Abstract：
BACKGROUND: Patients undergoing radical cystectomy with urinary diversions (UD) are at increased risk of bone fractures compared to the general population. Although a loss of bone mineral density (BMD) has been described in patients with UD, we still do not know with certainty why these patients follow this tendency.
OBJECTIVE: We performed a systematic review of the available literature to analyze the prevalence of osteoporosis and bone alterations in patients with ileal UD and the possible associated risk factors.
METHODS: We systematically searched PubMed® and Cochrane Library for original articles published before December 2022 according to PRISMA guidelines.
RESULTS: A total of 394 publications were identified. We selected 12 studies that met the inclusion criteria with 496 patients included. Six of the twelve studies showed decreased BMD values. Prevalence of osteoporosis was specified in three articles, with values ranging from 0% to 36%. Risk factors such as age, sex, body mass index, metabolic acidosis and renal function appear to have an impact on bone tissue reduction, while type of UD, follow-up, 25-hydroxyvitamin D and parathormone had less evidence or contradictory data. The heterogeneity of the studies analyzed could led to interpretation bias.
CONCLUSIONS: UD are associated with multiple risk factors for osteoporosis and bone fractures. Identifying patients at highest risk and establishing diagnostic protocols in routine clinical practice are essential to reduce the risk of fractures and the resulting complications.
OBJECTIVE: We performed a systematic review of the available literature to analyze the prevalence of osteoporosis and bone alterations in patients with ileal UD and the possible associated risk factors.
METHODS: We systematically searched PubMed® and Cochrane Library for original articles published before December 2022 according to PRISMA guidelines.
RESULTS: A total of 394 publications were identified. We selected 12 studies that met the inclusion criteria with 496 patients included. Six of the twelve studies showed decreased BMD values. Prevalence of osteoporosis was specified in three articles, with values ranging from 0% to 36%. Risk factors such as age, sex, body mass index, metabolic acidosis and renal function appear to have an impact on bone tissue reduction, while type of UD, follow-up, 25-hydroxyvitamin D and parathormone had less evidence or contradictory data. The heterogeneity of the studies analyzed could led to interpretation bias.
CONCLUSIONS: UD are associated with multiple risk factors for osteoporosis and bone fractures. Identifying patients at highest risk and establishing diagnostic protocols in routine clinical practice are essential to reduce the risk of fractures and the resulting complications.
摘要：
背景：与普通人群相比，接受根治性膀胱切除术并改尿（UD）的患者发生骨折的风险增加。尽管已经描述了UD患者的骨矿物质密度（BMD）丢失，我们仍然不确定为什么这些患者遵循这种趋势。
目的：我们对现有文献进行了系统回顾，以分析回肠UD患者骨质疏松和骨改变的患病率以及可能的相关危险因素。
方法：根据PRISMA指南，我们系统地搜索了PubMed®和CochraneLibrary，查找2022年12月之前发表的原始文章。
结果：共确定了394篇出版物。我们选择了符合纳入标准的12项研究，纳入496例患者。12项研究中有6项显示BMD值降低。骨质疏松症的患病率在三篇文章中有所说明，值范围从0%到36%。风险因素如年龄、性别,身体质量指数,代谢性酸中毒和肾功能似乎对骨组织减少有影响，而UD的类型,后续行动,25-羟基维生素D和副甲状腺激素的证据较少或数据相互矛盾。所分析研究的异质性可能导致解释偏差。
结论：UDs与骨质疏松和骨折的多种危险因素相关。识别风险最高的患者并在常规临床实践中建立诊断方案对于降低骨折和由此产生的并发症的风险至关重要。
目的：我们对现有文献进行了系统回顾，以分析回肠UD患者骨质疏松和骨改变的患病率以及可能的相关危险因素。
方法：根据PRISMA指南，我们系统地搜索了PubMed®和CochraneLibrary，查找2022年12月之前发表的原始文章。
结果：共确定了394篇出版物。我们选择了符合纳入标准的12项研究，纳入496例患者。12项研究中有6项显示BMD值降低。骨质疏松症的患病率在三篇文章中有所说明，值范围从0%到36%。风险因素如年龄、性别,身体质量指数,代谢性酸中毒和肾功能似乎对骨组织减少有影响，而UD的类型,后续行动,25-羟基维生素D和副甲状腺激素的证据较少或数据相互矛盾。所分析研究的异质性可能导致解释偏差。
结论：UDs与骨质疏松和骨折的多种危险因素相关。识别风险最高的患者并在常规临床实践中建立诊断方案对于降低骨折和由此产生的并发症的风险至关重要。
