Gastric Bypass Surgery Linked to Increased Risk for Nonvertebral Fractures

Roux-en Y gastric bypass (RYGB) was associated with increased risk for nonvertebral fractures, including hip, wrist, and pelvic fractures, compared with adjustable gastric banding, according to results of a large US population-based cohort study presented at ENDO 2018: The Endocrine Society Annual Meeting, held March 17-20 in Chicago, Illinois.¹

Investigators examined fracture rates among 50,649 Medicare Parts A, B, and D participants with severe obesity who underwent RYGB (n=35,920) or adjustable gastric banding (n=14,729) between 2006 and 2014. Participants who underwent RYGB were younger, more likely to have diabetes, and had shorter follow-up compared with participants who underwent adjustable gastric banding.

“Bariatric surgery procedures, such as RYGB, are highly effective treatments that induce sustained weight loss. . . .RYGB leads to greater improvements in metabolic health than [adjustable gastric banding], but RYGB also causes accelerated bone loss and may increase fracture risk,” stated lead study author Elaine Wei-Yin Yu, MD, assistant professor of medicine at Harvard Medical School and director of the Bone Density Center at Massachusetts General Hospital in a press release.²

Researchers estimated incidence rates and risk for nonvertebral fractures between the 2 groups using validated algorithms. Results were adjusted for age, sex, race, geography, markers of healthcare use, comorbidities, and medications.

A total of 1109 nonvertebral fractures were recorded throughout the study period. The estimated incidence rate was 9.8 per 1000 person-years (95% CI, 9.64-9.92) among participants who underwent RYGB and 7.1 (95% CI, 7.09-7.12) among participants who underwent adjustable gastric banding.

Participants who underwent RYGB had an increased risk for any nonvertebral fracture (hazard ratio [HR], 1.65; 95% CI, 1.46-1.85) compared with participants who underwent adjustable gastric banding. In addition, RYGB yielded an increased risk for hip (HR, 2.26; 95% CI, 1.79-2.88), wrist (HR, 1.62; 95% CI, 1.36-1.95), and pelvis fractures (HR, 2.72; 95% CI, 1.24-6.86) compared with adjustable gastric banding. Fracture risk associated with RYGB was not affected by age or diabetes status.

Results also showed that men had a nearly 2-fold increased risk for fracture after RYGB (HR, 2.08; 95% CI, 1.50-2.95) compared with women (HR, 1.42; 95% CI, 1.25-1.61; P =.02).

“This research is very relevant given the high prevalence of obesity and increasing utilization of bariatric surgery,” Dr Yu stated. “Over one-third of adults in the United States are obese, and bariatric surgery procedures have accordingly been increasing in popularity. Long-term skeletal health should be discussed and managed for all patients undergoing bariatric surgery. . . These data also emphasize the importance of devising therapies that can counteract fracture risk after gastric bypass.”

Disclosure: Seoyoung C. Kim, MD, ScD, has financial relationships with Pfizer, Inc, Roche Pharmaceuticals, Bristol-Myers Squibb, and Merck.

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References

1. Yu EW, Kim SC, Sturgeon DJ, Linderman KG, Weissman J. Fracture risk after bariatric surgery among Medicare recipients: Roux-en-Y gastric bypass versus adjustable gastric banding. Presented at: ENDO 2018: The Endocrine Society Annual Meeting; Chicago, IL; March 17-20, 2018. Abstract OR03-2.
2. Roux-en-Y surgery linked with more non-vertebral fractures than adjustable gastric banding [press release]. Washington, DC: Endocrine Society. Published March 17, 2018. Accessed March 17, 2018.