Does Bariatric Surgery Increase Risk of Fracture?

[southernlady]

This is a news summary that showed up in my email box. Will hunt for the study it summarizes. If someone else finds it before I get it posted, thank you.

Does Bariatric Surgery Increase Risk of Fracture?
BMJ; ePub 2016 Jul 27; Rousseau, Jean, et al

August 23, 2016


There was a greater risk for fracture among patients undergoing bariatric surgery when compared to obese or non-obese controls, a recent study found, and this risk remained higher after surgery. This case-controlled study included 12,767 patients who underwent bariatric surgery, and were age and sex matched with 38,028 obese and 126,760 non-obese controls. Fracture risk was also compared before and after surgery within each group and by type of surgery from 2006 to 2014. Researchers found:

• Prior to surgery, patients undergoing bariatric surgery were more likely to fracture vs obese or non-obese controls.

• A mean of 4.4 years after surgery, bariatric patients were still more susceptible to fracture (4.1%) than were obese (2.7%) and non-obese (2.4%) controls.

• Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (RR 1.38) and non-obese (RR 1.44) groups.

• Fracture risk was site specific and changed from a pattern associated with obesity to a pattern typical of osteoporosis after surgery.

Citation: Rousseau C, Jean S, Gamache P, et al. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. [Published online ahead of print July 27, 2016]. BMJ. doi:10.1136/bmj.i3794.

Commentary: This study shows that very obese patients have a higher fracture risk compared to obese or non-obese individuals. The reasons for this are not entirely clear but may be due to increased stress on the bone, vitamin D deficiency, or falls. The type of fracture changed from primarily lower limb fractures to fractures more typical of osteoporotic fractures after surgery, suggesting systematic changes in bone metabolism after bariatric surgery. This is helpful information as part of the risk/benefit discussion for patients contemplating bariatric surgery. —Neil Skolnik, MD

Edited: Found the study: http://www.bmj.com/content/354/bmj.i3794

 

[KathrynK]

Great information, thank you. From personal experience, after a broken wrist, kneecap and femur in falls since my 2005 DS, it is interesting that the fracture risk in the study was so high. I was recently diagnosed with "diffuse osteopenia"-- essentially on the border of osteoporosis. But I am 65 years old and many women my age have the same issues, without DS. I was advised to increase weight bearing exercise, and increase my calcium, and up my D to 60,000/day (even though I am compulsive about supplements and the levels were ok now.) It's always surprising when a doctor says "in women of your weight", and he is talking about low rather than high! In the article, there were interesting possible explanations for the fracture risk. But what about what we don't know? Nutrition science has a lot of unknowns. Is there some neurological balance effect of some vitamin/mineral deficiency? Are optimal blood levels of vitamin/minerals the same in the bariatric population as in normies? Should a certain number of hours of weight-bearing exercise per week be mandatory after surgery? Should there be a regular evaluation by a bone specialist after surgery? The orthopedist suggested I aim for the highest levels (within limits) rather than the middle levels on tests for vitamin D. Still, I have no doubt that diabetes and hypertension would have killed me by now, if I didn't have DS, so at least I am living long enough to encounter the diseases of old age. Looking back, I wish I had placed greater attention on exercise to strengthen my bones. Hope it is not too late.

 

[southernlady]

But I am 65 years old and many women my age have the same issues, without DS. I was advised to increase weight bearing exercise, and increase my calcium, and up my D to 60,000/day (even though I am compulsive about supplements and the levels were ok now.)

What was your last PTH? You might need more D to help bring that down.

 

[KathrynK]

It was 90 pg/mL; the upper limit of normal for that lab is 88, so barely high and within the margin of error. I asked about potential toxicity of vitamin D at higher and higher doses and was told they don't know, but haven't seen problems at 60,000/d.

 

[southernlady]

It was 90 pg/mL; the upper limit of normal for that lab is 88, so barely high and within the margin of error. I asked about potential toxicity of vitamin D at higher and higher doses and was told they don't know, but haven't seen problems at 60,000/d.

You actually want your PTH as low as possible. My lab range is 15-65. Mine is 19.

 

[DSRIGGS]

It was 90 pg/mL; the upper limit of normal for that lab is 88, so barely high and within the margin of error. I asked about potential toxicity of vitamin D at higher and higher doses and was told they don't know, but haven't seen problems at 60,000/d.

It is almost impossible to get vitamin d toxicity and 60,000 iu means nothing as we don't absorb like normies. That is why we take so much. FYI I get a vitamin d injection every 6 months and still have to take 300,000 iu daily to keep it up in the range where it should be (80-100) and to keep my PTH down.