Study: Bone Risks Lower with NSS

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Osteoporosis and fractures are significantly more likely to occur in patients undergoing radical nephrectomy (RN) than nephron-sparing surgery (NSS), researchers concluded.

Patients treated with RN have a 2.6 times and 5.3 times increased risk of osteoporosis and fracture, respectively, compared with those undergoing NSS.

Writing in Urology (2011;78:614-619), the researchers, led by Ithaar Derweesh, MD, of the University of California at San Diego School of Medicine in La Jolla, concluded that preoperative patient bone health is another factor with which the urologist should be familiar when counseling patients for radical versus partial nephrectomy and in follow-up visits.

In a retrospective study of 905 renal surgery patients with a mean age of 57.5 years and a mean follow-up of 6.4 years, Dr. Derweesh's group compared 610 patients who underwent RN and 295 who underwent NSS. Osteoporosis developed in 22.6% of RN patients compared with 12.5% of NSS patients. Fractures occurred in 9.8% of RN patients versus 4.4% of NSS patients.

In addition, female gender, Caucasian race, a preoperative estimated glomerular filtration rate below 60 mL/min/1.73 m2, and preoperative metabolic acidosis were associated with the development of osteoporosis post-operatively. Osteoporosis was 1.8 times more likely to develop in women than men, 2.3 times more likely to develop in Caucasians than in African Americans, three times more likely to develop in patients with an eGFR below 60 than in those with a higher eGFR, and 4.2 times more likely to develop in patients with metabolic acidosis than in those without the condition.

“Our findings demonstrate that renal surgery significantly impacts renal function, acid-base homeostasis and bone turnover—and consequently, fractures—and that NSS can mitigate this impact,” the authors wrote.

In an accompanying editorial commenting on the study, Michael L. Blute, MD, of the University of Massachusetts Medical School in Worcester observed: “Although hypothesis generating and requiring additional validation in prospective cohorts, these data provide additional evidence of the importance of considering the noncancer impact of renal surgery on patient outcome and quality of life.

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