Gabriel Marcil, MD1, Jonathan Bourget-Murray, MD1, Noah Switzer, MD2, Estifanos Debru, MD1, Neal Church, MD1, Philip Mitchell, MD1, Rajrishi Sharma, MD1, Richdeep S. Gill, MD1. 1University of Calgary, 2University of Alberta
INTRODUCTION: Bariatric surgery is a highly effective treatment for severe obesity. While its effect on improvement of the metabolic syndrome is well described, its effect on intrinsic bone fragility and fracture propagation is unclear. Therefore, the aims of this systematic review of the literature were to examine (1) the incidence of fracture following bariatric surgery, (2) the association of fracture with the specific bariatric surgical procedure (3) site-specific types of fractures associated with bariatric surgery.
METHODS: A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were gastric bypass, sleeve gastrectomy and fracture.
RESULTS: For the systematic review, 8 studies were included (n=42,567 patients) This included no randomized controlled trials. The average patient age was 43.3 years and 24.9% of patients were male. The average follow-up time was 3.66 years. One thousand nine hundred and sixty patients had at least one fracture of any type, and the total absolute number of fractures encountered was 2326. In all, 4.6% of patients who underwent bariatric surgery suffered from a fracture post-operatively. The greatest risk of fractures was associated with Biliopancreatic diversion (BPD) (10.51%), followed by restrictive procedures such as Adjustable Gastric Band (AGB) and Sleeve Gastrectomy (5.71%), with the Roux-en Y Gastric Bypass having the lowest risk (2.66%). Of the fractures encountered, 1466 (63.03%) were of the lower extremity and pelvis and 763 (32.8%) were of the upper extremity. Only 90 (3.87%) axial skeleton fractures were recorded.
CONCLUSION: It appears that the overall risk of sustaining a fracture of any type after undergoing bariatric surgery is approximately 5 percent after an average follow up of 3.6 years. The greatest risk of fractures is associated with the BPD, with the RYGB being the most favorable. Fractures following bariatric surgeries tend to follow osteoporotic and fragility patterns. Post-operative supplementation of vitamin D, calcium and weight bearing exercises need to be optimized, and long term follow-up studies will be needed to confirm that these interventions will indeed reduce fracture risk following bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86609
Program Number: P621
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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