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Rheumatology 1999; 38: 903-904
© 1999 British Society for Rheumatology

Letters to the Editor

Sacral insufficiency fractures: reply to correspondence

C. Li and B. Dasgupta

Department of Rheumatology, Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY

It is our pleasure to see that our grand round has received so much interest amongst the readers of Rheumatology. Isdale [1] reiterates the important point that, in any osteoporotic fracture, the lack of acute and, indeed, any symptom is common. With the increased knowledge of pharmacological treatments of osteoporosis this should not diminish our enthusiasm for early diagnosis and treatment. Indeed, a regional bone mineral density (BMD) assessment of the sacral/pelvic area may be a sensitive way to pick up early osteoporosis at this site, but we are not aware of any studies comparing this to the gold standard of BMD at the hip and femoral neck.

The case report of Lloyd et al. [2] illustrates once again the fact that clinical suspicion of the condition is paramount to its diagnosis. This is because plain radiographs are often entirely normal. MRI is probably as good as CT in picking up overt displaced pelvic girdle fractures. Bone isotope scan uptake pattern, together with the clinical information, is the most sensitive investigation for sacral insufficiency fractures (SIF). As our grand round cases demonstrate, inflammatory joint disease appears, even in the absence of corticosteroid therapy, to be a risk factor for this complication.

We are delighted to hear from Weber et al. [3] that there is considerable European interest in the diagnosis of SIF. We are contemplating a prospective audit in the setting of a British district general hospital and surrounding community, and would value a parallel collaboration on the continent.



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  		FIG. 1.  Near-total destruction of the right clavicle and scapula with disuse osteoporosis of the proximal humerus. (A) Chest X-ray; (B) magnified view of the right shoulder.

 

References

  1. Isdale AH. Sacral insufficiency fractures: an unsuspected cause of low back pain. Rheumatology 1999;38:90.
  2.  Lloyd ME, Hunt S, Spector TD. Imaging of pelvic fracture in a patient with psoriatic arthritis. [Letter] Rheumatology 1999; 38:902–903.
  3.  Weber M, Hasler P, Gerber H. Sacral insufficiency fractures as an unsuspected cause of low back pain. Rheumatology 1999;38:90.
Accepted 15 March 1999


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