Sleeve Gastrectomy Reduces Risk of Fracture

Syed Khalid, MD

Findings of a recent analysis suggest bariatric surgery is associated with a reduced risk of fracture in eligible patients.

The results of the retrospective multicenter cohort study demonstrated the possible best option for weight loss in patients concerned with fractures: sleeve gastrectomy.

Syed Khalid, MD, and a team of investigators assessed the rates of fractures associated with obesity and compared the rates between those who did not undergo bariatric surgery, those who underwent Roux-en-Y gastric bypass (RYGB), and those who underwent sleeve gastrectomy. The colleagues retrospectively analyzed Longitudinal Medicare Standard Analytic Files which contained 100% of inpatient and outpatient facility records billed to Medicare derived from Medicare parts A and B from January 2004-December 2014.

Patients were eligible for bariatric surgery if they were adults with a body mass index (BMI) >40, > 100 pounds overweight, or a BMI >35 with >1 obesity-related comorbidity—type 2 diabetes, hypertension, obstructive sleep apnea and other respiratory disorders, nonalcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease. The team excluded patients who were billed due to cancer, transplant, end-stage kidney disease, previous gastric operations, gastric banding procedures, or fractures prior to undergoing bariatric surgery.

Khalid and the team collected demographic data from records including sex and age. Data on comorbidities were also collected using ICD-9-CM diagnosis codes.

The primary outcome of the study was the odds of fracture based on exposure to bariatric surgery over a three-year period. Additional measures included odds of site-specific fractures based on exposure to bariatric surgery. ICD-9 codes were used to identify humeral, radial and ulnar, pelvic, hip, and vertebral fractures.

Overall, more than 3 million patients were eligible for participation in the study. Following the exclusion of those who were missing information, nearly 2.2 million were eligible but did not undergo either RYGB or sleeve gastrectomy. In total, 71,783 patients underwent RYGB, and 17,070 underwent sleeve gastrectomy as a weight loss intervention.

Nearly 50,000 patients were included and made up equally of 16,371 patients who did not undergo surgery, 16,371 patients who underwent RYGB, and 16,371 patients who underwent sleeve gastrectomy. Each group consisted of 25.1% men and 74.9% women and had an equal distribution of ages. A majority of the patients (72%) were <64 years old, while 25.8% were 65-69 years old, 2.1% were 70-74 years old, and .1% were 75-79 years old.

Those who underwent RYGB had no significant difference in odds of fractures compared with those eligible for bariatric surgery who did not choose to undergo it. Patients who underwent sleeve gastrectomy had decreased odds of fractures of the humerus (OR, .57; 95% CI, .45-.73), radius or ulna (OR, .38; 95% CI, .25-.58), hip (OR, .49; 95% CI, .33-.74), pelvis (OR, .34; 95% CI, .18-.64), vertebrae (OR, .6; 95% CI, .48-.74), or fractures in general (OR, .53; 95% CI, .46-.62).

In comparison to those who underwent sleeve gastrectomy, those who underwent RYGB had a significantly greater risk of total fractures (OR, 1.79; 95% CI, 1.55-2.06) and humeral fractures (OR, 1.6; 95% CI, 1.24-2.07).

The findings highlighted that sleeve gastrectomy may be the best option for weight loss in those concerned about fractures due to the increased risk of fractures associated with RYGB.

The study, “Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity,” was published online on JAMA Network Open.