A study just published in the British Medical Journal has found that obese patients who undergo bariatric surgery are not at an increased risk of broken bones in the first few years after the operation. However, the international research team did find a possibility of an increase in fracture risk after three to five years.
Bariatric Patients: Elevated Fracture Risk?
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Scientists from the Medical Research Council Lifecourse Epidemiology Unit (MRC LEU) at the University of Southampton, along with colleagues at the University of Utrecht, Netherlands, and the Medicines and Healthcare products Regulatory Agency in London, compared the fracture rates of people who had had bariatric surgery between 1987 and 2010, with people who had not had the surgery but were matched by age, sex, body mass index, practice, and calendar year.
Studies have shown that weight loss can lead to a reduction of bone density and specifically studies have suggested that bone density is lost after bariatric surgery; however no previous work has been able to investigate whether such changes might result in an increased risk of fracture relative to a control population.
Results showed that compared to the control group, the overall risk of fracture was not significantly increased in bariatric surgery patients in the first few years post-operation, but there was a slight trend towards an increased fracture risk after three to five years. The researchers also found a slight tendency for fracture risk to increase with greater post-operative decrease in body mass index.
Dr. Nicholas Harvey, Senior Lecturer at the MRC LEU at the University of Southampton commented in the August 6, 2012 news release, “Obesity is an increasing public health problem worldwide, which affects between 15 and 20% of Europeans; it has been recognised that surgical treatment is the most effective route to weight loss for many with morbid obesity. Overall, for the first few post-operative years, these results are reassuring for patients undergoing bariatric surgery, but do not exclude a more protracted adverse influence on skeletal health.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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