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Fracture risk following bariatric surgery: a population-based study

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Abstract

Summary

The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics.

Introduction

Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture.

Methods

We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985–2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model.

Results

The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m2, with an average age of 44 ± 10 years and 82 % (212) females. Gastric bypass surgery was performed in 94 % of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95 % confidence interval (CI), 1.8–2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95 % CI, 1.1–2.9), as well as for a first fracture at any other site (SIR, 2.5; 95 % CI, 2.0–3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95 % CI, 0.2–0.8) while prior fracture history was not associated with postoperative fracture risk.

Conclusions

Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.

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Acknowledgments

We would like to thank Dr. Michael Sarr for providing the database of all patients completing a bariatric surgery procedure at Mayo Clinic between 1985 and 2004. This study was supported in part by the Division of Endocrinology, Mayo Clinic, Rochester, and P01-AG-04875 from the National Institute on Aging and made possible by the Rochester Epidemiology Project (R01-AG-034676 from the National Institute on Aging), US Public Health Service. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Johns Hopkins Hospital, Baltimore, MD, USA

    K. M. Nakamura

  2. HealthEast Clinics, St. Paul, MN, USA

    E. G. C. Haglind

  3. Guthrie Clinic, Sayre, PA, USA

    J. A. Clowes

  4. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA

    S. J. Achenbach & E. J. Atkinson

  5. Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA

    L. J. Melton III

  6. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA

    L. J. Melton III & K. A. Kennel

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  1. K. M. Nakamura
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Correspondence to K. A. Kennel.

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Nakamura, K.M., Haglind, E.G.C., Clowes, J.A. et al. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int 25, 151–158 (2014). https://doi.org/10.1007/s00198-013-2463-x

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