Bariatric Surgery May Raise Risk of Fractures

Patients undergoing bariatric surgery are more susceptible to fractures before and after surgery than those not undergoing surgery, according to a new study from Canada.

To investigate whether bariatric surgery increased the risk of fracture, the researchers searched health care administrative databases for patients who had had bariatric surgery between 2001 and 2014 in Quebec, Canada.
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A total of 12,676 patients who had bariatric surgery were identified and were matched with 38,028 obese and 126,760 nonobese controls.

The researchers tracked fracture incidence and sites and then compared patients with controls and risk before and after surgery within each group and by type of surgery from 2006 to 2014.

After analyzing the data, the researchers found that before surgery, the risk of fracture was higher for patients undergoing bariatric surgery than it was for the control groups. Compared with the nonobese group, the bariatric surgery and obese groups had higher risk of distal lower limb fracture; lower risk of upper limb fracture; and similar risk of clinical spine, hip, femur, or pelvic fractures before surgery.

Patients who had undergone bariatric surgery were still more susceptible to fractures than both control groups after an average 4.4 years after surgery.

After surgery, the risk of distal lower limb fracture decreased, but risk of upper limb, clinical spine, pelvic, hip, or femur fractures increased.

“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 researchers concluded.

“Fracture risk was site specific, changing from a pattern associated with obesity to a pattern typical of osteoporosis after surgery. … Fracture risk assessment and management should be part of bariatric care.”

—Amanda Balbi

Reference:

Rousseau C, Jean S, Gamache P, et al. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study [published online July 27, 2016]. BMJ. http://dx.doi.org/10.1136/bmj.i3794.