Key clinical point: Gastric bypass surgery is associated with a higher risk of major osteoporotic fracture (MOF) in severely obese patients. However, this association is not found for sleeve gastrectomy.

Major finding: A total of 585 MOFs occurred in the surgical group (2.30 cases per 1,000 person-years) vs. 416 in the control group (1.93 cases per 1,000 person-years). MOF risk was significantly higher in the surgical group (hazard ratio [HR], 1.22). A higher risk for MOF was observed for gastric bypass (HR, 1.70) but not for sleeve gastrectomy (HR, 0.95) or adjustable gastric banding (HR, 0.95).

Study details: This French population-based cohort study included 40,992 patients who underwent bariatric surgery (mean age, 49.1 years; 78.4% females; sleeve gastrectomy, 45.5%; gastric bypass, 35.4%) and 40,992 matched control participants. All patients were followed for up to 8 years.

Disclosures: This study received no external funding. The authors declared no conflict of interest.

Commentary

“Despite benefits of bariatric surgery for the management of morbid obesity, it has been associated with metabolic complications, including higher fracture risk. In this population-based cohort study conducted in France, a total of 40,992 patients who had bariatric surgery were matched 1:1 on age, sex, class of obesity (BMI 40 to 49.9 kg/m2 and BMI ≥50 kg/m2), year of cohort inclusion, and Charlson comorbidity index (CCI) with 40,992 controls. Over an overall 6 years of follow up more major osteoporotic fractures (MOFs) occurred in the bariatric surgery group (2.30 cases per 1000 patient‐year) compared to the matched controls (1.93 cases per 1000 patient-year).

Examining the data by type of bariatric surgery, patients who had gastric bypass surgery had a higher risk of MOF, while no increased risk for sleeve gastrectomy or adjustable gastric banding. Notably, a higher risk of distal forearm and wrist fractures was observed. These findings will influence patients’ decisions regarding surgical approach for morbid obesity management.”

Maria I. Danila, MD, MSc, MSPH

University of Alabama at Birmingham