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Bariatric surgery and fracture risk

Study finds increased fracture risk after Roux-en-Y gastric bypass

Over a mean follow-up of 3.5, 658 non-vertebral fractures were identified and the fracture incidence rate was 6.6 in RYGB patients and 4.6 in AGB patients – a 73% increased risk of non-vertebral fracture among adults in the RYGB group vs AGB group

Researchers from the Massachusetts General Hospital in Boston, MA, have reported that bariatric surgery is associated with health benefits, however patients undergoing Roux-en-Y gastric bypass (RYGB) have an increased fracture risk and this should be considered when patients are in thinking of undergoing surgery.

The study, ‘Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries’, published in JAMA Surgery, compared fracture risk after RYGB and adjustable gastric banding (AGB) procedures in a large, nationally representative cohort enriched for older adults in the US.

The authors note that previous studies have shown that RYGB is associated with significant bone loss and may increase fracture risk, although there have been few studies that have examined patients aged 65 years or older, and it is currently unknown how age modifies fracture risk. In their study, they looked at claims data from 42,345 Medicare beneficiaries with severe obesity from 2006 to 2014 – 29,624 received RYGB and 12,721 received AGB.

The primary outcome was the incident of non-vertebral (ie, wrist, humerus, pelvis and hip) fractures after either surgery, defined using a combination of International Classification of Diseases, Ninth Edition and Current Procedural Terminology 4 codes.

Of the 42,345 participants, 33,254 (78.5%) were female with an average age of 51 (+/-12) years, RYGB patients were younger than AGB recipients (55, +/-12 years). The researchers found that both groups had similar comorbidities, medication use and health care utilisation in the 365 days before surgery. Over a mean follow-up of 3.5 (2.1) years, 658 non-vertebral fractures were identified, and the fracture incidence rate was 6.6 in RYGB patients and 4.6 in AGB patients. This translates to 73% increased risk of non-vertebral fracture among adults in the RYGB group vs AGB group.

“This study of a large, US population–based cohort including a substantial population of older adults found a 73% increased risk of nonvertebral fracture after RYGB compared with AGB, including increased risk of hip, wrist, and pelvis fractures,” the authors conclude. “Fracture risk was consistently increased among RYGB patients vs AGB across different subgroups, and to a similar degree among older and younger adults. Increased fracture risk appears to be an important unintended consequence of RYGB.”

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