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Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study
Catherine Rousseau1,2, Sonia Jean2,3, Philippe Gamache3
1Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2.
BMJ (Clinical Research Ed.)
|November 5, 2016
Summary
Bariatric surgery increases fracture risk, especially after the procedure. This risk is site-specific, shifting from obesity-related patterns to osteoporosis-like patterns, necessitating careful fracture risk assessment and management in bariatric care.
Area of Science:
- Orthopedics
- Bariatric Surgery
- Metabolic Surgery
- Bone Health
Background:
- Obesity is a significant health concern associated with various comorbidities.
- Bariatric surgery is an effective weight-loss intervention but its long-term effects on bone health require investigation.
Purpose of the Study:
- To determine if bariatric surgery is associated with an increased risk of fracture.
- To analyze fracture patterns and risk before and after bariatric surgery.
Main Methods:
- Retrospective nested case-control study using Quebec healthcare administrative databases (2001-2014).
- Included 12,676 bariatric surgery patients, matched with obese and non-obese controls.
- Multivariate conditional Poisson regression analyzed fracture incidence and site, adjusting for covariates.
Main Results:
- Bariatric patients had higher fracture rates pre- and post-surgery compared to controls.
- Postoperative fracture risk was significantly elevated (RR 1.38-1.44).
- Fracture sites shifted post-surgery from lower limb to upper limb, spine, pelvis, hip, and femur, indicative of osteoporosis. Biliopancreatic diversion showed a significant increase in fracture risk.
Conclusions:
- Bariatric surgery is associated with a sustained increase in fracture risk.
- The fracture pattern changes post-surgery, suggesting an osteoporosis-like risk profile.
- Fracture risk assessment and management are crucial components of bariatric care, particularly for specific surgical types like biliopancreatic diversion.
