title: Comparison of rates and risk factors for development of osteoporosis and fractures after radical or partial nephrectomy.
abstract: OBJECTIVE
  To examine incidence of and risk factors for development of osteoporosis and fractures in patients who underwent radical nephrectomy (RN) and partial nephrectomy (NSS), as osteoporosis is an important cause of morbidity in chronic kidney disease.
  
  
  METHODS
  This was a retrospective review of 905 patients (mean age 57.5 years, mean follow-up 6.4 years) who underwent RN or NSS for renal tumors at 2 institutions from July 1987 to June 2007. Demographics, renal function, metabolic parameters, and history of preoperative and postoperative osteoporosis and fractures were recorded. Data were analyzed within subgroups based on treatment (RN vs NSS). Multivariate analysis was conducted to elucidate risk factors for developing osteoporosis following surgery.
  
  
  RESULTS
  A total of 610 patients underwent RN and 295 underwent NSS. Tumor size (cm) was significantly larger for RN (RN 7.0 vs NSS 3.7, P<.0001). No significant differences were noted with respect to demographic factors and preoperative osteoporosis (RN 8.7% vs NSS 9.5%, P=.785) and fractures (RN 1.7% vs NSS 0.7%, P=.382). Postoperatively, significantly less osteoporosis (NSS 12.5% vs RN 22.6%, P<.001) and fewer fractures (NSS 4.4% vs RN 9.8%, P=.007) developed in the NSS cohort. MVA demonstrated female (OR 1.85, P=.001), Caucasian (OR 2.33, P<.0001), preoperative eGFR<60 mL/min/1.73 m2, (OR=3.02, P<.0001), preoperative metabolic acidosis (OR=4.22, P=.0006), and RN (OR 2.59, P<.0001) were risk factors for developing osteoporosis.
  
  
  CONCLUSIONS
  Patients undergoing RN had a significantly higher incidence of osteoporosis and fractures compared with a well-matched cohort of patients who underwent NSS. In addition to RN, female gender, Caucasian background, preoperative eGFR<60, and preoperative metabolic acidosis were associated with developing osteoporosis.
authors.affiliation: Moores Cancer Center, University of California, San Diego, Medical Center, La Jolla, CA 92093-0987, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Silberstein
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Omer
authors.initials: O
authors.lastname: Raheem
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wake
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Patterson
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D015502:Absorptiometry, Photon; D000138:Acidosis / Q000209:etiology; D002292:Carcinoma, Renal Cell / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology*; D058866:Osteoporotic Fractures / Q000209:etiology*; D012307:Risk Factors