Radiation-Induced Skeletal Injury

Irradiation of bone kills the cells that are responsible for bone maintenance and remodeling that renders the irradiated bone brittle and prone to injury. Though the incidence of bony injury has become increasingly uncommon with the use of megavoltage radiation and improved planning and radiation delivery techniques, even when careful attention is paid to radiation tolerance, bony injury can occur. Post-irradiation bony injuries include mandibular osteoradionecrosis (MORN), pelvic insufficiency fracture, hip fracture, fracture of long bones, rib fracture, and pediatric growth abnormalities. In this chapter, we will review the incidence, risk factors, techniques for risk reduction, and management of each of these bony radiation injuries.