Fracture Risk After Bariatric Surgery: A Systematic Literature Review and Meta-Analysis

• Published in: Endocrine practice Vol. 28; no. 1; p. 58
• Main Authors: Chaves Pereira de Holanda, Narriane, de Lima Carlos, Ingrid, Chaves de Holanda Limeira, Caio, Cesarino de Sousa, David, Serra de Lima Junior, Fábio Antônio, Telis de Vilela Araújo, André, Peres Montenegro, Ana Carla, Bandeira, Francisco
• Format: Journal Article
• Language: English
• Published: United States 01.01.2022
• Subjects: Bariatric Surgery - adverse effects; Fractures, Bone - epidemiology; Fractures, Bone - etiology; Humans; Risk; bone fractures; obesity; bariatric surgery
• ISSN: 1530-891X
• DOI: 10.1016/j.eprac.2021.09.007

Bariatric surgery has undeniable benefits for cardiovascular and metabolic health, but it can result in negative effects on mineral and bone metabolism. This study aimed to review the current data on fractures after the main types of bariatric surgery. Therefore, a systematic review was performed using the electronic literature available in the databases LILACS, CENTRAL, Web of Science, Embase, and PubMed/MEDLINE, with results until January 2021. Keywords were descriptors for bariatric surgery or bariatric medicine or bariatrics or gastroplasty and bone or bones or bone fractures, referenced in all words of the text in the study. The meta-analysis of observational studies and interventional trials showed that the risk of any type of fracture was higher in the surgical group than in the nonsurgical group (relative risk [RR], 1.20 [95% confidence interval {CI}, 1.15-1.26; P < .00001; Phetero < 0.000001; I  = 94%], and RR, 1.16 [95% CI, 1.00-1.33; P = .04; Phetero = 0.27; I  = 23%], respectively). It is worth noting that the included interventional studies have a low rating on the risk of bias assessment scales. Compared with those who underwent restrictive procedures, subjects had an increased fracture risk after malabsorptive procedures (RR, 0.49 [95% CI, 0.40-0.61; P < .00001); Phetero = 0.96; I  = 0%). We found that bariatric procedures are associated with an increased risk of fractures, especially the malabsorptive techniques.