Nav: Home

Weight loss surgery associated with increased fracture risk

July 27, 2016

Severely obese patients undergoing weight loss surgery are more likely to have increased fracture risks both before and after the surgical procedure compared to obese and non-obese people who don't need surgery, finds a large study published by The BMJ this week.

Obesity may not be as protective for fracture as originally thought, say the authors, and they suggest that fracture risk assessment and management should be part of weight loss care.

Guidelines should be followed on patient adherence to dietary supplements and physical activity, and patients should be referred to bone specialists if fracture risk is considered high.

Benefits and risks of surgery should be considered on an individual basis to propose the type of surgical procedure best suited to the patient as the efficacy of weight loss surgeries differs in terms of resolution of chronic conditions, they add.

The study, carried out by researchers in Canada, examined the incidence and sites of fracture in severely obese patients who had undergone weight loss surgery, and compared them to obese and non-obese controls matched for sex and age.

Data was analysed from the Quebec Integrated Chronic Diseases Surveillance System (QICDSS) on 12,676 patients, and 38,028 obese and 126,760 non-obese people in the control groups between 2001-2014.

Before surgery, 10.5% patients in the weight loss surgery group had at least one fracture compared with 8.1% obese and 6.6% non-obese people in the control groups.

After a mean follow-up of 4.4 years, 4.1% of the weight loss surgery patients had at least one fracture compared with 2.7% of obese and 2.4% of non-obese groups. The median time to first fracture was 3.9 years.

These increased fracture risks remained high even after adjusting for fracture history, number of comorbidities, material and social deprivation, and area of residence.

The post-operative fracture risk changed from a pattern associated with obesity in the distal lower limb fracture, to a pattern typical of osteoporosis in the upper limb, clinical spine, pelvis, hip and femur.

The authors speculate that the increased fracture risks are due to falls and obesity related conditions, such as type 2 diabetes, as well as anatomical changes, and nutritional deficiencies induced by weight loss surgery.

This is an observational study so no firm conclusions can be made about cause and effect, and the authors note several limitations, such as being unable to match participants on body mass index, and not considering other factors that may have caused fractures, such as vitamin intake and drug use.

They conclude by calling for more research on preventative and therapeutic strategies to reduce the adverse effects of weight loss surgery on the bone, because of the "paucity of evidence based guidelines in this area."

In a linked editorial, Marco Bueter, a bariatric surgeon at the University of Zurich, says that this study represents "an important contribution to the evidence" on the management of patients after weight loss surgery. Fracture risk assessment should be considered for all patients, as well as "following guidelines on nutritional supplementation that include the best available evidence."

However, he also calls for more research, especially randomised controlled trials, due to the study's limitations, and explains that "our understanding of bone physiology after [weight loss] surgery remains limited, and the clinical consequences of physiological alterations remain untested by appropriate prospective studies."
-end-
About BMJ

BMJ is a healthcare knowledge provider that aims to advance healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value. For a full list of BMJ products and services, please visit bmj.com

BMJ

Related Obese Articles:

Obese adults facing Medicaid expansion gap
Despite overall increases in insurance coverage for low-income individuals in Medicaid expansion states, some gaps remain for individuals who are obese.
Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.
Cellular stress makes obese mothers have obese babies
Maternal obesity increases the risk for obesity and metabolic perturbations in their offspring, but what are the mechanisms?
Truckies more obese than most: QUT study
More than 200,000 people are employed as truck drivers in Australia and while their role in transporting goods across its wide brown land is critical, they are among the nation's most unhealthy.
These gut bacteria prevent mice from becoming obese -- what could that mean for us?
A specific class of bacteria from the gut prevents mice from becoming obese, suggesting these same microbes may similarly control weight in people, a new study reports.
Obese people outnumber smokers two to one
New figures from Cancer Research UK show that people who are obese now outnumber people who smoke two to one in the UK, and excess weight causes more cases of certain cancers than smoking, as the charity urges government action to tackle obesity.
'Strongest evidence yet' that being obese causes depression
New research released today from the University of South Australia and University of Exeter in the UK has found the strongest evidence yet that obesity causes depression, even in the absence of other health problems.
Unlike obese adults, obese children don't have more pain after surgery
While obese adults often report more pain after surgery, the same does not appear to be true for obese children, according to the largest study of its kind, being presented at the ANESTHESIOLOGY® 2018 annual meeting.
People with asthma at higher risk of becoming obese
Obesity is known to be a risk factor for developing asthma but a new study shows that the reverse is also true: people with asthma are more likely to go on to become obese.
Can you really be obese yet healthy?
A new paper has called for an end to the term 'healthy obesity,' due to it being misleading and flawed.
More Obese News and Obese Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Meditations on Loneliness
Original broadcast date: April 24, 2020. We're a social species now living in isolation. But loneliness was a problem well before this era of social distancing. This hour, TED speakers explore how we can live and make peace with loneliness. Guests on the show include author and illustrator Jonny Sun, psychologist Susan Pinker, architect Grace Kim, and writer Suleika Jaouad.
Now Playing: Science for the People

#565 The Great Wide Indoors
We're all spending a bit more time indoors this summer than we probably figured. But did you ever stop to think about why the places we live and work as designed the way they are? And how they could be designed better? We're talking with Emily Anthes about her new book "The Great Indoors: The Surprising Science of how Buildings Shape our Behavior, Health and Happiness".
Now Playing: Radiolab

The Third. A TED Talk.
Jad gives a TED talk about his life as a journalist and how Radiolab has evolved over the years. Here's how TED described it:How do you end a story? Host of Radiolab Jad Abumrad tells how his search for an answer led him home to the mountains of Tennessee, where he met an unexpected teacher: Dolly Parton.Jad Nicholas Abumrad is a Lebanese-American radio host, composer and producer. He is the founder of the syndicated public radio program Radiolab, which is broadcast on over 600 radio stations nationwide and is downloaded more than 120 million times a year as a podcast. He also created More Perfect, a podcast that tells the stories behind the Supreme Court's most famous decisions. And most recently, Dolly Parton's America, a nine-episode podcast exploring the life and times of the iconic country music star. Abumrad has received three Peabody Awards and was named a MacArthur Fellow in 2011.