Pelvic insufficiency fracture simulating metastatic bone disease.

OBJECTIVE: To present a rare case of pelvic insufficiency fracture mistaken for metastatic bone disease. CLINICAL FEATURES: A 58-yr-old female received 3 wk of chiropractic treatment for mechanical low back pain. The treatment offered no relief. Two months later, a bone scan revealed increased uptake in the pelvis, suggesting metastatic bone disease. A CT scan demonstrated several pubic fractures. Subsequent biopsy failed to show evidence of malignancy. A diagnosis of insufficiency fractures secondary to osteoporosis was made. INTERVENTION AND OUTCOME: She was referred to a rehabilitation clinic for physiotherapy and medication. She consulted a rheumatologist and was prescribed calcitonin. Ten months later, she was improved and the fractures had united.
CONCLUSION: The absence of trauma frequently delays the diagnosis of parasymphyseal insufficiency fracture. The ambiguous X-ray features often lead to a diagnosis of metastatic bone disease. Early detection is important as significant morbidity may result from delaying the treatment.