Multiple vertebral fractures sustained 5 months after Roux-en-Y gastric bypass: a case report

We report a case of a patient sustaining multiple simultaneous vertebral fractures 5 months after Roux-en-Y gastric bypass (RYGB) surgery. Obesity is associated with increased rates of morbidity and mortality and obesity rates globally continue to rise. Bariatric surgical procedures are successful in inducing sustained weight loss with many improved health outcomes. Potential complications include nutritional deficiencies and adverse effects on bone mineral metabolism with increased rates of fracture.

We have recently cared for a 40-year-old female who sustained multiple vertebral fractures after bending forwards, occurring only 5 months after she underwent RYGB surgery, with post-operative weight loss of 55 kg. Blood tests performed several months after the fractures occurred revealed she had biochemical secondary hyperparathyroidism with low serum vitamin D levels.

It has been previously demonstrated that RYGB surgery is associated with an increased incidence of fractures, and with reduction in bone mineral density. Patients undergoing bariatric surgery are frequently vitamin D deficient pre-operatively and show variable responses to vitamin D supplementation in the post-operative period. With particular reference to the RYGB procedure, there is evidence from several studies that bone mineral density is reduced at 12 and 24 post-operative months. To the best of our knowledge, this case may be the first time that multiple vertebral fractures have been documented so soon after weight loss surgery. It therefore highlights the growing conclusion that early consideration must be given to the maintenance of bone health in patients undergoing weight loss surgery.