Bones at Risk After Bariatric Surgery

Fracture Free Survival Rate

From Rousseau et al ( Non-adjusted fracture-free survival rate (all fractures) by group and by type of bariatric procedure (for period between 2006 and 2014). Although fracture-free survival rate appears similar in adjustable gastric banding group to non-obese and obese groups, it is decreasing more rapidly in biliopancreatic diversion and Roux-en-Y gastric bypass groups. Follow-up time for sleeve gastrectomy is too short to draw conclusions

A careful new case-control study fills important gaps in knowledge about bones at risk after bariatric surgery. Catherine Rousseau and colleagues published their finding in The BMJ that the risk of bone fractures goes up by 30% after bariatric surgery.

The site of fractures also shifted to a pattern that is more typically seen in osteoporosis – upper limb, spine, pelvis, hip, and femur fractures became more common after surgery.

The American Society for Metabolic and Bariatric Surgery last updated its recommendations for addressing the risk of bone fractures after surgery in 2014. The new research by Rousseau et al adds to the importance of those recommendations.

The greatest risk is pretty clearly associated with biliopancreatic diversion. The trend for increased risk in gastric bypass surgery was similar, but did not reach statistical significance. Of course, since this is an observational study, clinical measures to prevent fractures after surgery cloud the picture a bit. No doubt guidelines help minimize the problem.

These data suggest that even with best efforts, bones are at risk after bariatric surgery – especially with biliopancreatic diversion procedures. Our friends gain so much in health and life after bariatric surgery. Seeing those gains set back with a bone fracture hurts deeply.

Current recommendations for calcium and vitamin D, along with careful monitoring of bone health are certainly important. But we need more to fully understand what’s going on with bone metabolism after bariatric surgery.

Click here for the study and here for a companion commentary. Click here for more from Endocrinology Today.

Bones, photograph © Phalinn Ooi / flickr

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August 3, 2016