A population-based study of the SEER database has revealed that patients with bladder cancer who undergo cystectomy with urinary diversion are at increased risk of fracture, possibly owing to chronic metabolic acidosis. The study looked at outcomes in 4,878 patients, and showed that the incidence of fracture was higher in post-cystectomy patients than those without cystectomy. Furthermore, cystectomy was associated with a 21% higher risk of fracture than no cystectomy after controlling for various characteristics, including age, sex and cancer stage.