Fracture risk after gastric bypass surgery: a retrospective cohort study
Open accessAbstract
Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38,971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31,213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation 1-year postsurgery was investigated. During a median follow-up time of 3.1 (interquartile range [IQR], 1.7 to 4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (hazard ratio [HR] 1.26; 95% CI, 1.05 to 1.53; and HR 1.32; 95% CI, 1.18 to 1.47; respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. © 2018 American Society for Bone and Mineral Research.
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A retrospective analysis found that Roux-en-Y gastric bypass was linked to increased risk of falls and fractures that escalated over time, and these risks were unrelated to amount of weight lost or presence of calcium and vitamin D supplementation.
“investigators found not only that RYGB was linked to an increased risk of falls and fractures that escalated over time but also that these risks were unrelated to the amount of weight lost or the presence of calcium and vitamin D supplementation (36).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [36]
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- Authors
- Axelsson, K. F., Werling, M., Eliasson, B., Szabo, E., Näslund, I., Wedel, H., Lundh, D., & Lorentzon, M.
- Affiliations
- Skaraborg Hospital (SE)
- University of Gothenburg (SE)
- Department of Surgery. Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Örebro University (SE)
- University of Skövde (SE)
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Lorentzon, Mattias
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-07-16
- Volume
- 33
- Issue
- 12
- Pages
- 2122-2131
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W2884324039
- Cited by
- 105
- References
- 39
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 12 · 2023: 6 · 2022: 17 · 2021: 14 · 2020: 20 · 2019: 21 · 2018: 5 · 2017: 1
- FWCI
- 15.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Bone and Mineral Research (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Funders
- Research fund
- Sahlgrenska University Hospital
- Swedish Research Council (VR)
- Gustaf V:s och Drottning Victorias Frimurarstiftelse
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- gastric bypass, fracture risk, bariatric surgery, obesity, diabetes mellitus, fall-related injuries, weight loss, calcium supplementation, vitamin D supplementation, bone loss
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Gastric Bypass, Proportional Hazards Models, Case-Control Studies, Treatment Outcome, Fractures, Bone, Propensity Score
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