Sacroiliitis or insufficiency fracture?

• Published in: Osteoporosis international Vol. 27; no. 3; pp. 1265 - 1268
• Main Authors: Memetoğlu, O. G., Ozkan, F. U., Boy, N. S., Aktas, I., Kulcu, D. G., Taraktas, A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.03.2016; Springer Nature B.V
• Subjects: Adult; Calcium; Case Report; Chronic Disease; Diagnosis, Differential; Endocrinology; Female; Fractures; Fractures, Stress - complications; Fractures, Stress - diagnostic imaging; Hip joint; Humans; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Orthopedics; Pain; Pain - etiology; Rheumatology; Sacroiliitis - complications; Sacroiliitis - diagnostic imaging; Sacrum - diagnostic imaging; Sacrum - injuries; Vitamin D; Sacral stress fracture; Pain; Sacral insufficiency fracture; Sacroiliitis
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-015-3363-z

Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.