Maybe not here?
 

I'll be glad to post this elsewhere but I wasn't sure where to put it. You all know I've been dealing with multiple sacral and pelvic stress fractures since Oct of 2007. I got the results of the latest pelvic CT scan yesterday and it is worse than it was the last time. The pubic bone on the right side is misaligned and will not heal in this position. I have a new one that has opened up on the wing of the ilium toward the sacroilliac joint. The others are in various stages of healing or breaking. I've been taking Forteo for 4 months and I'm still breaking. But how will the edges of the one that is misaligned ever meet up and heal.

I made an appt. with the Metabolic Bone Clinic at SWestern Medical Center in Dallas. A big medical university where they are teaching our doctors. I saw the professor of the Clinic with 3 medical students. No hands on exam. He wanted me to stop my Forteo and let him do a bunch of testing. I'm 4 months into a 2 year program. I'm not stopping until that 2 year period is over. So we ageed he'd leave an open door and to call if I changed my mind. He also agreed to send a letter with his findings (? what findings), suggestions and testing he thought should be done. This was to go to my Rheumatologist who referred me to him.

I get my copy of the letter on Monday. It's addressed to the neuro I saw at SWestern over 3 years ago. He mentioned during the interview that he'd send him the letter and I corrected him then. Obviously wasn't listening to me. He then stated I had told him I had had bilateral fractured knees. No...bi-lateral knee replacements. He said I didn't seem in any distress. I stood up from my wheelchair multiple times during the interview because I was hurting too badly to sit. And he ended the interview by tellling me he'd send a letter suggesting tests that should be run to investigate. The letter mentioned no test suggestions. I blew the ceiling off the top of my kitchen when I read that ridiculous letter. So I phoned the office, got the correct person on the line and made her day. :cool: So now I've received the corrected version of the letter and it still has fractured knees in it but the rest of it has been straightened out and the correct doctor is getting it (I hope). So I'm not anxious to go back to that place again. That is my second terrible experience with them. I will not return again. Wasted time and money.

But back to the original problem. I have a bone that cannot mend. It's not physically possible. My bladder has no support which is causing problems too. And the pain from all of this is just unreal. Do any of you have any suggestions for how they can repair this break or what type of doctor to see? I don't even know where to start.

Billye

I must admit I'm stumped, but I'm also furious on your behalf. Why should anyone take his recommendations seriously if he doesn't even know or care what bones are broken?? And he says you're in no apparent distress - does he think you're in a wheelchair for FUN? :mad::mad::mad::mad::mad::mad:

I wish I had something more constructive to say. My heart is breaking for you. :hug:

fanfaire
:cool:

so they can't align the bones and put screws in it?
Or do they think that wouldn't work?
Why can't they go in a and surgically support the bladder?
I knew of some ladies at work that had things like that done many many yrs ago.

sorry if I'm missing some details, but it seems that would be a logical step unless there is some reason that it is not an option.

So sorry Billye.
 

I feel very badly for encouraging you to go over there. I was so in hopes that you would be able to get some of the bones cemented back together. You know, I emailed him about that; he never mentioned that there were problems from that...

As you know, I saw the same doctor before you did. I now am questioning some of the recommendations that were made, one thing was reducing my calcium intake (could be because of kidney stones though.)

I have already gotten my Internist to rerun the 24 h urine for uric acid that was done there ...

I have had earlier problems at the school, but they were in the Dept. of Neurology.

I am just appalled that this happened and regret that I recommended this. I hope you can forgive me... When he said he knew of someone there who could cement (or was it glue) the bones back together, I was so excited for you.

Cathie

My recommendation...a good spinal doc; preferrably and OSS along with a GOOD Urogyn and even a spinal PM. I have written before a few times and grant you I don't have stress fractures. I do have a fractured coccyx and minor prolapses. But between my PM and Urogyn they have pretty much sorted it out. And, yes, I know...my issues are different. But the sit pain can be awful! But since you are speaking of the sacrum, illium, sacroilliac joint, and bladder. These are the docs I would see. Oops, I did want to mention the bladder. My prolapses are actually minor and are a cystocele and rectocele. The thing I found out later is that if they were to do the repairs, they would attach the sling at the sacrum! :eek: And that is precisely where I have nerve damage or lumbar/sacral pain. So, I am holding off and doing pelvic floor PT to release spasms caused by the nerve damage. So far so good because the prolapses are actually being helped by this. And it will be injections for the coccyx because it has been recommended to NEVER have that removed. I wish I could be of more help.

