In the study, obese patients who undergo bariatric surgery, the surgical treatment of morbid obesity, were found to have doubled their risk of fractures, mostly in the bones of the hands and feet.
Bariatric surgery is a medical procedure to treat severe obesity, a chronic condition that is difficult to treat through diet and exercise alone. The procedure includes the gastric bypass procedure as one of the numerous operations. The operation is an option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems.
The procedure produces weight loss by restricting food intake and, in some cases, interfering with nutrition through malabsorption, which results in low bone density in most patients.
"We knew there was a dramatic and extensive bone turnover and loss of bone density after bariatric surgery," study senior author Dr. Jackie Clowes, a Mayo rheumatologist, said in a Mayo news release. "But we didn't know what that meant in terms of fractures."
Study of bariatric surgery subjects
For the study, Clowes and colleagues analyzed medical records of 97 people- including 86 women, average age of 44 years- who underwent bariatric procedures, either stapling of the stomach (gastric bypass) or banding of the stomach (gastric band surgery) for medically complicated obesity from 1985 to 2004.
After an average seven-year follow-up, the research team noticed 31 fractures in 21 patients. These patients who had bariatric surgery were 1.8 times more likely to have a first fracture at any site of the body compared to people of the same age and sex who had not had the surgery.
Mayo Clinic researchers found that most breaks occurred in the bones of the hands and feet, with an increase of more than three times and almost four times, respectively. In addition, fractures were also reported in hip, spine and humerus (upper arm bone).
The study authors agree that bariatric surgery results in an increased bone turnover, which could cause an increased risk of fractures, but said larger study is required to determine what causes the increased risk for fractures.
“It is currently unclear why fractures are more common after bariatric surgery, especially at the hand and foot,” said Clowes. “There are data suggesting that obesity appears to protect against fracture. Given this, it would suggest that it is a complication of the procedure itself that leads to fractures.”
She added that, “although aggressive calcium and vitamin D supplementation after (bariatric) surgery may well help, it may still be insufficient to prevent the increased risk of fracture.”
To understand the specific risk factors and mechanisms involved in sheer increase of fracture risk, the research team now plans to examine data on the remaining patients who had bariatric surgery.
The findings of the ongoing study were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.
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