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Gastric bypass associated with higher non-vertebral fracture risk than gastric banding

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People who have a certain type of weight loss surgery may face a higher risk of non-vertebral fracture, new research suggests.

In a study presented at ENDO 2018, the 100th annual meeting of the Endocrine Society, patients undergoing Roux-en-Y gastric bypass (RYGB) surgery were found to have a greater risk for hip, wrist and pelvis fractures than those having adjustable gastric banding (AGB).

“Bariatric surgery procedures, such as RYGB, are highly effective treatments that induce sustained weight loss,” said lead study author Dr Elaine Wei-Yin Yu. “RYGB leads to greater improvements in metabolic health than AGB, but RYGB also causes accelerated bone loss and may increase fracture risk.”

RYGB was associated with an increased fracture risk across all age groups, in men and in women, although the effects were more pronounced among men, Yu explained.

The study included patients with severe obesity who underwent either RYGB or AGB surgery between 2006 and 2014.

Researchers analysed Medicare billing claims data from 50,649 adults (78% women), of whom 35,920 underwent RYGB and 14,729 underwent AGB. They compared fracture rates between the two groups, controlling for differences in age, sex, race, geographical location, index date, degree of healthcare utilisation, comorbidities, and prescribed medications.

On average, RYGB patients were younger than AGB patients (53 vs 56 years of age), and they were more likely to have diabetes (36% vs 32%) as well as a shorter average follow-up time (3.1 vs 3.8 years).

A total of 1,109 non-vertebral fractures were reported during follow-up, and the analysis showed that, compared with patients who received banding, those who underwent bypass had a 126% increased risk of hip fracture, a 62% increased risk of wrist fracture, and a 172% increased risk of pelvis fracture.

Gastric bypass increased overall fracture risk more dramatically in men (108%) than in women (42%), but age or diabetes status did not affect RYGB-associated fracture risk, the Endocrine Society reported.

“Long-term skeletal health should be discussed and managed for all patients undergoing bariatric surgery,” Yu said. “These data also emphasise the importance of devising therapies that can counteract fracture risk after gastric bypass.”