Gosh...this is terrible.
 

I saw a program on TV that said "soon" there will be a cement that doctors
will inject into a broken bone and you can go home with no cast...no support.

I don't know where this is being trialed however.

http://news-service.stanford.edu/new...onecement.html

Your weight bearing area would be more problematic.

Do you have a hip replacement on that side? I forgot if you have hip
replacements too?

Having had a son who fractured his neck and is now crippled for life,
it was the docs at the shock-trauma center that saved his life.
The surgeons at the emergency trauma ER at the hospital were the ones
who removed his C-5 and put titanium in place of it.
Maybe you should look into that area of surgery/surgeons for some ideas.

Also, I've heard of a mesh 'sling' type support for organs that have lost
their support, either thru muscle/tendon problems or bone problems.
Have any of your surgeons looked into this for the bladder support?

didn't put the whole story in
 

The CT scan was actually run by the new GYN I am seeing. She says the bladder needs sling surgery like Roxie has had done, but she has to go in thru the vaginal area to do that and she says frankly my vaginal tissue is in such poor shape due to the Sjogren's dryness. She's now treating me with Premarin in pill form and the Premarin vaginal cream to see if she can get the tissue in better shape. She says that in it's current condition the surgery wouldn't heal.

I've been told by the first orthopedic surgeon that putting a plate and screws in the misaligned bones would do no good. The bones are so fragile that the screws would pull out of the bone and I'd have a worse mess.

Mrs. D, I knew about the bone glue but they are having some issues with it. The doctor at SWest said they are finding that sometimes the glue migrates into other tissues and can make things worse. The doctor I saw there would not recommend it. There are doctors in Dallas doing it I believe. No, I don't have hip replacements at this time.

I'm seeing a new orthopedic doctor today. My left knee is giving me lots of problems so I got an appt to have it looked at, I'm afraid the prosthetic in that knee may be slipping. I'll ask this doctor about what she would do about the pelvic and sacral issues too.

It's just a mess.

Would you believe I can walk tho....sort of.

Billye

Hopeful You Will Have Your Needs Met~
 

Dear SiverLady,

I am "new" to the forum and we are not acquainted yet.

I do not have a any fantastic advice, unfortuantely.:( I wish I knew the answers... in order to share them! I'd love to be able to help in some way.:)

I am outraged with how you were treated.:mad:

I hope and pray you will find good answers and very helpful doctors sooner than later! You have needed to be a very strong person. You deserve to be treated better than you were. All of this must be so very trying and tiring at times.:(

I admire your ability to do whatever you must in looking for the answers you need and deserve. You also deserve to heal... on all levels. I hope this is an option in the very near future for you. :)

Your story deeply touches my heart and I wish I could do more to be helpful to you.:Heart:

Do you mind if I pray for you? (I always ask for permission, as not everyone wants to be prayed for. I have a list of people I pray for every day; I would simply include you in my prayers. Yet, I also understand if you feel uncomfortable with this; some people simply feel uncomfortable. I am fine with whatever your response, SilverLady, as I totally respect everyone as an individual! Just trying to finds ways to be supportive to you and your situation.)

May you continue to find the strength to pursue the answers and the help you need!:)

I can't believe what a ***** that metabolic guy is. I don't know how he got into that subspecialty. Some get in through being endocrinologists and others by being orthopedic surgeons. I'll be this guy is an endocrinologist and is scared of you. How he could tell you to stop the Forteo is beyond me.

You need to be on Forteo for 2 years to get full effect-that's the protocol, and you've only been on a few months.

Did the report say the aligned fractures were healing but the non aligned were not? Because I did think there was some healing. So maybe the non-aligned need to be glued, which I know is hard to find where you are.


You need better doctors; can you get back to Mayo? Or NY? (You can stay by me, as we say here). I think someone needs to look more carefully at what is going on, and this bone guy is not worth his weight in salt.

Did he evaluate what state the bone is in now? Is bone forming, turning over? Did they do a 24 hour urine for NTC--the collagen test that shows whether you're taking bone down.

