Pelvic Insufficiency Fracture in Severe Osteoporosis Patient

Abstract

Purpose: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures.

Materials and methods: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of -3.9 (range, -3.1 to -6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score.

Results: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached.

Conclusion: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.

Keywords: Insufficiency fractures; Osteoporosis; Parathyroid hormone; Pelvic fracture; Sacral fracture.

Fig. 1. Radiographs of a 82-year-old female patient. (A) Simple radiography shows left pubis superior and inferior ramus fracture. (B) Thorax and abdomen computed tomography shows multiple spine compression fracture (T3, T7, L1-L3).

Fig. 2. Radiographs of a 73-year-old female patient. (A, B) Simple radiography and computed tomography shows pelvic bone insufficiency fracture. (C) Bone scan shows Honda sign that means pelvic insufficiency fracture.

Fig. 3. Radiographs of a 74-year-old female patient. (A) Simple radiography shows right pubis superior and inferior ramus insufficiency fracture. (B) Forteo® (Eli Lilly) injected during 4 months and it shows complete bone union on simple radiography.