Insufficiency Fractures After Radiation Therapy: An Update

Purpose of Review: Radio therapy, alone or in combination with surgery and/or chemotherapy, is commonly used to treat a variety of neoplasms, resulting in effective local tumor control. Unfortunately radiation therapy can also change the structure of the skeletal system, leading to edema, vascular congestion, areas of hemorrhage, loss of cellularity, focal bone marrow changes, fatty transformation, osteitis, hematopoietic marrow regeneration, osteolysis of symphysis pubis or sacroiliac joints, avascular necrosis, insufficiency fractures, osteoradionecrosis, and radiation-induced neoplasms. Recent Findings: The various radiotherapy effects can be studied and diagnosed by analyzing MR signal intensity, CT attenuation, and FDG-PET activity. Summary: In this review, we report a complete analysis of side effects of radiotherapy on bones, focusing on the spine, chest wall, and pelvis.