ArticleJournal of orthopaedic surgery and research2026
Are sacral stress fractures in young women truly rare? a retrospective MRI analysis of 1970 patients.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSacral stress/insufficiency fractures (SSFs) are underrecognized causes of postpartum low-back/pelvic pain and are frequently misattributed to lumbar disc disease. To determine the MRI-based detection rate and clinical/imaging characteristics of SSFs in women aged 18-50 years undergoing lumbosacral MRI, with subgroup analyses for postpartum versus non-postpartum status.
methodsRetrospective review of 2400 lumbosacral MRI examinations (January 2020-December 2024) corresponding to 1970 unique women. SSFs were identified by a fellowship-trained musculoskeletal radiologist. Prespecified exclusions (chronic corticosteroid use, major pelvic trauma, incomplete follow-up) yielded the analytic cohort. Group comparisons reported effect sizes (Hedges' g for continuous; risk difference [RD]/odds ratio [OR] for binary) with 95% CIs.
resultsCrude MRI-based detection rate: 1.52% (30/1,970; 95% CI, 1.07-2.17); analytic MRI-based detection rate: 1.17% (23/1,970; 95% CI, 0.78-1.75). Median age 34 years (range 22-49); 10/23 (43.5%) postpartum. Five cases (21.7%) were initially misdiagnosed. Fractures most often involved the sacral ala (right 12, left 10, bilateral 1). Compared with non-postpartum patients, postpartum patients had lower hemoglobin (**11.5 vs 12.6 g/dL; p = 0.007; Hedges' g = 1.21, 95% CI 0.34-2.09) and hematocrit (**33.9% vs 37.3%; p = 0.007; g = 1.21, 95% CI 0.34-2.09); vitamin D was lower but nonsignificant (**15.4 vs 20.3 ng/mL; p = 0.204; g = 0.53, 95% CI - 0.28-1.34). Overall vitamin D status (n = 21): deficient < 20 ng/mL 11/21 (52.4%), insufficient 8/21 (38.1%), sufficient ≥ 30 ng/mL 2/21 (9.5%). The reported frequency reflects an MRI-based detection rate within a selected cohort of symptomatic women undergoing lumbosacral MRI and should not be interpreted as the true population prevalence of sacral stress fractures.
conclusionSacral stress fractures in young women, particularly in the postpartum period, may be underrecognized in symptomatic patients presenting with persistent low-back or pelvic pain. Overlapping symptoms with common musculoskeletal complaints during and after pregnancy often lead to diagnostic delays. MRI remains the gold standard for early detection. Increased clinical vigilance is crucial for prompt diagnosis and effective, non-surgical management.
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