Radiotherapy is a commonly used modality in pelvic malignancies such as prostate, gastrointestinal, or gynecological, either as a primary treatment or an adjuvant post-surgery. Despite its positive impact on the prognosis of these patients, it was found in several studies that it contributes to insufficiency fractures in different sites of the pelvis, more commonly in the sacral ala. This is particularly true for elderly patients. There are several hypotheses on how radiotherapy affects bone health, as it destroys the bone matrix and causes obliterative vasculitis. Several imaging techniques, particularly magnetic resonance imaging (MRI), help detect the radiotherapy-induced fracture and distinguish it from metastases. Some modalities, such as intensity-modulated radiotherapy (IMRT) and brachytherapy, have decreased fracture risk by escaping the adjacent structures to the targeted organ. Pharmacological interventions such as amifostine and desferrioxamine are promising in terms of bone protection, which necessitates further studies to confirm their mechanism of action.

Mohamed Elgendy currently a junior clinical fellow trauma and orthopedics in Bolton NHS trust and will start a new job as an orthopedic registrar in royal Shrewsbury hospital. He have 3 publications. I delivered 2 oral presentations before; He in British Orthopedic Sports Trauma and Arthroscopy Association in November 2023 and one in University of Lancashire, Preston in May 2024. He has full MRCS and have got the core surgical training comptenencies signed off.