The most effective surgery for weight loss is also one that is associated with the highest risk of secondary fractures. The bariatric surgery, called Roux-en-Y, has been linked to secondary fractures in a recent study.
Obese patients undergoing surgery for anastomosis (Roux-en-Y surgery) have a higher risk of non-vertebral fractures than those with a simple gastric band. This is the result of a new study presented at the ENDO 2018 Congress, the 100th Annual Meeting of the Endocrine Society in Chicago.
“Bariatric surgery procedures, such as Roux-en-Y surgery, are highly effective and induce sustained weight loss,” said study author El Hari Wei-Yin Yu of Harvard University Medical School, Boston, “but they can increase the risk of fracture.”
Increased fracture risk
Obese people in a Medicare cohort who underwent gastro-ileal anastomosis (Roux-en-Y surgery) had more fractures than those who had a gastric band. Compared with obese patients who had a gastric band, bariatric surgery, such as Roux-en-Y surgery, increased the risk of hip fractures by 126%, the wrist by 62% and the pelvis by 172%.
This increase in the risk of fracture is observed in all age groups and in men and women, although the effects were more pronounced in men. Bariatric surgery of the Roux-en-Y type increases the overall risk of fracture more markedly in men (108%) than in women (42%).
Marked risk with “Roux-en-Y” anastomosis surgery
The professor Yu and colleagues analyzed fracture rates in a cohort of 50,649 obese adult Medicare patients with severe obesity who underwent surgery (78% female, 22% Male). They compared those who had Roux-en-Y surgery (n = 35,920) and those who had a gastric band (n = 14,729) between 2006 and 2014. The authors compared fracture rates between the two groups, taking into account differences in age, sex, race, geographic location, co-morbidities and prescribed medications.
Obese patients who had bariatric anastomosis surgery had a lower average age than patients who had a ring (53 vs. 56 years), and were more likely to have diabetes (36% vs. 32%).
A total of 1,109 non-vertebral fractures were reported during follow-up. The estimated incidence rates for non-vertebral fractures per 1,000 patient-years are 9.8 in the Roux-en-Y surgery group and 7.1 in the gastric band group. Age or diabetes did not change the risk of fracture.
Adaptation of follow-up conditions after surgery
“This study is very interesting given the high prevalence of obesity and the increasing use of bariatric surgery. More than a third of adults in the United States are obese, and bariatric surgery procedures are becoming more common,” said Professor Yu.
The potential impact of bariatric surgery, which aims to replace a metabolic disease with a disease of digestive malabsorption, should be discussed with patients before surgery. Different deficiencies may occur due to intestinal malabsorption, including a lack of vitamin D absorption, and these must be compensated.
These results also underline the importance of developing optimized post-operative follow-up for these patients and treatments to counter the risk of fracture after Roux-en-Y type bariatric surgery.