Andrew D Ablett1, Bonnie R Boyle1, Alison Avenell2. 1. Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. 2. Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. a.avenell@abdn.ac.uk.
Abstract
BACKGROUND: Weight loss interventions for obesity, such as bariatric surgery, are associated with reductions in bone mineral density and may increase the risk of fractures. We undertook a systematic review and meta-analysis of bariatric surgery and lifestyle weight management programs (WMPs) with fracture outcomes. METHODS: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials from 1966 to 2018, and our trial registry of WMP randomized controlled trials (RCTs). We included RCTs, non-randomized trials, and observational studies of bariatric surgery, and RCTs of WMPs. Studies had follow-up ≥ 12 months, mean group body mass index ≥ 30 kg/m2. The primary outcome measure was incidence of any type of fracture in participants, and the secondary outcome was weight change. We used random effects meta-analysis for trial data. RESULTS: Fifteen studies were included. Three small trials provided short-term evidence of the association between bariatric surgery and participants with any fracture (365 participants; RR 0.82; 95% CI 0.29 to 2.35). Four out of six observational studies of bariatric surgery demonstrated significantly increased fracture risk. Six RCTs of WMPs with 6214 participants, the longest follow-up 11.3 years, showed no clear effect on any type of fracture (RR 1.04; 95% CI 0.91 to 1.18), although authors of the largest RCT reported an increased risk of frailty fracture by their definition (RR 1.40; 95% CI 1.04 to 1.90). CONCLUSION: Bariatric surgery appears to increase the risk of any fracture; however, longer-term trial data are needed. The effect of lifestyle WMPs on the risk of any fracture is currently unclear.
BACKGROUND: Weight loss interventions for obesity, such as bariatric surgery, are associated with reductions in bone mineral density and may increase the risk of fractures. We undertook a systematic review and meta-analysis of bariatric surgery and lifestyle weight management programs (WMPs) with fracture outcomes. METHODS: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials from 1966 to 2018, and our trial registry of WMP randomized controlled trials (RCTs). We included RCTs, non-randomized trials, and observational studies of bariatric surgery, and RCTs of WMPs. Studies had follow-up ≥ 12 months, mean group body mass index ≥ 30 kg/m2. The primary outcome measure was incidence of any type of fracture in participants, and the secondary outcome was weight change. We used random effects meta-analysis for trial data. RESULTS: Fifteen studies were included. Three small trials provided short-term evidence of the association between bariatric surgery and participants with any fracture (365 participants; RR 0.82; 95% CI 0.29 to 2.35). Four out of six observational studies of bariatric surgery demonstrated significantly increased fracture risk. Six RCTs of WMPs with 6214 participants, the longest follow-up 11.3 years, showed no clear effect on any type of fracture (RR 1.04; 95% CI 0.91 to 1.18), although authors of the largest RCT reported an increased risk of frailty fracture by their definition (RR 1.40; 95% CI 1.04 to 1.90). CONCLUSION: Bariatric surgery appears to increase the risk of any fracture; however, longer-term trial data are needed. The effect of lifestyle WMPs on the risk of any fracture is currently unclear.
