Does weight loss from bariatric surgery increase fracture risk in adults?

Takeaway

• Weight loss from bariatric surgery seems to be associated with increased risk for any fracture.
• No association is seen between lifestyle weight management programmes (WMPs) with increased risk of any fracture.

Why this matters

• Bariatric surgery for adults with obesity is associated with an increase in bone turnover and reduction in bone mineral density (BMD) which may increase the risk for fracture.

Study design

• 15 studies met eligibility criteria after a search on MEDLINE, Embase and the Cochrane database.
• Primary outcome: risk for any fracture; secondary outcome: weight change.
• Funding: Scottish Government Health and Social Care Directorates.

Key results

• The pooled results of 3 randomised trials showed bariatric surgery did not increase the risk for any fracture (adjusted relative risk [aRR], 0.82; 95% CI, 0.29-2.35) but led to marked weight loss (mean difference [MD], −22.2 kg; 95% CI, − 31.6 to − 12.8; I², 93%).
• The pooled results of 4 out of 6 observational studies showed bariatric surgery was associated with increased risk for fracture.
• No significant association was seen between WMPs and risk for any fracture (aRR, 1.04; 95% CI, 0.91-1.18), although the results of the largest randomised trial reported increased risk for frailty fracture with WMPs (aHR, 1.39; 95% CI, 1.02-1.90).

Limitations

• Heterogeneity among included studies.