Multidisciplinary team approach for CKD-associated osteoporosis.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: D.H. reports research grant from Vifor Pharma and Gedeon Richter and consultancy fees and lecture fees from UCB Nordic, GSK and AstraZeneca. A.C.F. reports lecture fees from Vifor and AstraZeneca. R.J. received fees as site PI in a pharmacy-initiated study (SHP634-401) of Takeda. S.K. reports consultancy fees from Vifor Pharma, GSK and Bayer, and lecture fees from AstraZeneca. M.H.L.-P. reports research grant from Kiowa Kirin. K.E.S.P. educational fora lecture fees and honoraria from UCB and Amgen, with all fees donated to charity via waiver before undertaking the work. P.E. reports research grant from Vifor Pharma, and consultancy fees and lecture fees from UCB and Vifor Pharma. M.H. advisory board Resverlogix and employee at Diaverum AB. H.S.J., T.L.A., A.F., H.K., L.M., and X.T. report no conflicts of interest. 3. Radiologe. 2020 Jun;60(6):498-505. doi: 10.1007/s00117-020-00693-3. [Radiologic diagnosis of pathologic fractures]. [Article in German] Wuennemann F(1), Kintzelé L(2), Weber MA(3), Kauczor HU(2), Rehnitz C(2). Author information: (1)Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. felix.wuennemann@med.uni-heidelberg.de. (2)Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. (3)Institut für diagnostische und interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland. BACKGROUND: Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. OBJECTIVES: This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. MATERIALS AND METHODS: A PubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". RESULTS: The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described. DOI: 10.1007/s00117-020-00693-3