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Bone fractures

RYGB associated with more non-vertebral fractures than AGB

Gastric bypass increased overall fracture risk more dramatically in men (108 percent) than in women (42 percent)

Patients undergoing Roux-en-Y gastric bypass (RYGB) surgery may be at greater risk for non-vertebral fracture than those having adjustable gastric banding (AGB), according to a population-based study by researchers from Massachusetts General Hospital.

"Bariatric surgery procedures, such as RYGB, are highly effective treatments that induce sustained weight loss," said lead study author, Dr Elaine Wei-Yin Yu, assistant professor of medicine at Harvard Medical School and director of the Bone Density Center at Massachusetts General Hospital, in Boston, MA. "RYGB leads to greater improvements in metabolic health than AGB, but RYGB also causes accelerated bone loss and may increase fracture risk."

Yu and her colleagues investigated the fracture rates among Medicare Parts A, B and D enrolees with severe obesity who underwent either RYGB or AGB surgery between 2006 and 2014. The researchers analysed Medicare billing claims data from 50,649 adults (78 percent women). Of these, 35,920 underwent RYGB and 14,729 underwent AGB. The authors compared fracture rates between the two groups, controlling for differences in age, sex, race, geographical location, index date, degree of healthcare utilization, comorbidities, and prescribed medications.

RYGB patients were younger than AGB patients (53 vs 56 years of age), and they were more likely to have diabetes (36 percent vs 32 percent), as well as a shorter average follow-up time (3.1 vs 3.8 years).

A total of 1,109 non-vertebral fractures were reported during follow-up. The estimated incidence rates of non-vertebral fractures per 1,000 person-years were 9.8 in the RYGB group and 7.1 in the AGB group. Age or diabetes status did not affect RYGB-associated fracture risk.

"We found that Medicare patients who received RYGB had more fractures compared to those who received AGB,” she revealed. “Importantly, we found that RYGB increased the risk for hip, wrist, and pelvis fractures. RYGB increased fracture risk across all age groups, in men and in women, although the effects were more pronounced among men.”

Compared with patients who received banding, those who underwent bypass had a 126 percent increased risk of hip fracture, a 62 percent increased risk of wrist fracture, and a 172 percent increased risk of pelvis fracture. Gastric bypass increased overall fracture risk more dramatically in men (108 percent) than in women (42 percent).

"This research is very relevant given the high prevalence of obesity and increasing utilisation of bariatric surgery. Over one-third of adults in the US are obese, and bariatric surgery procedures have accordingly been increasing in popularity," added Yu. "Long-term skeletal health should be discussed and managed for all patients undergoing bariatric surgery. . . These data also emphasise the importance of devising therapies that can counteract fracture risk after gastric bypass."

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