Posttraumatic osteolysis of the pubic bone simulating malignancy

Posttraumatic osteolysis (PO) of the os pubis is a diagnostic entity characterized at radiography by rapidly progressing destructive changes in fractures of the pubic body or rami. Fourteen patients with PO are here reported of whom in 8 the radiographic course of the condition was followed. They were all post-menopausal women and 7 were predisposed to osteopenia. The primary fractures were related to mild trauma in 7 patients and 7 had insufficiency fractures. Four patients had bilateral symmetrical PO. All 14 patients had concomitant insufficiency fractures of the sacrum observed at radiography, CT, scintigraphy or MR, probably due to pelvic instability caused by the PO of the os pubis. Symptoms of the sacral fractures usually dominated the clinical condition. Bony healing of the PO did not occur in any of the patients, but in all 8 patients followed radiographically, the fractures of the sacrum healed clinically and at CT. Knowledge about the condition is important to avoid unnecessary biopsy of the PO considered a metastatic lesion and/or extensive diagnostic search for a primary tumor.