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Sleeve gastrectomy might be preferable for bariatric patients at risk of bone fractures

Fri, 06/12/2020 - 12:51
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Sleeve gastrectomy (SG) might be the best option for weight loss in patients in whom fractures could be a concern, compared with Roux-en-Y Gastric Bypass (RYGB) which maybe be associated with an increased fracture risk, according to researchers from Rush University Medical Center, Chicago, IL.

The authors noted that this study “provides valuable clinical information to the field of bariatrics by providing, for the first time to our knowledge, specific analysis of the risk of fracture among patients who undergo bariatric surgery compared with patients who are eligible for bariatric surgery but do not.”

In this study, ‘Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity’, published in JAMA Network Open, the authors sought to explore the absolute risk of fracture in patients with severe obesity who did not undergo bariatric surgery compared with those who underwent surgical interventions with both restrictive and malabsorptive features (RYGB) and with less malabsorptive features (SG). In addition, the study also examined the odds of type of fracture (humerus, radius or ulna, pelvis, hip, vertebrae and total fractures) after bariatric surgery.

In total, 49,113 patients were included in the study in three groups of 16,371 eligible patients who did not undergo weight loss surgery, who had undergone RYGB or had SG. Furthermore, the groups each consisted the same number of men 4,109 men (25.1%) and 12,262 women (74.9%), had equal age distributions (11,780 patients (72.0%) 64 years or younger, 42,30 (25.8%) aged 65 to 69 years, 346 (2.1%) aged 70 to 74 years and 15 (0.1%) aged 75 to 79 years). The researchers also equally matched the groups in regards to rates of hypertension (71.8%), smoking status (30.8%), hyperlipidaemia (56.8%), OSA (45.2%), T2D (47.6%), NAFLD (0.7%), osteoporosis (3.8%) and osteoarthritis (26.2%).

Outcomes

From the 49,113 patients, a total of 1,382 patients (2.8%) experienced a fracture with vertebral fractures (522 or 1.1%) found to be the most common. The non-surgery group reported 562 (3.4%) fractures, the RYGB group 523 (3.2%) fractures and the SG group 297 (1.8%) fracture, which is a significantly lower rate of overall fractures at three years following surgery (p<0.001).

The paper stated that that there were no significant differences between the non-surgical group and the RYGB group for all and specific types of fracture. However, patients who had a SG had lower odds of fractures of the humerus, radius or ulna, hip, pelvis, vertebrae or in general. Patients in the RYGB group had a significantly greater risk of total fractures and fractures of the humerus compared with those undergoing SG, although there were no significant differences in the risk associated with developing fractures of the radius or ulna, pelvis, hip, or vertebrae between patients who underwent RYGB vs SG.

The authors note that pervious research has postulated that higher levels and rates of bone mineral density (BMD) loss and fracture risk in RYGB patients could, in part, be caused by the malabsorptive implications and associated changes in alimentary-associated hormones ghrelin, glucagon-like peptide 1, and peptide YY, changes in estradiol, leptin, visfatin, resistin, and adiponectin, and changes in bile acid metabolism. Whereas, there is a lack of data on the effects of SG on BMD or comparison between the two surgical procedure on this specific topic.

“Specifically, SG might be the best option for weight loss in patients in whom fractures could be a concern, as RYGB may be associated with an increased fracture risk compared with SG,” the authors concluded. “Additional studies are needed to not only further characterise the risk profile of obesity on rates of fracture but also to access fracture risk and benefits of different surgical weight loss options.”

To access this paper, please click here