Archives of Osteoporosis · Mar 11, 2026

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

By Domínguez A, Casado E, Muñoz-Rodríguez J et al.

UNLABELLED: 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.

doi.org/10.1007/s11657-026-01685-x Open access PubMed 41814044 Biomarkers