BONE FRACTURES INCREASING FOLLOWING OBESITY SURGERY

The findings came from long-term follow-up of about 97 patients -- mean age 44, 86 women -- who had bariatric surgery from 1985 to 2004. Gastric bypass accounted for 90% of the surgical procedures, and the rest of the patients had either vertical banded gastroplasty or biliopancreatic diversion. Follow-up averaged seven years.

Compared with the fracture rate in Olmsted County, Minn., which includes Rochester, investigators found that the bariatric surgery patients had a standard incidence ratio (SIR) of 1.8 for first fracture at any site (95% CI 1.1 to 2.8).

The SIR for fracture of the hip, wrist, spine, and humerus was 1.4 (95% CI 0.5 to 3.1). The ratio for first fracture at all other sites was 2.1 (95% CI 1.2 to 3.3) and was driven by a SIR of 3.3 for hand fractures and 3.9 for foot fractures, both of which were statistically significant.

"A majority of the fractures occurred more than two years after the surgery, suggesting this is a late complication of bariatric surgery. The extent of the findings came as a surprise, to investigators despite the fact that they hypothesized that bariatric surgery would increase fracture risk. The prevailing scientific opinion is that obesity affords protection against osteoporosis and, by extension, fractures.

The 97 patients are among almost 300 who had the obesity surgery. Investigators have now reviewed data on about half of the patients, and the overall fracture risk remains about twice the expected rate, although the difference is no longer statistically significant.

The risk of foot fracture, however, remains about threefold higher than would be predicted and is statistically significant.

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