shah N, Brown H et al (1998) Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol 37:789–793PubMedCrossRef
56.
go back to reference Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81PubMed Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81PubMed
57.
go back to reference Lin J, Lane JM (2003) Sacral stress fractures. J Womens Health 12:879–888CrossRef Lin J, Lane JM (2003) Sacral stress fractures. J Womens Health 12:879–888CrossRef
58.
59.
go back to reference Finiels H, Finiels PJ, Jacquot JM et al (1997) Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases. Presse Med 26:1568–1573PubMed Finiels H, Finiels PJ, Jacquot JM et al (1997) Fractures of the sacrum caused by bone insufficiency. Meta-analysis of 508 cases. Presse Med 26:1568–1573PubMed
60.
go back to reference Negishi H, Kobayashi M, Nishida R et al (2002) Primary hyperparathyroidism and simultaneous bilateral fracture of the femoral neck during pregnancy. J Trauma 52:367–369PubMedCrossRef Negishi H, Kobayashi M, Nishida R et al (2002) Primary hyperparathyroidism and simultaneous bilateral fracture of the femoral neck during pregnancy. J Trauma 52:367–369PubMedCrossRef
61.
go back to reference Henry AP, Lachmann E, Tunkel RS et al (1996) Pelvic insufficiency fractures after irradiation: diagnosis, management, and rehabilitation. Arch Phys Med Rehabil 77:414–416PubMedCrossRef Henry AP, Lachmann E, Tunkel RS et al (1996) Pelvic insufficiency fractures after irradiation: diagnosis, management, and rehabilitation. Arch Phys Med Rehabil 77:414–416PubMedCrossRef
62.
go back to reference Eastell R, Dickson ER, Hodgson SF et al (1991) Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis. Hepatology 14:296–300PubMedCrossRef Eastell R, Dickson ER, Hodgson SF et al (1991) Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis. Hepatology 14:296–300PubMedCrossRef
63.
go back to reference Peris P, Navasa M, Guanabens N et al (1993) Sacral stress fracture after liver transplantation. Br J Rheumal 32:702–704 Peris P, Navasa M, Guanabens N et al (1993) Sacral stress fracture after liver transplantation. Br J Rheumal 32:702–704
64.
go back to reference Lips P (2001) Vitamin D deficiency and secondary hyperthyroidism in the elderly: concequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRef Lips P (2001) Vitamin D deficiency and secondary hyperthyroidism in the elderly: concequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedCrossRef
65.
go back to reference Lips P, Obrant KJ (1991) The pathogenesis and treatment of hip fractures. Osteoporosis Int 1:218–231CrossRef Lips P, Obrant KJ (1991) The pathogenesis and treatment of hip fractures. Osteoporosis Int 1:218–231CrossRef
66.
go back to reference Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy-a case report. Acta Orthop Scand 70:525–526PubMed Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy-a case report. Acta Orthop Scand 70:525–526PubMed
67.
go back to reference Schmid L, Pfirrmann C, Hess T et al (1999) Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int 10:91–93PubMedCrossRef Schmid L, Pfirrmann C, Hess T et al (1999) Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int 10:91–93PubMedCrossRef
68.
go back to reference Rousiere M, Kahan A, Job-Deslandre C (2001) Postpartal sacral fracture without osteoporosis. Joint Bone Spine 68:71–73PubMedCrossRef Rousiere M, Kahan A, Job-Deslandre C (2001) Postpartal sacral fracture without osteoporosis. Joint Bone Spine 68:71–73PubMedCrossRef
69.
go back to reference Kohlmeier L, Marcus R (1995) Calcium disorders of pregnancy. Review. Endocrinol Metab Clin North Am 24:15–39PubMed Kohlmeier L, Marcus R (1995) Calcium disorders of pregnancy. Review. Endocrinol Metab Clin North Am 24:15–39PubMed
70.
go back to reference Black AJ, Topping J, Durham B (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563PubMedCrossRef Black AJ, Topping J, Durham B (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563PubMedCrossRef
71.
go back to reference Kent GN, Price RI, Gutteridge DH et al (1990) Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Miner Res 5:361–369PubMedCrossRef Kent GN, Price RI, Gutteridge DH et al (1990) Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Miner Res 5:361–369PubMedCrossRef
72.
go back to reference McFarland EG, Giangarra C (1996) Sacral stress fractures in athletes. Clin Orthop Relat Res 329:240–243PubMedCrossRef McFarland EG, Giangarra C (1996) Sacral stress fractures in athletes. Clin Orthop Relat Res 329:240–243PubMedCrossRef
73.
