Increased Risk of Osteoporosis and Fracture Following Nephrectomy

A new study shows how kidney surgery affects both chronic kidney disease (CKD) and bone, and points to the importance of pursuing kidney-sparing surgery in an effort to reduce the risk of osteoporosis later in life.

Researchers at the University of California, San Diego (UCSD; USA;) conducted a retrospective review involving 905 patients (mean age 57.5 years, mean follow-up 6.4 years) who underwent radical nephrectomy (RN) and partial nephrectomy (NSS) for renal tumors between July 1987 and June 2007. Demographics, renal function, metabolic parameters, and history of preoperative and postoperative osteoporosis and fractures were recorded to examine the incidence of and risk factors for development of osteoporosis and fractures following surgery.

The results showed that a total of 610 patients underwent RN, and 295 underwent NSS; tumor size was significantly larger for RN. No significant differences were noted with respect to demographic factors and preoperative osteoporosis and fractures. Postoperatively, significantly less osteoporosis and fewer fractures developed in the NSS cohort. The analysis demonstrated that female sex, Caucasian race, preoperative estimated Glomerular Filtration Rate (eGFR) lower than 60 mL/min per 1.73 m2, preoperative metabolic acidosis, and RN were risk factors for developing osteoporosis. The study was published early online on July 19, 2011, in Urology.

“Women facing kidney surgery should investigate whether partial kidney removal is an option to treat their disease as it may help prevent bone brittleness,” said coauthor professor of surgery Christopher Kane, MD, chief of the division of Urology. “Too often urologists have done radical nephrectomies for patients who were candidates for partial nephrectomy. While partial nephrectomy is more complex for the surgeon to perform, it can offer better quality of life later in life.”

Osteoporosis may develop in patients with reduced renal function or CKD as a result of adynamic bone disease, hyperparathyroidism, and osteomalacia (very high or very low bone turnover).

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