Entities:
Keywords:
Bariatric surgery; Fractures; Obesity; Weight loss
Authors: Anne L Schafer; Galateia J Kazakia; Eric Vittinghoff; Lygia Stewart; Stanley J Rogers; Tiffany Y Kim; Jonathan T Carter; Andrew M Posselt; Courtney Pasco; Dolores M Shoback; Dennis M Black Journal: J Bone Miner Res Date: 2018-02-05 Impact factor: 6.741
Authors: Adam H Maghrabi; Kathy Wolski; Beth Abood; Angelo Licata; Claire Pothier; Deepak L Bhatt; Steven Nissen; Stacy A Brethauer; John P Kirwan; Philip R Schauer; Sangeeta R Kashyap Journal: Obesity (Silver Spring) Date: 2015-07-20 Impact factor: 5.002
Authors: Jessica Zibellini; Radhika V Seimon; Crystal M Y Lee; Alice A Gibson; Michelle S H Hsu; Sue A Shapses; Tuan V Nguyen; Amanda Sainsbury Journal: J Bone Miner Res Date: 2015-06-16 Impact factor: 6.741
Authors: Jun Ma; Veronica Yank; Lan Xiao; Philip W Lavori; Sandra R Wilson; Lisa G Rosas; Randall S Stafford Journal: JAMA Intern Med Date: 2013-01-28 Impact factor: 21.873
Authors: D Hofsø; N Nordstrand; L K Johnson; T I Karlsen; H Hager; T Jenssen; J Bollerslev; K Godang; R Sandbu; J Røislien; J Hjelmesaeth Journal: Eur J Endocrinol Date: 2010-08-26 Impact factor: 6.664
Authors: Anita P Courcoulas; Bret H Goodpaster; Jessie K Eagleton; Steven H Belle; Melissa A Kalarchian; Wei Lang; Frederico G S Toledo; John M Jakicic Journal: JAMA Surg Date: 2014-07 Impact factor: 14.766
Authors: Gail L Daumit; Faith B Dickerson; Nae-Yuh Wang; Arlene Dalcin; Gerald J Jerome; Cheryl A M Anderson; Deborah R Young; Kevin D Frick; Airong Yu; Joseph V Gennusa; Meghan Oefinger; Rosa M Crum; Jeanne Charleston; Sarah S Casagrande; Eliseo Guallar; Richard W Goldberg; Leslie M Campbell; Lawrence J Appel Journal: N Engl J Med Date: 2013-03-21 Impact factor: 91.245
Authors: Karen C Johnson; George A Bray; Lawrence J Cheskin; Jeanne M Clark; Caitlin M Egan; John P Foreyt; Katelyn R Garcia; Stephen Glasser; Frank L Greenway; Edward W Gregg; Helen P Hazuda; Andrea Hergenroeder; James O Hill; Edward S Horton; John M Jakicic; Robert W Jeffery; Steven E Kahn; William C Knowler; Cora E Lewis; Marsha Miller; Maria G Montez; David M Nathan; Jennifer L Patricio; Anne L Peters; Xavier Pi-Sunyer; Henry J Pownall; David Reboussin; J Bruce Redmon; Helmut Steinberg; Thomas A Wadden; Lynne E Wagenknecht; Rena R Wing; Catherine R Womack; Susan Z Yanovski; Ping Zhang; Ann V Schwartz Journal: J Bone Miner Res Date: 2017-07-28 Impact factor: 6.741
Authors: Kristen M Beavers; Daniel P Beavers; Adolfo Z Fernandez; Katelyn A Greene; Ashlyn A Swafford; Ashley A Weaver; Sarah J Wherry; Jamy D Ard Journal: Clin Obes Date: 2021-09-27
Authors: Fernando M Mendonça; João S Neves; Maria M Silva; Marta Borges-Canha; Cláudia Costa; Pedro M Cabral; Vanessa Guerreiro; Rita Lourenço; Patrícia Meira; Maria J Ferreira; Daniela Salazar; Jorge Pedro; Sara Viana; Selma Souto; Ana Varela; Sandra Belo; Eva Lau; Paula Freitas; Davide Carvalho Journal: Obes Surg Date: 2021-06-12 Impact factor: 4.129
Authors: Fernando Guerrero-Pérez; Anna Casajoana; Carmen Gómez-Vaquero; Nuria Virgili; Rafael López-Urdiales; Laura Hernández-Montoliu; Jordi Pujol-Gebelli; Javier Osorio; Anna Prats; Anna Vidal-Alabró; Manuel Pérez-Maraver; Sonia Fernández-Veledo; Joan Vendrell; Nuria Vilarrasa Journal: J Clin Med Date: 2020-06-11 Impact factor: 4.241
Authors: Danielle E Robinson; Ian Douglas; Garry D Tan; Antonella Delmestri; Andrew Judge; Cyrus Cooper; M Kassim Javaid; Victoria Y Strauss; Daniel Prieto-Alhambra Journal: J Bone Miner Res Date: 2021-07-29 Impact factor: 6.390