It's a bit weird for your osteoporosis to be getting worse at this point, when you are getting so much treatment for it. If they didn't do the urine, I think they should. I don't know what else, but a deeper look.

The bone metabolism guy I see here is an orthopedist.
He sees three illnesses: bone cancers, Paget's disease, and osteoporosis. He spends 2 days a week evaluating patients and 2 days doing surgery on them, mostly spine.

I just wish you had better doctors.
and prescribing things like Forteo and 2

I suspect Forteo skews the testing done in their research lab. I was told to stop all calcium intake about 10 days, maybe 2 weeks before the testing was done.

Testing is not done in the initial visit; the first visit is an interview. I had to wait nearly a month before I could even have the extensive testing done that he ordered. The morning after the 24 hour urine test was completed, I spent almost 5 hours there in testing, presumbly for the calcium load.

I assumed the calcium restriction was so that he could tell from baseline testing what was going on, prior to making a treatment plan.

Lab testing that was ordered included: 24 hr urine chemistries and bone turnover markers, fasting blood, PTH, BMD, 1,25-(OH)2D, 25 OH-Vitamin D tests, fasting urine Ca:Cr ratio and a 1g oral calcium load to assess the degree of calcium mobilization from the bone and intestinal calcium absorption. I don't even know what most of this is.

Bone density testing is also ordered. He prefers to compare results from the same facility.

I reminded him of my friend's problem in my visit with him and he said he remembered this. He had told me he felt he could help her, although I cannot recall the exact words. Perhaps at that time he was not aware of the cement or glue problems.

Silverlady,

I hope you appointment goes well today with the new ortho doc. Yes, PLEASE ask about the sacral and pelvic issues. I know there all kinds of blocks that can be done as well. But I am not sure if the docs would want to do that because of the osteoporosis. And it may be that you have to address one issue at a time. I had to. But please report back as to what the new doc has to say. I wish you well.

spine doc
 

Billye, I agree with advice that you see a spine surgeon. This is there area of expertise.

Hi Billye

Sorry I haven't contributed earlier....I am still trying to get my own biopsy results!!! I am very irritated at this point, as I have several issues and am sick. And we had another serious medical emergency in my family. Just haven't been on the computer.

If I am reading this correctly, you have bilateral knee replacements?

Has any thought been given to the possibilty of a rejection? Could you have a rejection to those implants, causing bone all over to be attacked? I know it would be odd, but, it is possible.

Also, if fractures are continuing, perhaps the testing is worth it, as perhaps, Forteo is doing no good, not addressing the problem? It seems to me to be a bone metabolism issue, or GI issue of not absorbing the nutrients you need. It sounds as if your bone is deteriorating due to SOME unknown factor and the usual treatments such as Forteo, are not stopping it, and that identifying the cause of the degredation is of utmost importance.

I don't know if my opinion helps, but, from my perspective, this is what I see.

I am so sorry you have to go thru all this, and have such a perplexing condition.

Billye there are two things going on here, no?
 

One is the way that 'specialist' treated you [NOT] and the other is whether YOU can find any relief anywhere and anyhow? Am I correct here?
"What a fine mess you seem to be in!" It is definitely not fun, neverending and seemingly untreatable.
IF it were me? I'd seek and find out my state medical board and report that doc. Simultaneously I'd contact the hospital's PR dept and DEMAND an accounting of such sloppy behaviour and a pro-bono re-examination from other professionals at another facility at the cost of this hosital to avoid potentail lawsuit? Give them "X" days to respond making it clear that you are inclined to go to the press about such 'shabby & negligent' treatment - It IS the equivalent of amputation of the wrong leg in many ways.
IF I had to set foot in that facility again? I do think I would carry a 'walking stick' akin to the one Mrs D uses [BIGG STICK!] and make it clear that you could use it to 'propel' your self down halls and such...so you COULD use it in such inappropriate situations as you have encountered. Sometimes such things add stature?
YOU did not ask for all this, nor did you anticipate that the therapies that were given you to HELP you would leave you in such a state. At times the docs who were trying to help you did not know all of the consequences. Who all is to blame? Everyone and no one, unfortunately. I truly wish I could offer some solutions? They always seem to be far too obscure and out of reach to be of use.
My heart and soft hugs go to you now, I simply wish I could do more to ease your pain and help you become more whole. :hug:'s - j

O.K. here is where we are
 

I'm sorry didn't get you all answered last night. I did post a long message but it was lost.

