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

## TL;DR

This study evaluates fracture risk in men with ileal urinary diversion after cystectomy, finding many have weakened bones and higher fracture risk.

## Contribution

The study integrates BMD, TBS, and FRAX® to assess fracture risk in a poorly investigated patient group.

## Key findings

- 32.1% of patients had osteoporosis, and 40.2% had low trabecular bone scores.
- Age and BMI were significant predictors of osteoporosis and low TBS values.
- Structured bone health assessments are recommended for routine follow-up in these patients.

## Abstract

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.

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s11657-026-01685-x.