What Are Sacral Insufficiency Fractures and Who’s at Risk?

Stress fractures known as sacral insufficiency fractures are more common in the elderly, particularly in those who were born with osteoporosis and are allocated to a female skeleton.

Our bodies and organs, especially our bones, alter as we get older. Even with regular physical activity, our bones might weaken and become more prone to breaking or fractures.

An example of a stress fracture that results from normal tension on a bone that no longer has elastic resistance is an insufficiency fracture. A sacral insufficiency fracture is a type of fracture that affects the sacrum, which is the pelvic bone that sits at the base of the lumbar vertebrae.

Although the precise prevalence is unknown, 1.8% is suggested; nevertheless, it is believed that this may be an underestimate because of underdiagnosis.

The symptoms, aetiology, and management of sacral insufficiency fractures are examined in more detail in this article.

Language matters

In this article, "female" refers to a person's chromosomally determined sex.

Chromosomes determine sex, but gender is a social construct that varies among cultures and historical times. Both historically and by the agreement of contemporary science, both of these aspects are recognised to exist on a continuum.

What are the symptoms of a sacral insufficiency fracture?

Diffuse low back pain that improves with rest and gets worse with movement is the most typical sign of a sacral insufficiency fracture. Occasionally, the hip, groyne, or buttocks may also get affected by this ache.

Though not usually, there could also be some lower back soreness to the touch. Sacral radiculopathy, or discomfort along the sciatic nerve, is a rare occurrence that affects 5-6% of patients.

The symptoms of a sacral insufficiency fracture might occasionally go unnoticed because they are misinterpreted as signs of a common ageing body ailment or as a potential metastatic disease.

What causes a sacral insufficiency fracture and who’s at risk?

Fractures due to sacral insufficiency are more common as we age because our bones become weaker. These fractures can occur as a result of ordinary stress and activities; a specific physical event, like a fall, is not necessary.

Elderly persons with osteoporosis who were assigned to be female at birth frequently suffer from sacral insufficiency fractures. Osteoporosis is the main cause of bone fractures.

Almost all patients with a sacral insufficiency fracture will have substantial osteopenia on imaging testing, regardless of any risk factors. As to a 2010 study, other risk factors consist of:
  • age greater than 55, and particularly in the 70–75 age range
  • pelvic radiation
  • renal osteodystrophy
  • Paget disease
  • hyperparathyroidism
  • steroid-induced osteopenia
  • rheumatoid arthritis
  • multiple myeloma
It's important to keep in mind that having one of these disorders does not guarantee that a person will experience a sacral insufficiency fracture. These elements merely raise the possibility that one will occur.

How are sacral insufficiency fractures treated?

Sacral insufficiency fractures are typically treated with noninvasive techniques such as:
  • bed rest
Early in the healing process, physical therapy is initiated to reduce the risk of:
  • blood clots
  • pressure sores
  • adverse emotional consequences of extended bed rest
  • opioids and nonsteroidal anti-inflammatory medications (NSAIDs) are examples of pain medicine
Drugs that stop bone loss, such as:
  • vitamin D
  • bisphosphonates
  • calcium supplementation
Percutaneous sacroplasty is one type of surgical repair that is considered more invasive. A type of bone cement is injected into the damaged sacral wing during a minimally invasive procedure called percutaneous sacroplasty.

This method has been linked to reduced opioid use for pain, improved mobility, and symptom reduction as compared to noninvasive treatment.

According to a 2019 analysis, sacroplasty is a low-risk, highly effective technique that consistently relieves pain in patients with sacral insufficiency fractures and has minimal rates of complications.

How long does it take to recover from a sacral insufficiency fracture?

The length of recovery and healing periods varies based on the severity of the fracture as well as additional factors such as:
  • the fundamental cause of the fracture
  • the person's general state of health
  • ailments that could compromise bone strength or repair
  • reaction to the medication
In the past, three to six months of total bed rest was advised. However, given the hazards of extended bed rest, this is no longer advised.

When sacroplasty is used as a treatment, symptoms go away fast. A case study conducted in 2019 discovered:
  • a 60% decrease in discomfort throughout the first 30 minutes after the operation
  • a 75% decrease after four weeks
  • 90% less after a year
Following a sacroplasty, recovery may take many months. Consult a physician about your circumstances and the expected course of recovery, taking into account the chosen course of therapy.


Stress fractures such as sacral insufficiency fractures are more common in the elderly, particularly in women who have been born with osteoporosis. Individuals with radiation therapy to the pelvis are also susceptible to fractures.

Certain symptoms are hard to pin down, like lower back pain that may or may not radiate down the leg or buttock. Individuals frequently write off the discomfort as the aches and stiffness that come with ageing, which can cause delays in both diagnosis and treatment.

Sacral insufficiency fractures can be treated with a combination of minimally invasive techniques and more invasive surgical methods, such as sacroplasty. Although recovery times vary, they are often several months.


How is a sacral insufficiency fracture treated?

Sacroplasty is a safe and effective technique for the treatment of sacral insufficiency fractures

Do insufficiency fractures heal?

most younger patients will heal on their own with rest and time

Is a sacral fracture serious?

If a fracture is severe or affects nerves, you may need surgery

Is sacral insufficiency fracture a fragility fracture?

Fragility fractures of the sacrum (FFS, synonym: sacral insufficiency fractures, osteoporotic sacral fractures)

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