Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1327-1342 |
| Number of pages | 16 |
| Journal | Obesity Surgery |
| Volume | 29 |
| Issue number | 4 |
| Early online date | 6 Feb 2019 |
| DOIs | |
| Publication status | Published - Apr 2019 |
Fingerprint
Keywords
- fractures
- bariatric surgery
- obesity
- weight loss
- Obesity
- Fractures
- Bariatric surgery
- Weight loss
- BONE-MINERAL DENSITY
- PREVENTION
- RISK
- DEFICIENCIES
- CARE
- VITAMIN
- OUTCOMES
- INTERVENTION
ASJC Scopus subject areas
- Nutrition and Dietetics
- Surgery
- Endocrinology, Diabetes and Metabolism
Cite this
Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity : Systematic Review and Meta-analysis. / Ablett, Andrew D. (Corresponding Author); Boyle, Bonnie R; Avenell, Alison (Corresponding Author).
In: Obesity Surgery, Vol. 29, No. 4, 04.2019, p. 1327-1342.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity
T2 - Systematic Review and Meta-analysis
AU - Ablett, Andrew D.
AU - Boyle, Bonnie R
AU - Avenell, Alison
N1 - Open access via Springer Compact Agreement The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.
PY - 2019/4
Y1 - 2019/4
N2 - BackgroundWeight 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.MethodsWe 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.ResultsFifteen 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).ConclusionBariatric 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.
AB - BackgroundWeight 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.MethodsWe 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.ResultsFifteen 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).ConclusionBariatric 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.
KW - fractures
KW - bariatric surgery
KW - obesity
KW - weight loss
KW - Obesity
KW - Fractures
KW - Bariatric surgery
KW - Weight loss
KW - BONE-MINERAL DENSITY
KW - PREVENTION
KW - RISK
KW - DEFICIENCIES
KW - CARE
KW - VITAMIN
KW - OUTCOMES
KW - INTERVENTION
UR - http://www.scopus.com/inward/record.url?scp=85061190010&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/fractures-adults-after-weight-loss-bariatric-surgery-weight-management-programs-obesity-systematic-r
U2 - 10.1007/s11695-018-03685-4
DO - 10.1007/s11695-018-03685-4
M3 - Article
VL - 29
SP - 1327
EP - 1342
JO - Obesity Surgery
JF - Obesity Surgery
SN - 0960-8923
IS - 4
ER -