I saw the ortho who is a PA but was my Mom's PA and she dealt with lots of geriatric patients in a nursing home. I respect her highly. She tells it like it is and isn't afraid to consult with other doctors.

She read the CT report and says that the misaligned bone is doing some healing but will heal misaligned. There is nothing surgically that can be done. But she told me that she had never seen pelvic bones spontaneously fracture without a trauma of some kind. So she has ordered a neuclear bone scan which was done today, ..to rule out bone cancer. My Grandmother died from bone cancer. Multiple myeloma. When my anemia got so bad, I saw an onocologist while I was in the hospital and he recommended a bone biopsy which I refused. But the ortho told me that depending on what they find with the bone scan, I may have to revisit that decision.

The ortho confered with a pain doc in the same office and he said he could do blocks, but that means steriods and I'm not going there. I don't have enough bone.

Yorkiemom...it's not your fault this happened, it's sloppy bookwork which fortunately did not kill me. Texas medicine is still in the dark ages unless you get a doctor who was educated elsewhere. I won't be returning any time soon.

I thank you all for your time and effort spent on me. I'll be posting when I get an update on the report. I expect to get it Tuesday. I have an appt. with the ortho PA and the doctor she works for on Friday to discuss this but I'll have my husband pick up a copy for me on Tues.

Billye

Ohh, Billye
 

I had no idea about the bone cancer and myeloma in your family. You must be feeling pretty scared, in addition to exhausted.

Dahlek--your suggestions are great! but they are the type that need to be followed by an advocate. It's near impossible for any of us, when exhausted and scared and in pain to do that level of advocacy. Someone else has to fill that role for us, and lucky are those who have such a person in their life.

Billye, it sounds like you have ONE GOOD
 

and wise advocate in your corner! That is one more than you had before, and I suspect the toll in finding that one...well has been greater than most of us can know or appreciate. I hope that this is a person who can get things done....sounds like it.

Liza Jane the advocate concept is great as a concept....but those of us with heavy pain issues simply have to 'work' the constructive complaint and personal advocacy in-between dealing with meeting the bills and wrestling with insurance coverages [making sure the 'i's' are dotted and 't's' are crossed]. It takes me an average of 8-10 man hours to FIND a cogent warm body who can de-bug the intrastate foibles of coordinated medical coverages for tests! Fortunately I became an old pro at it decades before I came down with the immune PN issues. It's a matter of getting and keeping copies of all test orders and EOBS. Then it's a bit of luck in finding a 'plan benefits rep' who isn't brain dead and being passed around until the paperwork gets plugged in all correctly. It is simply far, far harder when one hurts. The option for most on Medicare/Medicaid is that they've probably been near or are bankrupted by their illnesses and qualified 'advocates' are few and far between AND usually for a fee. There is no 'equivalant' for Legal Aid in the medical world YET. I suspect there will be in the next decade and it will be drowning in cases tho.

As for ME? I am doing as much as I can WHILE I can! As I find cogent resources I will definitely try to post them. IN and of themselves, PN issues tho, usually fall far down on the priority totem pole tho, compared to deadly tumors and other dramatic issues one sees on the news... These folks all re quire time and attention. Doesn't mean we don't hurt tho, does it? Hugs to all - j :hug::hug::hug:'s

Dahlek--I agree, I agree. I, too, must be my own advocate. But there are days when one is just too tired.

A few thoughts
 

Billye, so sorry that you are going thru all of this, seems like it never ends and you are continually fighting these challenges - maybe it would be wise to have the biopsy just to put your mind at ease.... (I've heard they are painful - but somehow doesnt seem worse then you are continually dealing with every day now?)

As for advocates - if anyone does know how to find one for free - please share! I have spent years trying to find one - talked to hospital social workers, adult protective services , searched the net, etc, none of whom were any help.... what it boils down to if you dont have the resources to buy one - or family to stand in with you - they dont exist.... and we just spend what little energy we do have making call after call and days of paperwork just to keep insurance insurances under control, paperwork done, copies of tests sent to docs, etc....

Hopefully at least the knowledge we gleam from each other helps us when we do see our doctors....

Billye, will be waiting to hear what your doc has to say next week - take care.....

Oh...
 

