Quick Take: Fracture risk after Roux-en-Y gastric bypass adjustable gastric banding among Medicare beneficiaries

Roux-en-Y gastric bypass (RYGB) is associated with significant bone loss and may increase fracture risk as a result. This is in contrast to other bariatric procedures, such as adjustable gastric banding (AGB), which has not been found to confer the same fracture risk to date. In this retrospective cohort study, 42,345 severely obese adults that underwent either RYGB or AGB were followed up using Medicare claims (2006-2014), to compare fracture risk after RYGB and AGB procedures. Of note, 78.5% of participants were women, with a mean age of 51 years. Researchers found that the fracture incidence rate was 6.6 (95% CI 6.0 to 7.2) after RYGB as compared to 4.6 (95% CI 3.9 to 5.3) after AGB (HR 1.73, 95% CI 1.45 to 2.08). Skeletal site-specific analyses demonstrated an increased risk of fracture at the hip (HR 2.81, 95% CI 1.82 to 4.49), wrist (HR 1.70, 95% CI 1.33 to 2.14), and pelvis (HR 1.48, 95% CI 1.08 to 2.07) among RYGB recipients. In a subgroup analysis of patients age 65 years and older, researchers also found that the incidence rate for any non-vertebral fracture was 9.9 per 1000 person-years (95% CI 7.6 to 11.7) in patients from the RYGB group, compared to 5.3 per 1000 person-years (95% CI 3.6 to 6.7) in patients who underwent AGB. This study therefore shows that when compared to those undergoing AGB, patients undergoing RYGB are at a significantly increased risk of fracture.

Click to read the study in JAMA Surgery

Image: PD

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