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<i>Summary</i> <p>We conducted a comprehensive fracture risk assessment in 112 men with urinary diversion (UD) after radical cystectomy, integrating bone mineral density (BMD), trabecular bone score (TBS), and FRAX®. A substantial proportion met the diagnostic criteria for osteoporosis or had lower TBS values. These findings support routine skeletal assessment during follow-up.</p> Purpose <p>Patients undergoing radical cystectomy with UD face an increased risk of fracture; however, this aspect remains poorly investigated. We aimed to provide an integrated evaluation of skeletal health and fracture risk in men with UD.</p> Methods <p>We conducted a cross-sectional study of 112 men (mean age 70.6 ± 7.98&#xa0;years; range 50–83) with ileal UD. BMD was measured using DXA, TBS was obtained from lumbar spine DXA images, and 10-year fracture risk was estimated using FRAX®. Logistic regression was used to identify predictors of osteoporosis and lower TBS values.</p> Results <p>Osteoporosis was identified in 32.1% of patients, and 40.2% were classified in the lowest TBS category (TBS &lt; 1.23). Only 12.5% had normal results for both BMD and TBS. Median FRAX-MOF was 3.9% (IQR 2.7–6.05) without BMD, 5.3% (2.98–7.82) with BMD, and 5.8% (3.4–9.5) when adjusted for TBS. Median FRAX-HIP was 1.35% (0.7–2.78), 1.8% (0.9–4.55) with BMD, and 2% (1–5.2) with TBS adjustment. Age (per year, OR = 1.11, 95% CI 1.02–1.20; <i>p</i> = 0.012) and BMI (per kg/m<sup>2</sup>, OR = 0.73, 95% CI 0.62–0.86; <i>p</i> &lt; 0.001) were independently associated with osteoporosis, while serum creatinine (per mg/dL, OR = 2.11, 95% CI 1.08–4.11; <i>p</i> = 0.028), BMI (per kg/m<sup>2</sup>, OR = 0.91, 95% CI 0.83–0.99; <i>p</i> = 0.041), and prior fracture (OR = 5.23, 95% CI 2.08–13.13; <i>p</i> &lt; 0.001) were associated with TBS &lt; 1.23. Metabolic acidosis was not associated with adverse skeletal outcomes or higher FRAX estimates.</p> Conclusions <p>Men with ileal UD showed reduced bone mass and a notable proportion of low TBS values, consistent with increased skeletal fragility and fracture risk. Structured bone health assessment should be considered during routine follow-up.</p>

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Fracture risk assessment in patients with ileal urinary diversion after radical cystectomy: a comprehensive evaluation integrating bone mineral density, trabecular bone score, and FRAX®

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  • 发表日期：

    2026年3月11日

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  • Arturo Domínguez,
  • Enrique Casado,
  • Jesús Muñoz-Rodríguez,
  • Joan Prats,
  • María Laura Grubicy,
  • Núria Masip,
  • Cristina Piqué,
  • Clara Centeno,
  • Teresa Bonfill,
  • Diana Fuertes,
  • Xavier Serra-Aracil

摘要

Summary

We conducted a comprehensive fracture risk assessment in 112 men with urinary diversion (UD) after radical cystectomy, integrating bone mineral density (BMD), trabecular bone score (TBS), and FRAX®. A substantial proportion met the diagnostic criteria for osteoporosis or had lower TBS values. These findings support routine skeletal assessment during follow-up.

Purpose

Patients undergoing radical cystectomy with UD face an increased risk of fracture; however, this aspect remains poorly investigated. We aimed to provide an integrated evaluation of skeletal health and fracture risk in men with UD.

Methods

We conducted a cross-sectional study of 112 men (mean age 70.6 ± 7.98 years; range 50–83) with ileal UD. BMD was measured using DXA, TBS was obtained from lumbar spine DXA images, and 10-year fracture risk was estimated using FRAX®. Logistic regression was used to identify predictors of osteoporosis and lower TBS values.

Results

Osteoporosis was identified in 32.1% of patients, and 40.2% were classified in the lowest TBS category (TBS < 1.23). Only 12.5% had normal results for both BMD and TBS. Median FRAX-MOF was 3.9% (IQR 2.7–6.05) without BMD, 5.3% (2.98–7.82) with BMD, and 5.8% (3.4–9.5) when adjusted for TBS. Median FRAX-HIP was 1.35% (0.7–2.78), 1.8% (0.9–4.55) with BMD, and 2% (1–5.2) with TBS adjustment. Age (per year, OR = 1.11, 95% CI 1.02–1.20; p = 0.012) and BMI (per kg/m2, OR = 0.73, 95% CI 0.62–0.86; p < 0.001) were independently associated with osteoporosis, while serum creatinine (per mg/dL, OR = 2.11, 95% CI 1.08–4.11; p = 0.028), BMI (per kg/m2, OR = 0.91, 95% CI 0.83–0.99; p = 0.041), and prior fracture (OR = 5.23, 95% CI 2.08–13.13; p < 0.001) were associated with TBS < 1.23. Metabolic acidosis was not associated with adverse skeletal outcomes or higher FRAX estimates.

Conclusions

Men with ileal UD showed reduced bone mass and a notable proportion of low TBS values, consistent with increased skeletal fragility and fracture risk. Structured bone health assessment should be considered during routine follow-up.