Obesity surgery increases the risk of secondary fractures

Obese people operated on for anastomosis-type surgery (Roux-en-Y surgery) have a higher risk of non-vertebral fractures than those with a simple gastric band. This is what emerges from a new study presented at the ENDO 2018 congress, the 100th annual meeting of the Endocrine Society in Chicago.
“Bariatric surgery procedures, such as Roux-en-Y surgery, are very effective and induce sustained weight loss,” said study author Prof Elaine Wei-Yin Yu of Harvard Medical School, Boston, “but they can increase the risk of fractures.”

Increased risk of fracture

Obese people in a Medicare cohort who underwent gastro-ileal anastomosis (Roux-en-Y surgery) had more fractures compared to those who had a gastric band. Compared with obese people who have had a gastric band, bariatric surgery, such as Roux-en-Y surgery, increases the risk of hip fractures by 126%, of the wrist by 62% and of the pelvis by 172%.

This increased risk of fracture is seen in all age groups and in both men and women, although the effects are more pronounced in men. Roux-en-Y bariatric surgery increases the overall risk of fracture more markedly in men (108%) than in women (42%).

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Marked risk with the so-called “Roux-en-Y” anastomosis surgery

Professor Yu and his colleagues analyzed fracture rates in a cohort of 50,649 obese operated adults (78% female) from Medicare with severe obesity. They compared those who had Roux-en-Y surgery (n = 35,920) and those who had a gastric band (n = 14,729) between 2006 and 2014. The authors compared the fracture rates between the two. groups, taking into account differences in age, sex, race, geographic location, co-morbidities and medications prescribed.
Obese people who had bariatric anastomosis surgery were younger than patients who had a ring (53 vs 56), and they were more likely to have diabetes (36% vs 32%).

A total of 1,109 non-vertebral fractures were reported during follow-up. The estimated incidence rates of non-vertebral fractures per 1,000 patient-years are 9.8 in the Roux-en-Y surgery group and 7.1 in the gastric band group. Age or diabetes did not change the risk of a fracture.

Adaptation of the follow-up conditions after surgery

“This study is very interesting given the high prevalence of obesity and the increasing use of bariatric surgery. More than a third of adults in the United States are obese, and weight loss surgery procedures are becoming more common, ”said Prof Yu.

The potential impact of bariatric surgery, which aims to replace metabolic disease with digestive malabsorption disease, should be discussed with patients before surgery. Various deficiencies may appear as a result of intestinal malabsorption, including a deficit in the absorption of vitamin D, and these must be compensated for.

These results also underline the importance of developing optimized postoperative follow-up for these patients and treatments to counter the risk of fracture after bariatric surgery of the Roux-en-Y anastomosis type.