RYGB may increase risk for fracture in adults
Risk for nonvertebral fracture and fractures at the hip and wrist may be more frequent in adults after Roux-en-Y gastric bypass compared with adjustable gastric band, study data show.
Elaine W. Yu, MD, of the endocrine unit, Massachusetts General Hospital in Boston, and colleagues evaluated claims data from United HealthCare (2005-2013) on adults (mean age, 44 years; 79% women) who underwent Roux-en-Y gastric bypass (RYGB; n = 7,516) or adjustable gastric band (n = 7,516) to determine the risk for fracture after each surgery. Follow-up time was similar between the two groups (RYGB, 2.3 years; adjustable gastric band, 1.9 years).
Overall, 281 nonvertebral fractures occurred in both groups for an incidence of 9.7 per 1,000 person-years in the RYGB group and 6.8 per 1,000 person-years in the adjustable gastric band group. Compared with the adjustable gastric band group, the RYGB group had an increased rate of nonvertebral fractures (HR = 1.43; 95% CI, 1.13-1.81), as well as higher risks for fracture at the hip (HR = 1.54; 95% CI, 1.03-2.3) and wrist (HR = 1.45; 95% CI, 1.01-2.07).
In the first 2 years after surgery, researchers observed no significant difference in nonvertebral fractures risk between the two groups but noted a progressive increase in the risk in the fifth year after surgery in the RYGB group (HR = 3.91; 95% CI, 1.58-9.64).
“This large population-based cohort study demonstrates that RYGB is associated with a 43% increase in the risk of clinically relevant fractures as compared with [adjustable gastric band],” the researchers wrote. “This higher risk becomes apparent after 2 years, and is driven predominately by fractures of the hip and the wrist. Fracture risk should be considered in risk–benefit discussions of bariatric surgery, particularly among patients with high baseline risk of osteoporosis who are deciding between RYGB and [adjustable gastric band] procedures. Furthermore, evaluation of skeletal health may be warranted for RYGB patients in the long-term postoperative period.” – by Amber Cox
Disclosure: Yu reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.