HealthDay News – Patients who are severely obese who undergo bariatric surgery have an increased risk of developing a fracture compared to non-obese patients, and this risk persists post-surgical intervention. These results were recently published in the BMJ.
Catherine Rousseau, from the CHU de Québec Research Center in Québec City, and colleagues conducted a retrospective nested case-control study involving patients who underwent bariatric surgery from 2001 to 2014. Data were included for 12 676 patients who underwent bariatric surgery and 38 028 and 126 760 age- and sex-matched obese and non-obese controls, respectively.
The researchers found that patients undergoing bariatric surgery were more likely to fracture than obese or non-obese controls (10.5 versus 8.1% or 6.6%, respectively) before surgery. Bariatric patients were more susceptible to fracture than obese or non-obese controls at a mean of 4.4 years after surgery (4.1% versus 2.7% and 2.4%).
The bariatric group had a higher postoperative adjusted fracture risk compared with obese and non-obese groups (relative risks, 1.38 and 1.44, respectively). Before surgery, the bariatric group had higher risk of distal lower limb fracture and upper limb fracture; risks of clinical spine, hip, femur, or pelvic fractures were similar for bariatric and obese groups versus non-obese.
The risk of distal lower limb fracture was lower, while upper limb, clinical spine, pelvic, hip, or femur fractures increased after surgery.
“Patients undergoing bariatric surgery were more likely to have fractures than were obese or non-obese controls, and this risk remained higher after surgery,” the authors write. “Fracture risk assessment and management should be part of bariatric care.”
Summary and Clinical Applicability
“To minimize the effect of bariatric surgery on bone, guidelines should be followed and the importance of adherence to supplements and physical activity should be reinforced among patients and healthcare professionals,” the authors recommended.
Limitations and Disclosures
- Groups of patients in the bariatric and obese groups not matched according to body mass index
LB has received grants from Johnson and Johnson, Valen Tx, and GI Windows; LM has received honorariums (speakers’ fees) from Amgen, Abbvie, Eli Lilly, and Britsol Myers Squibb, as well as research equipment from Roche Diagnostics Canada; CG has been a member of advisory boards for Amgen and Eli Lilly; LB has been a member of advisory board for GI Windows
Rousseau C, Jean S, gamache P, et al. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ. 2016;354:i3794.