In the Journals

Fracture risk 73% higher after Roux-en-Y gastric bypass than adjustable gastric banding

Older adults who undergo Roux-en-Y gastric bypass surgery are 73% more likely to experience a nonvertebral fracture compared with those who undergo adjustable gastric banding, according to findings published in JAMA Surgery.

Elaine W. Yu

“The clinical take-home message is that it is important to monitor the long-term skeletal health of patients who have received Roux-en-Y gastric bypass surgery,” Elaine W. Yu, MD, MMSc, an assistant professor at Harvard Medical School, director of the Bone Density Center at Massachusetts General Hospital in Boston, told Endocrine Today. “This study is clinically relevant as bariatric procedures are increasingly performed in older adults who are already at increased risk for fracture and for whom hip fractures can be especially debilitating.”

Yu and colleagues identified 29,624 adults who underwent Roux-en-Y gastric bypass (mean age, 51 years; 78.8% women) and 12,721 who underwent adjustable gastric banding (mean age, 55 years; 77.9% women) in Medicare claims from 2006 to 2014. All patients had a BMI of at least 40 kg/m2 before surgery. After surgery, those who had Roux-en-Y gastric bypass were followed for a mean of 3.3 years, and those with adjustable gastric bandings were followed for a mean of 3.9 years, with the researchers identifying instances of nonvertebral fracture.

The incidence rate of nonvertebral fracture was higher for those who had Roux-en-Y gastric bypass (6.6 per 1,000 person-years; 95% CI, 6-7.2) compared with those who had adjustable gastric banding (4.6 per 1,000 person-years; 95% CI, 3.9-5.3). The two groups had 658 nonvertebral fractures combined. The researchers noted that those who had Roux-en-Y gastric bypass were 73% more likely to experience a fracture (HR = 1.73; 95% CI, 1.45-2.08) and were also more likely to have hip (HR = 2.81; 95% CI, 1.82-4.49), wrist (HR = 1.7; 95% CI, 1.33-2.14) and pelvis (HR = 1.48; 95% CI, 1.08-2.07) fractures compared with those who had adjustable gastric banding.

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Older adults who undergo Roux-en-Y gastric bypass surgery are 73% more likely to experience a nonvertebral fracture compared with those who undergo adjustable gastric banding.
Adobe Stock

The gap in the incidence rate was more pronounced when comparing those aged at least 65 years who had Roux-en-Y gastric bypass (9.9 per 1,000 person-years; 95% CI, 7.6-11.7) with those aged at least 65 years who had adjustable gastric banding (5.3 per 1,000 person-years; 95% CI, 3.6-6.7). Similarly, among all individuals within this age range, nonvertebral fractures were more likely for those with Roux-en-Y gastric bypass (HR = 1.75; 95% CI, 1.22-2.52), including at the hip (HR = 2.51; 95% CI, 1.25-5.93) and wrist (HR = 1.65; 95% CI, 1.25-2.77), compared with those who had adjustable gastric banding.

“It is important to note, however, that bariatric surgery leads to many sustained benefits, such as long-term weight loss and improvements in obesity-related comorbidities, and therefore the reported increase in fracture risk should not prevent the use of [Roux-en-Y gastric bypass] among older adults,” Yu said. “Instead, we suggest that patients who receive [Roux-en-Y gastric bypass] warrant long-term follow-up of bone health with bone density screening and fracture risk assessments. Patients should also be reminded that appropriate calcium and vitamin D supplementation and weight-bearing exercise are lifelong requirements to maximize bone health.” – by Phil Neuffer

Disclosures: Yu reports she has received research grants from Seres Therapeutics. Please see the study for all other authors’ relevant financial disclosures.

Older adults who undergo Roux-en-Y gastric bypass surgery are 73% more likely to experience a nonvertebral fracture compared with those who undergo adjustable gastric banding, according to findings published in JAMA Surgery.

Elaine W. Yu

“The clinical take-home message is that it is important to monitor the long-term skeletal health of patients who have received Roux-en-Y gastric bypass surgery,” Elaine W. Yu, MD, MMSc, an assistant professor at Harvard Medical School, director of the Bone Density Center at Massachusetts General Hospital in Boston, told Endocrine Today. “This study is clinically relevant as bariatric procedures are increasingly performed in older adults who are already at increased risk for fracture and for whom hip fractures can be especially debilitating.”

Yu and colleagues identified 29,624 adults who underwent Roux-en-Y gastric bypass (mean age, 51 years; 78.8% women) and 12,721 who underwent adjustable gastric banding (mean age, 55 years; 77.9% women) in Medicare claims from 2006 to 2014. All patients had a BMI of at least 40 kg/m2 before surgery. After surgery, those who had Roux-en-Y gastric bypass were followed for a mean of 3.3 years, and those with adjustable gastric bandings were followed for a mean of 3.9 years, with the researchers identifying instances of nonvertebral fracture.

The incidence rate of nonvertebral fracture was higher for those who had Roux-en-Y gastric bypass (6.6 per 1,000 person-years; 95% CI, 6-7.2) compared with those who had adjustable gastric banding (4.6 per 1,000 person-years; 95% CI, 3.9-5.3). The two groups had 658 nonvertebral fractures combined. The researchers noted that those who had Roux-en-Y gastric bypass were 73% more likely to experience a fracture (HR = 1.73; 95% CI, 1.45-2.08) and were also more likely to have hip (HR = 2.81; 95% CI, 1.82-4.49), wrist (HR = 1.7; 95% CI, 1.33-2.14) and pelvis (HR = 1.48; 95% CI, 1.08-2.07) fractures compared with those who had adjustable gastric banding.

#
Older adults who undergo Roux-en-Y gastric bypass surgery are 73% more likely to experience a nonvertebral fracture compared with those who undergo adjustable gastric banding.
Adobe Stock

The gap in the incidence rate was more pronounced when comparing those aged at least 65 years who had Roux-en-Y gastric bypass (9.9 per 1,000 person-years; 95% CI, 7.6-11.7) with those aged at least 65 years who had adjustable gastric banding (5.3 per 1,000 person-years; 95% CI, 3.6-6.7). Similarly, among all individuals within this age range, nonvertebral fractures were more likely for those with Roux-en-Y gastric bypass (HR = 1.75; 95% CI, 1.22-2.52), including at the hip (HR = 2.51; 95% CI, 1.25-5.93) and wrist (HR = 1.65; 95% CI, 1.25-2.77), compared with those who had adjustable gastric banding.

“It is important to note, however, that bariatric surgery leads to many sustained benefits, such as long-term weight loss and improvements in obesity-related comorbidities, and therefore the reported increase in fracture risk should not prevent the use of [Roux-en-Y gastric bypass] among older adults,” Yu said. “Instead, we suggest that patients who receive [Roux-en-Y gastric bypass] warrant long-term follow-up of bone health with bone density screening and fracture risk assessments. Patients should also be reminded that appropriate calcium and vitamin D supplementation and weight-bearing exercise are lifelong requirements to maximize bone health.” – by Phil Neuffer

Disclosures: Yu reports she has received research grants from Seres Therapeutics. Please see the study for all other authors’ relevant financial disclosures.