title: Sacral insufficiency fractures: a case of mistaken identity.
abstract: BACKGROUND
  Sacral insufficiency fractures are an important cause of lower back pain in the elderly. Clinically and radiologically, they must be distinguished from osseous metastases, which frequently coexist. To date, no case report has comprehensively explored the full range of diagnostic hurdles and potential pitfalls.
  
  
  METHODS
  We report the case of a 70-year-old Caucasian female who presented to our services with a short history of progressive back pain without any history of trauma. A prior history of breast cancer was noted. Bone scintigraphy was initially reported as consistent with metastatic sacral deposits. Further characterization with magnetic resonance imaging and computed tomography revealed bilateral insufficiency fractures of the sacral alar. The patient responded well to conservative management.
  
  
  CONCLUSIONS
  To avoid misdiagnosis, particularly in those who are also at risk of osseous metastases, sacral insufficiency fractures must always be considered as a cause of lower back pain.
authors.affiliation: Oxford Deanery, Oxford, UK.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Baldwin
authors.affiliation: Oxford Deanery, Oxford, UK.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Tucker
keywords: insufficiency fractures; metastatic disease; misdiagnosis; sacral fractures