go back to reference Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy-a case report. Acta Orthop Scand 70:525–526PubMedCrossRef Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy-a case report. Acta Orthop Scand 70:525–526PubMedCrossRef
74.
go back to reference Di Gregorio S, Danilowicz K, Rubin Z et al (2000) Osteoporosis with vertebral fractures associated with pregnancy and lactation. Nutrition 16:1052–1055PubMedCrossRef Di Gregorio S, Danilowicz K, Rubin Z et al (2000) Osteoporosis with vertebral fractures associated with pregnancy and lactation. Nutrition 16:1052–1055PubMedCrossRef
75.
go back to reference Magee DJ (eds) (1997) Orthopedic physical assessment, 3rd ed. W.B. Saunders, Philadelphia Magee DJ (eds) (1997) Orthopedic physical assessment, 3rd ed. W.B. Saunders, Philadelphia
76.
go back to reference Jacquot JM, Finiels H, Fardjad S et al (1999) Neurological complications in insufficiency fractures of the sacrum. Three case-reports. Rev Rhum Engl Ed 66:109–114PubMed Jacquot JM, Finiels H, Fardjad S et al (1999) Neurological complications in insufficiency fractures of the sacrum. Three case-reports. Rev Rhum Engl Ed 66:109–114PubMed
77.
go back to reference Mathers DM, Major GA, Allen L et al (1993) Insufficiency fractures of the sacrum. Ann Rheum Dis 52:621–623PubMed Mathers DM, Major GA, Allen L et al (1993) Insufficiency fractures of the sacrum. Ann Rheum Dis 52:621–623PubMed
78.
go back to reference Peh WC, Ooi GC (1997) Vacuum phenomena in the sacroiliac joints and in association with sacral insufficiency fractures: incidence and significance. Spine 22:2005–2008PubMedCrossRef Peh WC, Ooi GC (1997) Vacuum phenomena in the sacroiliac joints and in association with sacral insufficiency fractures: incidence and significance. Spine 22:2005–2008PubMedCrossRef
79.
go back to reference Peh WC, Khong PL, Yin Y et al (1996) Imaging of pelvic insufficiency fractures. Radiographics 16:335–348PubMed Peh WC, Khong PL, Yin Y et al (1996) Imaging of pelvic insufficiency fractures. Radiographics 16:335–348PubMed
80.
go back to reference Grangier C, Garcia J, Howarth NR et al (1997) Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol 26:517–524PubMedCrossRef Grangier C, Garcia J, Howarth NR et al (1997) Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol 26:517–524PubMedCrossRef
82.
go back to reference Lin J, Lachmann E, Nagler W (2001) Sacral insufficiency fractures: a report of two cases and a review of the literature. J Womens Health Gend Based Med 10:699–705PubMedCrossRef Lin J, Lachmann E, Nagler W (2001) Sacral insufficiency fractures: a report of two cases and a review of the literature. J Womens Health Gend Based Med 10:699–705PubMedCrossRef
83.
go back to reference Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention trial Research Group. Lancet 248:1535–1541CrossRef Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention trial Research Group. Lancet 248:1535–1541CrossRef
84.
go back to reference McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340PubMedCrossRef McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340PubMedCrossRef
85.
go back to reference Odvina CV, Zerwekh JE, Rao DS et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90:1294–1301PubMedCrossRef Odvina CV, Zerwekh JE, Rao DS et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90:1294–1301PubMedCrossRef
86.
go back to reference Mashiba T, Turner CH, Hirano T et al (2001) Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 28:524–531PubMedCrossRef Mashiba T, Turner CH, Hirano T et al (2001) Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 28:524–531PubMedCrossRef
87.
go back to reference Ott SM (2005) Editorial: Long term safety of bisphosphonates. J Clin Endocrinol Metab 90:1897–1899PubMedCrossRef Ott SM (2005) Editorial: Long term safety of bisphosphonates. J Clin Endocrinol Metab 90:1897–1899PubMedCrossRef
88.
go back to reference Vogelvang TE, van der Mooren MJ, Mijatovic V (2004) Hormone replacement therapy, selective estrogen receptor modulators, and tissue-specific compounds: cardiovascular effects and clinical implications. Treat Endocrinol 3:105–115PubMedCrossRef Vogelvang TE, van der Mooren MJ, Mijatovic V (2004) Hormone replacement therapy, selective estrogen receptor modulators, and tissue-specific compounds: cardiovascular effects and clinical implications. Treat Endocrinol 3:105–115PubMedCrossRef
89.
