944 RISK AND PREDICTORS OF FRACTURES AFTER RADICAL CYSTECTOMY AND URINARY DIVERSION

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You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010944 RISK AND PREDICTORS OF FRACTURES AFTER RADICAL CYSTECTOMY AND URINARY DIVERSION Amit Gupta, Elena Elkin, Nicole Ishill, Shahrokh Shariat, Harry Herr, and Farhang Rabbani Amit GuptaAmit Gupta More articles by this author , Elena ElkinElena Elkin More articles by this author , Nicole IshillNicole Ishill More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Harry HerrHarry Herr More articles by this author , and Farhang RabbaniFarhang Rabbani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1823AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer patients who undergo cystectomy may be at high risk of developing fractures due to comorbid conditions and chronic acidosis associated with intestinal urinary diversion. We examined the frequency and predictors of fracture in a population-based cohort of Medicare beneficiaries with bladder cancer. METHODS In Surveillance, Epidemiology and Ends Results (SEER) cancer registry data linked with Medicare claims, we identified 5,644 subjects (4,095 men and 1,549 women) who had radical cystectomy and urinary diversion between 1998 and 2007. We estimated the fracture incidence and used multivariable Cox proportional hazards regression analysis to identify predictors of fracture. RESULTS 1,974 patients developed a fracture with a median time to fracture of 51 months after cystectomy. 1,381 patients were alive and fracture free at last follow-up with a median follow-up of 43 months. The overall incidence of fracture was 0.176 fractures per person-year. For men the incidence was 0.142 fractures per person-year, and for women it was 0.295 fractures per person-year. Considering death as a competing risk, the 5-year cumulative incidence of fracture was 28.5% for men and 46.1% for women (figure). In multivariable regression, age (hazard ratio[HR] 1.28 for age>=80 vs 65-69), female gender (HR 2.0), white ethnicity (HR 0.62 for African Americans), higher Charlson comorbidity score (HR 1.5 for >=2 vs 0), presence of lymph node metastasis (HR 1.32), incontinent urinary diversion (HR 1.14) and urban residence (HR 1.4) were associated with a greater risk of fracture (all p<0.05). Bladder cancer stage, grade, receipt of chemotherapy, marital status, census tract median income and SEER registry were not independently associated with fracture risk. CONCLUSIONS Bladder cancer patients who have radical cystectomy and urinary diversion are at high risk for fractures. Older age, female gender, white ethnicity, more comorbidities, lymph node metastasis and incontinent urinary diversion are associated with a greater risk of fracture. Bone preservation and fracture prevention strategies should be considered in this patient population. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e368 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amit Gupta More articles by this author Elena Elkin More articles by this author Nicole Ishill More articles by this author Shahrokh Shariat More articles by this author Harry Herr More articles by this author Farhang Rabbani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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