Sacral alar and midline sacral insufficienty

@aardvark2118 Did you recently receive that diagnosis? Did you notice any symptoms?

I was diagnosed with a sacral alar and midline sacral insufficiency one year after I finished pelvic radiation for an endometrial cancer recurrence. My radiation oncologist told me prior to radiation therapy that there was a chance my bone density in the lower spine would be affected by external pelvic radiation. I had no symptoms and the fracture was found incidentally in a CT scan. Because of the sacral fracture I was referred to endocrinology and a bone density scan was ordered. Fortunately, I had a bone density scan just prior to starting the external pelvic radiation because I had just finished 4 1/2 years of alendronate medication. Prior to radiation therapy my bone density was in the osteopenia range (I'd have to look up the exact t score). After radiation therapy and with the sacral insufficiency fracture I was back in the osteoporosis range as my bone density had decreased. The endocrinologist recommended that I get Evenity injections for 12 months which I did. My bone density then increased significantly back into the osteopenia range. I had a Reclast infusion within one month of completing the Evenity to lock in the gains. I will have a follow-up exam with my endocrinologist later this year.

By the way, I have had 2 falls since completing the Evenity and Reclast infusion. Both falls happens when I was x-country skiing. I did not experience any fractures with those falls.

When did you receive your diagnosis and what is the recommendation for you?

Hello thank you for responding! I just had a PET/CT this past Wednesday and that was when the fractures were identified. I am 19 months since my last radiation (I had 25 external beam and three brachytherapy). I’ve had lower back and hip discomfort (can’t really call it pain) fir a year and it was felt to be osteopenia. I too had been warned I was at increased risk of fractures but mistakenly thought that meant if I fell. I’m wondering if o haven’t brought this on myself as due to fear of a recurrence and reading that exercise might help prevent a recurrence I have been almost obsessed with walking at least 10,000 steps a day , taking the stairs etc My rad onc has referred me back to my gyn onc to look at bone density meds and I see her April 10 . He also suggested physical therapy and I’ve already been working with them as I had a flare up of pain in my hips since last fall. Took me until late January to get an appointment and they felt the issues with my hip were related to my feet ( I have chemo induced peripheral neuropathy- jeez I sound like a wreck ) but now with this info we’ll be reviewing next week when I see them. He also suggested vitamin D so am waiting to hear from my primary doctor on dose. Sorry this is so long Have to admit cancer seems to be the gift that keeps on giving but so far I am in remission and will be two years in august. Thanks for listening (reading)

I had a pelvic insufficiency fracture 3+ months after completing pelvic ☢️ and brachytherapy. It presented to me as sciatica and I did not connect it with a fall that I had a few weeks prior. I had been diagnosed with osteoporosis years before my cancer diagnosis and was put back on a bisphosonate after the PIF was verified, along with repeated reminders of “Do Not Fall!”
I did get a PT script for balance and now meet with a trainer once a week trying to build my core (to help support my deteriorating spine) and to continue with balance exercises.
You said it so well: Cancer is the gift that keeps on giving.
(I was going to make a list of the permanent effects of treatment, but it was too depressing!)
Hang in.

Hi Folks, bone density scans and results are this topic. I, too have had chemo, internal & external pelvic radiation for gyn cancer. I'd been doing some reading on post treatment effects & bone density / fractures became prominent in my search due to knee strain, wondering if I had bone loss that could've caused sudden change in gait. And I was almost shocked at what I learned, called my 2 cancer DR'S & PCP, asked what I should have checked. DEXA scan.
WOW. We should all get one. Holy cow! But I had no idea the DEX didn't include SACRAL vertebrae. My gosh you get a lot of surprises with these illnesses. So only 4 lumbar are checked lumbar #5 isn't (sits on top of sacrals). On.y L #1-4; included in DEX both right femer neck & rt hip. So only 3 areas checked for DEXA.
I learned lumbar have more bone loss naturally because type of bone, trabecular bone. So they will show greater loss than the other 2 areas overall. Shocking is how soon bone loss starts after treatment- 3mths, 1yr, 2yrs & increased fracture risk. I didn't have a clue.
Still don't know what my sacral or public symphysis look like, & I've read L5 is vulnerable for our group as well given proximity to hazard zone. Supplements recommended for me, & I'll do some specialized gym work - sacral & lumbar anybody? Man, the things you learn!
Ladies, please ask for a DEX scan - and ask doc about those sacrals!

I've read that some people have PIF - pelvic insuffiency fractures- with no symptoms presenting. It's a surprising percentage with no discomfort at all, and problems are seen on different types of scans. After seeing a member report her PIF /SIF were seen on a CT scan I'll ask my doc to revisit last CT & PET to review bones.
I, too have had 3 types of treatments, including about the same # & type of radiation treatments. PIF is considered common with this menu of care, and I'll bet we're a.l surprised.
I wonder if overuse injuries will increase risk and / or make us simply more sore at times than others. That said, discomfort or pain = surveillance. It's a new & odd way to live. But my friends, get those DEX scans, & ask for sacral data - I assume the radiologist SEES more than L 1-4, & that reporting is a convention designed for general use, not cancer care & radiation complications.
And I don't like having to make calls & initiate more medical contact - wanting time away from medical care.

I had osteopenia and osteoporosis before Gyn cancer. A few months after treatment (chemo, external radiation, and brachytherapy) I had back/hip/thigh pain that I thought was sciatica. I mentioned it as a misc. comment to my oncologist at a regularly scheduled appt. Scan results came back saying I had bone metastasis and I freaked, but my oncologist reviewed the images and it was a PIF. This was only 4-5 months after treatment had ended.
I am taking risedronate which, per the last dexascan, has been only minimally helpful. My back has been bothering me so we shall see what the next scan shows.
I did learn from my endocrinologist that some of the stronger osteoporosis/bone building drugs cannot be prescribed until five years after treatment has been completed. My doctors always say, “Do Not Fall!” I have been doing balance and strength exercises (not often enough) and wear practical footwear. Snow & ice are avoided when possible. Cancer is the gift that keeps on giving and the constant reminders sometimes make me sad.
As to not wanting to initiate more medical contact…. I couldn’t agree more!

I had scans this week and have been recalled to visit my GP. I was osteopenic 2 years ago, so asked for it to be done again. In Australia the scans are covered every 2 years.
I have been taking weekly Actonel and vitamin D. I’ve had chemotherapy 8 times (51 cycles) in total. I have malabsorption issues too, due to a Whipples procedure that removed most of my pancreas.
Take each day as it comes. Age doesn’t help either!