Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study

Arief Lalmohamed, Frank de Vries, Marloes T Bazelier, Alun Cooper, Tjeerd-Pieter van Staa, Cyrus Cooper, Nicholas C Harvey, Arief Lalmohamed, Frank de Vries, Marloes T Bazelier, Alun Cooper, Tjeerd-Pieter van Staa, Cyrus Cooper, Nicholas C Harvey

Abstract

Objectives: To estimate fracture risk in patients receiving bariatric surgery versus matched controls.

Design: Population based, retrospective cohort study.

Setting: Use of records from the United Kingdom General Practice Research Database, now known as the Clinical Practice Research Datalink (from January 1987 to December 2010).

Participants: Patients with a body mass index of at least 30, with a record of bariatric surgery (n=2079), and matched controls without a record (n=10,442). Each bariatric surgery patient was matched to up to six controls by age, sex, practice, year, and body mass index. Patients were followed from the date of bariatric surgery for the occurrence of any fracture. We used time dependent Cox regression to calculate relative rates of fracture, adjusted for disease and previous drug treatment, and time-interaction terms to evaluate fracture timing patterns.

Main outcome measure: Relative rates of any, osteoporotic, and non-osteoporotic fractures.

Results: Mean follow-up time was 2.2 years. Overall, there was no significantly increased risk of fracture in patients who underwent bariatric surgery, compared with controls (8.8 v 8.2 per 1000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33). Bariatric surgery also did not affect risk of osteoporotic and non-osteoporotic fractures. However, we saw a trend towards an increased fracture risk after three to five years following surgery, as well as in patients who had a greater decrease in body mass index after surgery, but this was not significant.

Conclusion: Bariatric surgery does not have a significant effect on the risk of fracture. For the first few years after surgery, these results are reassuring for patients undergoing such operations, but do not exclude a more protracted adverse influence on skeletal health in the longer term.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the International Osteoporosis Foundation and SERVIER for the submitted work; AL, FV, MB, and TS are employed by the Division of Pharmacoepidemiology and Clinical Pharmacology at Utrecht Institute for Pharmaceutical Sciences, which has received unrestricted research funding from the Netherlands Organisation for Health Research and Development, Dutch Health Care Insurance Board, Royal Dutch Pharmacists Association, private-publicly funded Top Institute Pharma (www.tipharma.nl, which includes cofunding from universities, government, and industry), EU Innovative Medicines Initiative, EU 7th Framework Program, Dutch Medicines Evaluation Board, Dutch Ministry of Health and industry (including GlaxoSmithKline, Pfizer); no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790627/bin/lala004608.f1_default.jpg
Fig 1 Number of bariatric surgery procedures performed between 1990 and 2010, by year and type of bariatric surgery
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790627/bin/lala004608.f2_default.jpg
Fig 2 Spline regression plot of time since bariatric surgery and risk of any fracture in bariatric surgery patients versus matched controls. Risk adjusted for confounders as shown in table 2

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