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Mid-term results

Study suggests bariatric fracture fears unfounded

Researchers found no statistically significant increase in risk of bone fracture post-operation. Photo: Flickr/igboo
Bone fracture risk not increased in fracture patients over medium term, despite loss of bone mass
Study looked at patients for mean period of 2.2 years after operation

Bariatric patients do not face an increased risk of bone fracture in the first two years after their operation, according to a new study published in the British Medical Journal.

The study, “Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study”, examined the outcomes of 2,079 UK bariatric operations, and did not find an increased number of bone fractures compared to a cohort of 10,442 people who had not undergone bariatric surgery.

However, the study did not rule out the possibility of an increased risk of fracture beyond the period investigated. 

The finding comes despite the fact that bariatric surgery has been shown to negatively affect bone remodelling, leading to a loss in bone density.

Study co-author Nicholas Harvey, honorary consultant rheumatologist at Southampton General Hospital, said “Overall, for the first few post-operative years, these results are reassuring for patients undergoing bariatric surgery, but do not exclude a more protracted adverse influence on skeletal health.”

The authors say that the study is the first to investigate fracture risk in patients who underwent bariatric surgery versus matched controls.

Study results

The study looked at records of 2,079 patients with a BMI of at least 30 from the United Kingdom General Practice Research Database, and matched them to 10,442 control cases who did not have bariatric surgery. The mean follow-up time was 2.2 years.

The investigators found that the rate of fractures (calculated as the number of fractures divided by the number of person years in a given period) was comparable between the group of bariatric surgery patients and the group of matched controls.

Up to three months post-operation, the rate of fractures for bariatric surgery patients was 1.01%, compared to 0.76% for the control. At 13-24 months, the rate had fallen to 0.80% compared to 0.79%; between 25-60 months, the figures were at 0.59% and 0.83%.

The investigators stated that they did not observe an increase in overall risk for any fracture (8.8 vs 8.2 per 1,000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33), osteoporotic fractures (0.67, 0.34 to 1.32), or non-osteoporotic fractures (0.90, 0.56 to 1.45).

They noted that the patients in their study had a modestly increased risk of fracture over the first three months, which reduced over the next few years before trending towards an increased risk after three to five years; however, there was no statistical significance to the trend (figure 1, below).

Figure 1: Spline regression plot of time since bariatric surgery and risk of any fracture in bariatric surgery patients versus matched controls. Risk adjusted for confounders. Source: “Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study”

The study found that bariatric surgery patients who had used anti-anxiety agents in the previous six months, had a history of cerebrovascular disease or a previous fracture had a raised risk of fracture.

The researchers observed an increased risk of fracture with greater reduction of excess BMI after surgery, but did not find a statistically significant trend.

The study co-authors were Arief Lalmohamed, Frank de Vries, Marloes T Bazelier, Alun Cooper, Tjeerd-Pieter van Staa, Cyrus Cooper, and Nicholas C Harvey.

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