Weight loss surgery associated with increased fracture risk, even before surgery

http://www.eurekalert.org/pub_releases/2016-07/b-wls072616.php

Public Release: 27-Jul-2016
Weight loss surgery associated with increased fracture risk
Fracture risk assessment and management should be part of weight loss care
BMJ

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.

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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.

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