Radiology Rounds - January 2011 - Diagnosing Insufficiency Fractures in the Pelvis and Proximal Femur

Over 1.5 million cases of fractures related to osteoporosis and osteopenia occur in the USA annually. Pelvic and sacral insufficiency fractures are an important subset of this entity. First described by Lourie in 1982, insufficiency fractures arise when a normal or physiologic stress is applied to weakened bone with reduced mineralization and elasticity. Insufficiency fractures may be associated with several conditions including osteoporosis, previous radiation therapy, rheumatoid arthritis, prolonged corticosteroid therapy, renal failure, and mechanical changes after hip replacement surgery. Most patients with insufficiency fractures are older than 55 years of age, with the mean age of 70-75. The true incidence of the disease is unknown but is estimated to be 1-5% of the at-risk population.