Osteoporosis and fracture risk after cholecystectomy: A Systematic review and meta-analysis

Cholecystectomy, a common surgical procedure for treating gallbladder diseases, has been associated with metabolic and endocrine changes that may impact bone health. This systematic review and meta-analysis aim to evaluate the risk of osteoporosis and fractures in patients undergoing cholecystectomy.

A systematic literature search was conducted across major databases to identify relevant studies. Inclusion criteria comprised studies investigating osteoporosis and fracture outcomes in patients who underwent cholecystectomy. The Joanna Briggs Institute (JBI) Risk of Bias Tool was employed to evaluate the methodological quality of the included studies. Meta-analysis was performed using hazard ratios where available.

We included 8 studies, comprising 624,290 cholecystectomy patients and 2,006,246 controls. The meta-analysis revealed a 1.08-fold increase (95% CI: 1.05-1.11) in fracture risk for post-cholecystectomy patients compared to controls. In the descriptive synthesis of osteoporosis incidence, some studies showed an association with cholecystectomy. On the other hand, some studies reported the aforementioned outcomes to show no difference in cases and controls. Several studies reported that bone mineral density (BMD) status was worse in cholecystectomy cases, whereas a few suggested to be the same between groups.

Although our meta-analysis shows a modest increase in fracture risk among post-cholecystectomy patients, it remains unclear whether cholecystectomy is associated with higher osteoporosis risk or poorer BMD, as studies yielded conflicting results. These discrepancies highlight the need for further prospective studies to clarify the relationship between cholecystectomy and bone health outcomes.

The online version contains supplementary material available at 10.1007/s40200-026-01921-8.