go back to reference Body JJ, Gaich GA, Scheele WH et al (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535PubMedCrossRef Body JJ, Gaich GA, Scheele WH et al (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535PubMedCrossRef
90.
go back to reference Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedCrossRef Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedCrossRef
91.
go back to reference Dempster DW, Cosman F, Kurland ES et al (2001) Effects of daily treatment with parathyroid hormone on bone microarchitecture and turnover in patients with osteoporosis: a paired biopsy study. J Bone Miner Res 16:1846–1853PubMedCrossRef Dempster DW, Cosman F, Kurland ES et al (2001) Effects of daily treatment with parathyroid hormone on bone microarchitecture and turnover in patients with osteoporosis: a paired biopsy study. J Bone Miner Res 16:1846–1853PubMedCrossRef
92.
go back to reference Jilka RL, Weinstein RS, Bellido T et al (1999) Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest 104:439–446PubMedCrossRef Jilka RL, Weinstein RS, Bellido T et al (1999) Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest 104:439–446PubMedCrossRef
93.
go back to reference Simon AM, Manigrasso MB, O’Connor JP (2002) Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Re 17:963–976CrossRef Simon AM, Manigrasso MB, O’Connor JP (2002) Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Re 17:963–976CrossRef
94.
go back to reference Altman RD, Latta LL, Keer R et al Effect of non-steroidal anti-inflammatory drugs on fracture healing: a laboratory study in rats. J Orthop Trauma 9:392–400 Altman RD, Latta LL, Keer R et al Effect of non-steroidal anti-inflammatory drugs on fracture healing: a laboratory study in rats. J Orthop Trauma 9:392–400
95.
go back to reference Giannoudis PV, MacDonald DA, Matthews SJ et al (2000) Non-union of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br 82:655–658PubMedCrossRef Giannoudis PV, MacDonald DA, Matthews SJ et al (2000) Non-union of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br 82:655–658PubMedCrossRef
96.
go back to reference Chao EY, Inoue N, Koo TK et al (2004) Biomechanical considerations of fracture treatment and bone quality maintenance in elderly patients and patients with osteoporosis. Clin Orthop Relat Res 425:12–25PubMedCrossRef Chao EY, Inoue N, Koo TK et al (2004) Biomechanical considerations of fracture treatment and bone quality maintenance in elderly patients and patients with osteoporosis. Clin Orthop Relat Res 425:12–25PubMedCrossRef
97.
go back to reference Fishmann AJ, Greeno RA, Brooks LR et al (1994) Prevention of deep veil thrombosis and pulmonary embolism in acetabular and pelvic fracture. Clin Orthop Rel Res 305:133–137 Fishmann AJ, Greeno RA, Brooks LR et al (1994) Prevention of deep veil thrombosis and pulmonary embolism in acetabular and pelvic fracture. Clin Orthop Rel Res 305:133–137
98.
go back to reference Buerger PM, Peoples JB, Lemman GW et al (1993) Risk of pulmonary emboli in patients with pelvic fractures. Am Surg 59:505–508PubMed Buerger PM, Peoples JB, Lemman GW et al (1993) Risk of pulmonary emboli in patients with pelvic fractures. Am Surg 59:505–508PubMed
99.
go back to reference Chobanian AV, Lillie RD, Tercyak A et al (1974) The metabolic effects and hemodynamic effects of prolonged bed rest in normal subjects. Circulation 49:551–559PubMed Chobanian AV, Lillie RD, Tercyak A et al (1974) The metabolic effects and hemodynamic effects of prolonged bed rest in normal subjects. Circulation 49:551–559PubMed
100.
go back to reference Babayev M, Lachmann E, Nagler W (2000) The controversy surrounding sacral insufficiency fractures: to ambulate or notto ambulate? Review. Am J Phys Med Rehabil 79:404–409PubMedCrossRef Babayev M, Lachmann E, Nagler W (2000) The controversy surrounding sacral insufficiency fractures: to ambulate or notto ambulate? Review. Am J Phys Med Rehabil 79:404–409PubMedCrossRef
Metadata
Title
Sacral insufficiency fractures: current concepts of management
Authors
E. Tsiridis
N. Upadhyay
P. V. Giannoudis
Publication date
01-12-2006
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 12/2006
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0175-1

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