{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:45:32Z","timestamp":1791492332318,"version":"4.3.4"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Radiotherapy (RT) brings a broad spectrum of side effects that could affect patient well-being. Pelvic insufficiency fractures (PIF) are one of them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>The aim of our study was to identify easily detectable risk factors for radiation-related PIF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Prospective, single-center study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included 104 patients aged 52.9\u2009\u00b1\u200913.8\u2009years following radical RT for advanced cervical cancer. Patients underwent a pretreatment computed tomography (CT) imaging and a minimally 1-year follow-up by CT or magnetic resonance imaging. We evaluated the association between pretreatment CT attenuation values of L1, their deviation from normative values, age, body mass index, total received radiation dose, smoking habits, and radiation-related bone side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In 28 (26.9%) patients PIF were found and first detected at a mean of 16\u2009\u00b1\u20097\u2009months after RT. Patients with PIF were significantly older; 62.5\u2009\u00b1\u200910.2 versus 49.4\u2009\u00b1\u200912.6\u2009years,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&gt;\u20090.001; their pretreatment CT L1 attenuation values were significantly lower; 117.5\u2009\u00b1\u200946.9\u2009HU versus 165.9\u2009\u00b1\u200944.8\u2009HU,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001, as well as more negative deviation from normative values. Age and L1 attenuation values were strongly correlated,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001, precluding separation of their independent effects on PIF occurrence. According to logistic regression modeling, a 50-year-old woman had an estimated 16.3% probability of PIF (95% CI [8.6%; 25.9%]); the associated odds ratio increased by approximately 182% [72%; 357%] per 10-year increase in age. Thus, the estimated probability of PIF increased to 34.1% for a 60-year-old and 58.0% for a 70-year-old woman. The pretreatment CT attenuation values of 100\u2009Hounsfield units (HU) were associated with a 51.1% probability of PIF (95% CI [36.2%; 66.5%]), and the probability decreased at higher attenuation values (odds ratio 0.766 [0.663; 0.865] per 10-HU increment). No other variables showed significant associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Increasing age and lower pretreatment CT L1 attenuation values are strong predictors for radiation-related PIF, reflecting osteoporosis status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057261426799","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T17:48:51Z","timestamp":1772128131000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pretreatment computed tomography L1 attenuation values: Easy reaching predicting factor for radiation-related bone insufficiency fractures in females treated for advanced cervical cancer (prospective study)"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-1347","authenticated-orcid":false,"given":"Hana","family":"Malikova","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2446-6775","authenticated-orcid":false,"given":"Klaudia","family":"Graffneter","sequence":"additional","affiliation":[{"name":"Department of Oncology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5546-1136","authenticated-orcid":false,"given":"Karin","family":"Kremenova","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6094-7584","authenticated-orcid":false,"given":"Romana","family":"Burgetova","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-4945","authenticated-orcid":false,"given":"Viktor","family":"Laskov","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1082-229X","authenticated-orcid":false,"given":"Jiri","family":"Lukavsky","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3770-651X","authenticated-orcid":false,"given":"Lukas","family":"Rob","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13865"},{"key":"e_1_3_3_4_2","first-page":"77","article-title":"Effects of radiotherapy upon bone structure-strength relationships vary with sex and fractionation of dosing","volume":"43","author":"Sakyi MY","year":"2023","unstructured":"Sakyi MY, Miller BJ, Coleman MC, et al. Effects of radiotherapy upon bone structure-strength relationships vary with sex and fractionation of dosing. Iowa Orthop J 2023; 43: 77\u201386.","journal-title":"Iowa Orthop J"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-024-03099-8"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.12356"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.21037\/qims-20-553"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/pore.2021.1609915"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14080810"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019181648"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v080.i01"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.32614\/RJ-2018-017"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v100.i05"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-8-201304160-00003"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32807"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-020-01690-0"},{"key":"e_1_3_3_18_2","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijrobp.2012.03.042","article-title":"Insufficiency fractures after pelvic radiation therapy for uterine cervical cancer: an analysis of subjects in a prospective multi-institutional trial, and cooperative study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)","volume":"84","author":"Tokumaru S","year":"2012","unstructured":"Tokumaru S, Toita T, Oguchi M, et al. Insufficiency fractures after pelvic radiation therapy for uterine cervical cancer: an analysis of subjects in a prospective multi-institutional trial, and cooperative study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG). Int J Radiat Oncol Biol Phys 2012; 84: e195\u2013e200.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/1206235"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24811"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00933-4"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.10.008"},{"key":"e_1_3_3_23_2","first-page":"30","article-title":"Comparative assessment of late toxicity in patients of carcinoma cervix treated by radiotherapy versus chemo-radiotherapy\u2014minimum 5 years follow up","volume":"14","author":"Misra S","year":"2018","unstructured":"Misra S, Lal P, Kumar Ep S, et al. Comparative assessment of late toxicity in patients of carcinoma cervix treated by radiotherapy versus chemo-radiotherapy\u2014minimum 5 years follow up. Cancer Treat Res Commun 2018; 14: 30\u201336.","journal-title":"Cancer Treat Res Commun"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/jimaging9100209"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12030671"}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057261426799","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17455057261426799","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057261426799","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:30:34Z","timestamp":1777710634000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17455057261426799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":24,"alternative-id":["10.1177\/17455057261426799"],"URL":"https:\/\/doi.org\/10.1177\/17455057261426799","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"article-number":"17455057261426799"}}