I sure hope you don't have myeloma! :hug:

Although--
 

--am I correct in assuming that you've had normal blood work-ups done, including CBC's, on a fairly regular basis, and no blood cellular abnormalities have shown up?

The disntiction here is between cancers of the bone tissue itself ( and primary bone cancer is very, very rare) and cancers of the blood marrow/cell producing regions--myeloma falls into the second category. If there was some suspicion of the latter, likely some tell-tale signs would have shown up, such as increased immunoglobulin levels, or evidence of rogue monoclonal protein on immunofixation electrophoresis (have you had one of those recently)? Plus, your serum calcium levels (especially ionic levels) would likely be significantly elevated.

Of course, neither of these are an outcome anyone likes, and I hope this is not in the cards for you. (Given you history, though, I'm still suspicous that metabolically something is leaching the calcium out of your bones.)

Some of it
 

Glenn,
I've had regular blood work. They did an electrophoresis test in Oct when I received the transfusions. Everything was normal at that point. But I was told the only way to be sure was to do the bone biopsy. I resisted. Everything else was normal and so I saw no need for it.

There will be more bloodwork done and a repeat of some of it.

Billye

Billye I am among the ones who'd love to help you. I am sorry, unfortunately I can't ¡... i am only wishing and praying for your recovery i hope the blood work comes back fine.

Glenn
 

A number of the women believed to be suffered from autoimmune illness relating to implants have tested positive for MGUS. This is the abnormal (rogue) protein found in Multiple Myeloma. People with MGUS sometimes go on to develop MM, although this is supposed to be rare. (MGUS=monoclonal gammopathy of unknown significance)

As far as the rogue monoclonal protein goes, there was nothing to suggest that I had this, nothing... I read of these findings in one of the implant support groups, went to my Immunologist and insisted on being tested for it. He was floored when it came back positive.

While physicians I have spoken with assure me that there are no symptoms relating to MGUS, some of the women have reported that there are indeed symptoms. I would say that it is hard to differentiate between what is related to their autoimmune symptoms and what might be related to the presence of this protein. Also, many have neuropathy.

If my memory serves me correctly, this protein can also cause a neruopathy of sorts. I pointed this out recently to my Oncologist, whose response was that if this was actually the cause of my neuropathy, Prednisone was the treatment...

Perhaps the immunofixation electrophoresis is above and beyond protein total and protein electrophoresis, as they were recently normal. However, the protein finding is clearly positive in my Oncologist's testing; her testing must go above and beyond protein electrophoresis in some manner, but this is beyond my level of understanding...

I will query the support group to see if any are suffering from bone loss or fractures and post this, if I find out anything.

Cathie

Yes--
 

--the presence of monoclonal proteins in the blood, even in the absence of blood dyscrasias, has been shown to be associated with neuropathy; thre seems to be a cross reaction between the antibodies and certain glycolipids on the surface of nerve tissue (sort of like a key that happens to fit a certain shaped lock).

Neuropathic symptoms are more common with an elevation in the IgM class or gammoglobulin, though they can occur with elevations in all the other classes (IgA, IgG), or with elevations in more than one class.

The immunofixation electrophoresis of serum and urine is the more specific test to detect these--a protein electrophoresis is not enough, as small elevations in the gammaglobulin portion may be obscured in such a test. If these are detected, a number of other tests are then performed, including calcium ion and bone marrow biopsy. The finding of M-protein is actually fairly common in older people (roughly 2% in people over 50, and about 5% in people over 70).

The Washington University Neuromuscular website describes this well:

http://neuromuscular.wustl.edu/antibody/mprotein.htm

I'm just sitting here soaking all of this up
 

Glenn,
It is very over my head. We will see what Monday or Tues
brings. I just refuse to dwell on it until I know what I am dealing with. Yeah...I know sticking my head in the sand.

Billye

optimistic
 

"When you hear hoofbeats, think of horses."

When a patient's been on MTX, think of osteoporosis. When they are known to have osteoporosis, think of osteoporosis when they have fractures.

Don't think of zebras. Myeloma, osteosarcoma--these are zebras.

Nothing indicates it and I'm very optimistic for you.

J Endocrinol Invest. 2007 Jul-Aug;30(7):590-7.

Looking beyond low bone mineral density: multiple insufficiency fractures in a woman with post-menopausal osteoporosis on alendronate therapy.

