title: Risk of fracture after radical cystectomy and urinary diversion for bladder cancer.
abstract: OBJECTIVE
  Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture.
  
  
  METHODS
  Population-based study using SEER-Medicare-linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics.
  
  
  RESULTS
  The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage.
  
  
  CONCLUSIONS
  Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture.
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY. drgupta79@gmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Coral L
authors.initials: CL
authors.lastname: Atoria
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
authors.affiliation: Amit Gupta, University of Iowa, Iowa City, IA; Coral L. Atoria, Behfar Ehdaie, Harry W. Herr, Bernard H. Bochner, Elena B. Elkin, Memorial Sloan Kettering Cancer Center, New York, NY; Shahrokh F. Shariat, Medical University of Vienna, Vienna, Austria; Farhang Rabbani, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012306:Risk; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*