Bariatric Weight Loss Sugery May Increase Fracture Risk: Study

New research suggests that patients who undergo bariatric surgeries for weight loss may face a much higher risk of fractures than patients who do not have bariatric surgery. 

In a study published in the December issue of the journal Medicine, researchers from Taiwan indicate that obese patients who underwent bariatric weight loss surgery had a 21% increased risk of breaking a bone in the next five years.

Researchers from the College of Medicine at National Taiwan University in Taipei focused on more than 2,000 patients who underwent bariatric surgery from 2001 to 2009. Those patients were matched with more than 5,000 obese patients who did not undergo bariatric surgery.

The data was taken from the National Health Insurance Research Database of Taiwan. Patients were matched for age, sex, morbidity index, diabetes, hypertension, hyperlipidemia and the year of morbid obesity was diagnosed.

Both sets of patients were followed until death, a fracture occurred, or December 31, 2012; whichever occurred first.

Dr. Kuo-Chin Huang, lead author of the study, found patients who underwent any type of bariatric surgery had a 21% higher risk of breaking a bone within the next five years compared to patients who did not undergo bariatric surgery.

Prior studies have also shown increased risk of fracture after bariatric surgery. A study published in 2011 revealed patients had double the risk of fracturing a bone after having bariatric surgery.

Researchers said more dramatic risk was seen in patients who underwent what they call “malabsorptive” procedures. This is a type of surgery that prevents food from being properly absorbed, such as gastric bypass surgery.

Patients who underwent “malabsorptive” procedures, like gastric bypass, were 47% more likely to break a bone or have some type of fracture during the 12 years of followup.

There was no increased risk among patients who had surgeries that restricted the total amount of food a patient could consume at once, this includes gastric banding.

Other Side Effects of Bariatric Surgery

A study published in 2014 found that patients who underwent gastric bypass were more likely to experience negative side effects compared to patients who had lap band or gastric banding surgery. These patients had a higher death rate, re-hospitalization rate and had a higher rate of needing a followup surgery.

Researchers compared the fracture rates for bariatric surgeries and patients who did not undergo surgery. At two years, the rates compared at 2.37% for bariatric surgery patients and 1.65% for patients who didn’t undergo surgery.

The increased fracture risk was most significantly seen within the first two years following surgery.

Another study published in 2013, found that results of bariatric surgeries vary widely. Thirty-percent of patients experienced a partial remission of health side effects of obesity, including hypertension and diabetes.

Researchers said it is most common to lose vitamin D and calcium after undergoing baraitic surgeries, both nutrients related to the development of osteoporosis. Researchers recommend patients begin taking both supplements after having surgery and undergo balance training to prevent falls.

Dr. Huang warns that the benefits of undergoing bariatric surgery should outweigh the risks, including the risk of fracture. Many patients experience a reversal of diabetes, and high blood pressure after surgery. Both should be considered before surgery.

Another study found many patients experience unfavorable side effects, including reduced long-term survival rates, risks of microvascular and macrovascular events, and negative mental health outcomes. One study found a link between bariatric surgery and an increased risk of alcohol abuse.

Over the last decade, the use of bariatric surgery has increased seven-fold. The prevalence of obesity in the U.S. Is more than five percent of the population, in Europe, nearly 20% among the middle-aged.