Lee P, van der Wall H, Seibel MJ.

Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, The University of Sydney, Sydney Concord, NSW 2139, Australia. pcylee@gmail.com

Insufficiency fractures occur most commonly in the pelvic girdle and in the sacrum, followed by the tibia and the femoral neck. Insufficiency fractures of the femoral diaphyses are rare, with only few reported cases in the literature. The strongest associations exist with untreated osteoporosis. We describe an unusual case of multiple insufficiency fractures in a 73-yr-old Chinese woman who presented with a 10-month history of bilateral groin pain and difficulty with walking in the absence of trauma, diagnosed 18 months following the commencement of anti-resorptive therapy with alendronate. The pathogenesis of such insufficiency fractures is poorly understood, but next to low bone mineral density and micro-architectural damage likely involves other components such as changes in bone turnover and patient-related factors (e.g. non-compliance). This case report and review of the literature draws attention to some of the challenges in the diagnosis and management of such rare insufficiency fractures.


2: J Bone Miner Metab. 2007;25(5):333-6. Epub 2007 Aug 25.

Pelvic insufficiency fracture associated with severe suppression of bone turnover by alendronate therapy.

Imai K, Yamamoto S, Anamizu Y, Horiuchi T.

Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Medical Center, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan. imaik-ort@umin.ac.jp

Publication Types:

* Case Reports


PMID: 17704999 [PubMed - indexed for MEDLINE]

3: Joint Bone Spine. 2005 Oct;72(5):372-5.

Osteoporotic fractures of the proximal humerus, pelvis, and ankle: epidemiology and diagnosis.

Guggenbuhl P, Meadeb J, Chalès G.

Rheumatology Department, Rennes Teaching Hospital, South Hospital, 16 Bd de Bulgarie, 35203 Rennes cedex 2, France. pascal.guggenbuhl@chu-rennes.fr

Although fractures involving the wrist, spine, and proximal femur are known to be strongly associated with osteoporosis, the underlying bone insufficiency often receives insufficient diagnostic and therapeutic attention. Osteoporosis also increases the risk of fractures at other sites. Low-energy fractures in patients older than 50 years should lead to investigations for osteoporosis, the only exceptions being fractures of the skull, cervical spine, fingers, and toes. The incidence rates of fractures of the proximal humerus, pelvis, and ankle are climbing relentlessly. Whereas fractures of the proximal humerus and pelvis are undoubtedly related to osteoporosis, the link is less well established for fractures of the ankle. Mortality and morbidity rates associated with pelvic fractures are similar to those seen with fractures of the proximal femur, in keeping with the fact that both fractures occur in elderly individuals.

Publication Types:

* Review


PMID: 16214070 [PubMed - indexed for MEDLINE]


Mayo Clin Proc. 1988 Aug;63(8):807-12.

Insufficiency fractures of the pelvis that simulate metastatic disease.
Hauge MD, Cooper KL, Litin SC.

Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL 32224.

Insufficiency fractures of the pelvis, which almost always occur in elderly women with osteoporosis, are often misinterpreted as metastatic disease. The initial symptom of such fractures is severe pain unassociated with an obvious history of trauma. The typical sites of involvement are the sacrum, the iliac bones, and the pubis. The plain film appearance of the sacral and iliac fractures is usually subtle and easily overlooked, and bone scans will show the abnormal areas more readily. The existence of multiple fractures not only in the pelvis but also in the vertebrae and ribs should suggest the diagnosis of insufficiency-type stress fractures. Computed tomography can exclude the presence of a destructive process and an associated soft tissue mass, as would be seen in metastatic disease. If insufficiency fractures are identified in the typical anatomic locations, bone biopsy is unnecessary.


1: J Clin Densitom. 2000 Summer;3(2):203-6.

Osteolysis of the pelvis presenting as insufficiency fracture in a patient with rheumatoid arthritis.
Duston M.

mduston@Actel.net.

Physician awareness of the risk of osteoporosis and subsequent fractures in a patient with a history of long-term steroid treatment is high. The tendency to assume that a fracture is owing to steroid-induced osteoporosis may result in an unnecessarily intense antiresorptive treatment regimen for a patient who may not have osteoporosis. I report here about a patient with rheumatoid arthritis who presented with bone fracture despite antiresorptive therapy and without evidence of osteoporosis by bone mineral density testing.



