Pelvic insufficiency fractures in the elderly - what insights has the past year of research brought? A narrative review.

Pelvic insufficiency fractures (PIFs) are low-energy fractures typically occurring in osteoporotic bone and are associated with significant morbidity, reduced quality of life, and increased mortality. PIF requires individualized, often interdisciplinary treatment strategies combining surgical, conservative, and systemic approaches. This narrative review aims to summarize recent findings on the diagnosis, management, and outcomes of PIFs and place them in the context of existing literature. For this purpose, a selective literature search was conducted in January 2025 to identify publications on the topic of PIFs. The search was performed on PubMed and clinical studies addressing the diagnosis, treatment, outcomes and complications of PIFs from January 2024 to 2025 were selected for evaluation. A total of 11 studies with a total of 27,672 patients were included in this review. The findings emphasise the significant morbidity, mortality and healthcare burden associated with these fractures. Conventional radiography frequently fails to detect this type of fracture, thus necessitating advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) to ensure an early diagnosis. The treatment decision is determined by the stability of the fracture, presence and intensity of pain, and the patient's mobility levels. The treatment options, whether conservative or surgical, are adapted to these factors. The osteoporotic fracture (OF) Pelvis Score has emerged as a promising tool for guiding therapeutic strategies, though there is still potential for further development in the use of pharmaceutical treatment of underlying conditions such as osteoporosis. Despite the advances that have been made, the existing literature remains heterogeneous, underscoring the importance of conducting prospective studies and developing evidence-based guidelines. Interdisciplinary and orthogeriatric care is important for improving outcomes for this vulnerable patient group.