Bariatric Surgery Fracture Risk Examined in New Study

Severely obese patients undergoing bariatric surgery for weight loss may face an increased risk of suffering a bone fracture, both before and after surgery, according to the findings of new research. 

In a study published this week in the medical journal The BMJ, Canadian researchers indicate that severely obese patients who undergo bariatric surgery had a 10% increased fracture risk before surgery and a 4% increased risk of suffering a fracture after surgery, compared to obese and non-obese patients.

Researchers focused on patients who underwent bariatric surgery in Quebec, Canada, between 2001 and 2014. They were selected using healthcare administrative databases. A total of 12,600 patients underwent bariatric surgery compared to more than 38,000 obese patients and 126,700 non-obese patients. They were matched for age and sex.

The incidence and types of fractures were compared among all patients as well as fracture risk before and after surgery.

Patients who were undergoing bariatric surgery were more likely to suffer a fracture before surgery than the obese and non-obese patients. Obese patients’ fracture risk was increased by eight percent and non-obese by six percent; bariatric surgery patients by nearly 11%.

The risk of suffering a fracture after surgery also remained high for bariatric patients. Patients had an average of four years after surgery before suffering a fracture.

After surgery, bariatric patients had four percent increased risk of fracture; obese patients a three percent increased risk and non-obese patients a two percent increased risk. The study also indicated postoperative adjusted fracture risk was higher in bariatric patients than obese and non-obese patients.

Risk of fracture to the legs was higher and risk to the arms lower for bariatric patients before surgery. The risk of fractures to the spine, hip, femur and pelvis were similar for bariatric, obese and non-obese patients.

After surgery, the risk of fracture to the lower limbs decreased for the bariatric patients and risk of fracture to the arms, spine, pelvis, hip and femur increased. Researchers said this indicated the fracture risk was site specific, meaning there was a pattern of fracture risk associated with obesity before surgery and then similar to osteoporosis after surgery.

The authors also speculate that increased fracture risks may be due to falls and obesity related conditions, like type 2 diabetes, changes to the body, and nutritional deficiencies caused by weight loss surgery.

The findings of the new study are similar to the findings of a study published last year. The 2015 research indicated patients who undergo bariatric surgery for weight loss have a 21 percent increased risk of breaking a bone within the 5 years following the surgery.

Another study published in 2011 concluded bone fracture risk doubles after undergoing bariatric surgery, compared to patients who did not have weight loss surgery. The study indicates bone fractures are a common risk that should be evaluated and considered when a patient elects to undergo weight loss surgery.

Authors of the new study recommend fracture risk assessment and management should be part of weight loss surgery care. Guidelines should be followed for patients to maintain dietary supplements and physical activity following surgery. They also recommended patients be referred to bone specialists if their fracture risk is considered high.