- Design
- Nationwide register-based matched cohort, Sweden
- Population
- 2,908 radical cystectomy patients and 13,669 matched referents
- Primary outcome
- Femoral fracture, any fracture and start of bone drug therapy
- Effect
- Women: any fracture HR 2.06 (95% CI 1.54–2.76); men: HR 1.51 (1.22–1.88)
This nationwide Swedish register study compared 2,908 patients who had radical cystectomy with urinary diversion between 2011 and 2019 with 13,669 matched people from the general population, accounting for competing risk of death.
Women who had cystectomy had about twice the risk of femoral fracture (HR 1.97, 95% CI 1.25 to 3.10) and of any fracture (HR 2.06). Men had a smaller rise in any fracture (HR 1.51). Despite this, cystectomy patients were no more likely to start bone-protective drugs. Men treated with curative radiotherapy instead also had more fractures, suggesting the cancer and its treatment both contribute.
Urinary diversion can cause metabolic acidosis and bone loss, and these patients are often older, frail and have had chemotherapy. The finding is a prompt to treat bone health as part of survivorship. The study is observational and could not measure bone density or acidosis directly.
- Assess fracture risk and bone health after radical cystectomy with urinary diversion, particularly in women.
- Check bicarbonate periodically after diversion and treat chronic acidosis.
- Consider bone density assessment and treatment according to osteoporosis guidance.
- Advise on falls prevention, vitamin D and calcium as part of survivorship care.
- Share the fracture risk with the patient's GP in the discharge summary.
Why it matters
A higher fracture risk went with no rise in bone treatment, which is a gap in survivorship care.
Don't overread it
This was observational; it cannot separate the effect of diversion from that of cancer, age and frailty.
The statistics, in plain English
A hazard ratio of 2.06 means women after cystectomy had fractures at about twice the rate of matched women from the general population. Because this is observational, the excess may reflect frailty and other illness as well as the operation.
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