Are sacral stress fractures in young women truly rare? a retrospective MRI analysis of 1970 patients
Abstract
Background: Sacral 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.
Methods: Retrospective 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.
Results: Crude 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 -…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,970 participants or records.
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