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Bariatric Surgery and Bone Fracture: Is There a Risk?

By Dana A. Telem, MD, of the Stony Brook Bariatric and Metabolic Weight Loss Center

Dr. Dana A. Telem | Bariatric Surgeon
Dr. Dana A. Telem

If you have had, or are considering, bariatric surgery it is important to be well informed about the potential long-term risks. Recently, there has been debate on whether bariatric surgery puts one at increased risk for bone fracture.

The bones in your body are in a continual state of turn-over. The balance between cells that dissolve or "resorb" and those that stimulate bone regrowth is crucial to maintaining strong, healthy bones. When this turn-over rate is disrupted, cells responsible for bone regrowth may not be able to keep up, and bones can become weak and susceptible to fracture.

There are several theories as to why bariatric surgery may predispose a patient to increased risk of fracture.

First, patients who undergo bariatric surgery are at increased risk for vitamin and nutritional deficiencies that may affect the turn-over balance. Second, hormonal changes and excessive weight loss may increase bone turn-over rate, impeding the ability for cells responsible for regrowth to work fast enough to overcome bone resorption.

Despite the theories, the medical literature remains mixed about the risk of fracture following bariatric surgery.

Most recently, a study published in the August 2012 issue of The British Medical Journal, titled "Risk of Fracture after Bariatric Surgery in the United Kingdom: Population-Based, Retrospective Cohort Study," has shed new light on the subject (click here to read the report).

This study is the largest study, to date, addressing this issue. It evaluated 2,079 patients who had undergone bariatric surgery, compared with 10,442 obese patients who did not undergo a bariatric procedure, the so-called controls in the study.

Our bariatric surgeons have partnered with the biomedical engineers here at Stony Brook to collaborate
on the development of innovative new ways to prevent bone loss in our bariatric patients.

Patients were matched by age, gender, surgical practice, year, and body mass index; and followed from time of surgery to time of fracture. Mean follow-up time was 2.2 years.

What the researchers demonstrated in this study is that there was no significantly increased risk of fracture in patients who underwent bariatric surgery, when compared to controls (adjusted relative risk of 0.89, with 95% confidence interval of 0.6 to 1.33), within two years of surgery.

After three years, there was a trend toward an increased risk of fracture in bariatric patients, but this finding was not statistically significant.

This study demonstrates that bariatric surgery does not affect the risk of osteoporotic and non-osteoporotic fractures at two-year follow-up. More data and longer-term studies are needed before making a final conclusion regarding long-term risks.

While the data are promising, there are ways to help protect your bones after weight loss surgery. Such methods include vitamin D and calcium supplements, regular exercise, and screening for osteoporosis. In addition, the Bariatric and Metabolic Weight Loss Center has partnered with the Biomedical Engineering Department here at Stony Brook to devise innovative new ways to prevent bone loss.

Bariatric surgery remains an exceptional tool to aid with weight loss, improve weight-associated medical problems, and serve as the initial step in establishing a healthy and active life-style.

"This is the first time that we have been able to investigate risk of fracture following bariatric surgery by comparing patients with nonsurgical controls," says one of the study's authors, Cyrus Cooper, DM, a rheumatologist. "The results suggest that, at least in the short term, such changes in bone density are unlikely to lead to increased fracture risk."

Dr. Cooper, chair of musculoskeletal science at the University of Oxford, leads an internationally competitive program of research into the epidemiology of musculoskeletal disorders, most notably osteoporosis. Among his key research contributions are large trials of calcium and vitamin D supplementation in the elderly as immediate preventative strategies against hip fracture.

If you are considering weight loss surgery, a discussion with one of our surgeons at the Bariatric and Metabolic Weight Loss Center can help you figure out which procedure is best for you; call 631-444-2274 (BARI) for a consultation/appointment.