Br J Hosp Med. 1995 Jun 21-Jul 11;54(1):15-9.

Insufficiency fractures of the sacrum and os pubis.
Peh WC, Khong PL, Ho WY.

Department of Diagnostic Radiology, University of Hong Kong.

Insufficiency fractures are increasingly seen among postmenopausal women. Sacral fractures are difficult to detect clinically and radiographically, while os pubis fractures may mimic malignancy. Diagnosis is made by bone scintigraphy, supplemented by computed tomography. As patients respond well to conservative management, increased awareness and use of appropriate imaging may avoid unnecessary and invasive investigations.


AJR Am J Roentgenol. 1985 Sep;145(3):601-6

Pubic and sacral insufficiency fractures: clinical course and radiologic findings.

De Smet AA, Neff JR.

Distinctive vertical insufficiency fractures of the pelvis were found in nine osteopenic patients. Each patient had subacute pelvic pain without antecedent trauma. The sacral fractures healed fairly quickly, but the pubic fractures often had a protracted course. Eight patients had combined sacral and pubic fractures; one had only sacral alar fractures. In three patients the sacral fractures preceded the pubic fractures by 3-4 months. All nine patients had skeletal demineralization due to metabolic bone disease, radiation therapy, or multiple myeloma. Recognition of the association between pubic and sacral insufficiency fractures should aid in recognizing the diffuse nature of the skeletal disease so that unnecessary biopsy of the fracture sites can be avoided.





J Manipulative Physiol Ther. 1994 Sep;17(7):485-8.

Pelvic insufficiency fracture simulating metastatic bone disease.
Stern PJ, Côté P, Dust W.

Canadian Memorial Chiropractic College, Toronto, Ontario.

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.



J Radiol. 1986 Oct;67(10):741-4.
[Spontaneous fracture of the sacrum due to "insufficiency". An overlooked cause of low lumbago in elderly women]
[Article in French]

Guilbeau JC, Arrivé L, Maurice F, Nahum H.

A case of insufficiency fracture of the sacrum is reported. These fractures usually occur in elderly women and are secondary to various conditions, mainly postmenopausal or steroid-induced osteoporosis and radiation therapy. They are often overlooked or confused clinically and radiographically with metastatic disease. Findings on plain films are often subtle. Radionuclide bone scan shows a characteristic H or butterfly shaped pattern of increased uptake in the sacral alae. The diagnosis is confirmed by conventional tomograms or CT which show the fracture always surrounded by prominent sclerosis.

Agreed--
 

--as I mentioned, if you had a bone marrow condition that was contributing to this, there probably would have been some blood test signs that would have pointed in that direction.

On the other hand, many of us here are not only zebras, but quaggas (google that one up).

I suspect that there is something about what's currently going with you on that is related to abnormal calcium/vitamin D absoprtion/processing, and that generally makes one suspect drug interaction, or hormonal insuficiency, first.

My Goodness Liza Jane!
 

You've been busy girl!!! Thanks for all the articles. I thought I'd print them out for the ortho PA. I think she has some things to learn. And knowing her, she'd be willing to learn.

I called, asked for and got my test results this morning. Reading them myself, I believe I'm in the clear for bone cancer. They show significant arthritic activity and lots of breaks. But some of the breaks seem to be healing. So I guess I'm doing something right. I will still meet with the doctor and PA on Friday and get the official results and see if they have any more suggestions.

Many, many thanks for all the good wishes, research, love and support. You are all a super group of friends to have! :hug:

Billye

i have to say that the way you handle these things and problems that come up really impresses me. Im sure you have your moments but you handle them much better than i would.

Billye you resisted the bone Biopsy may I ask why ?? Thanks Sue

Just me..
 

Joe,
It's just me. I've had so very much happen to me in my lifetime. You all wouldn't believe my life. It's a real soap opera. I learned to bounce when I fell. I was 28 years old. That's when the soap opera started. One of our local doctor's made the comment that I held my family together and did it all in spite of enormous odds. Long story. Another time maybe. It's all just the way I cope with things.

Anyway, Shiney Sue, there were no indications that there was anything warranting the bone biopsy. And they are terribly terribly painful and difficult to heal for someone in my shoes. So I said no.

Again, thank you all for all of the support. You are part of my family.

Billye