Gastric bypass but not sleeve gastrectomy increases risk of major osteoporotic fracture: French population‐based cohort study

OBJECTIVE: To investigate the risk of major osteoporotic fracture (MOF - hip, proximal humerus, wrist and distal forearm, and clinical spine) in bariatric surgery patients versus matched controls. BACKGROUND: Bariatric surgery is associated with an increase in fracture risk. However, it remains unclear whether the same degree of fracture risk is associated with sleeve gastrectomy, which has recently surpassed gastric bypass. METHODS: Records from the French National Inpatient database were used from 2008 to 2018. Bariatric surgery patients, aged 40-65, with BMI ≥40 kg/m², hospitalised between January 1st, 2010 and December 31st, 2014 were matched to one control (1:1) by age, sex, Charlson Comorbidity Index, year of inclusion and class of obesity (40-49.9 vs. ≥50 kg/m²). We performed a Cox regression analysis to assess the association between the risk of any MOF, and respectively (i) bariatric surgery (yes/no), (ii) type of surgical procedure (gastric bypass, gastric banding, vertical banded gastroplasty and sleeve gastrectomy) versus no surgery. RESULTS: 81,984 patients were included in the study (40,992 in the bariatric surgery group, and 40,992 matched controls). There were 585 MOFs in the surgical group (2.30 cases per 1000 PY) and 416 MOFs in the matched controls (1.93 cases per 1000 PY). The risk of MOF was significantly higher in the surgical group (HR = 1.22 [1.08 to 1.39]). We observed an increase in risk of MOF for gastric bypass only (HR=1.70 [1.46 to 1.98]) compared with the matched controls. CONCLUSIONS: In patients aged 40-65, gastric bypass but not sleeve gastrectomy or the other procedures increased risk of major osteoporotic fractures. This article is protected by copyright. All rights reserved.