Bone metastases or an insufficiency fracture? Oncology patients reporting pain or showing bone abnormalities on a scan
Meerveld-Eggink, A.; Bollen, T.L.; Wijrdeman, H.K.; Los, M.
Nederlands Tijdschrift Voor Geneeskunde 157(28): A6098
2013
ISSN/ISBN: 0028-2162 PMID: 23841929 Document Number: 669484
A 71-year-old patient reported pain in the left hip 14 months after treatment with radiotherapy for a ypT3N1M0 rectal carcinoma, and a 61-year-old patient reported pain in the lower back with radiation to the buttocks 8 months after radiotherapy for a ypT3N2M0 rectal carcinoma. In both patients the initial diagnosis considered was bone metastasis. After MRI and nuclear bone scans, however, diagnoses of insufficiency fractures of the acetabulum and sacroiliac (SI) joints, respectively, were made. Insufficiency fractures of the SI joints or acetabula are a frequent complication of radiotherapy and should be considered in all oncology patients who present with sudden onset of back pain or lower back pain after radiotherapy. A MRI scan is the initial investigation of choice. Treatment is conservative, with analgesia and physiotherapy. Prognosis is good; symptoms disappear within 1 year in almost all patients.