Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity

Systematic Review and Meta-analysis

Andrew D. Ablett (Corresponding Author), Bonnie R Boyle, Alison Avenell (Corresponding Author)

Research output: Contribution to journalArticle

2 Citations (Scopus)
5 Downloads (Pure)

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.
Original languageEnglish
Pages (from-to)1327-1342
Number of pages16
JournalObesity Surgery
Volume29
Issue number4
Early online date6 Feb 2019
DOIs
Publication statusPublished - Apr 2019

Fingerprint

Bariatric Surgery
Meta-Analysis
Weight Loss
Obesity
Weights and Measures
Randomized Controlled Trials
Observational Studies
Life Style
MEDLINE
Bone Density
Registries
Body Mass Index
Outcome Assessment (Health Care)
Incidence

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 journalArticle

@article{4db9cbddd47c49e6bfadb57f9e3e82a2,
title = "Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity: Systematic Review and Meta-analysis",
abstract = "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.",
keywords = "fractures, bariatric surgery, obesity, weight loss, Obesity, Fractures, Bariatric surgery, Weight loss, BONE-MINERAL DENSITY, PREVENTION, RISK, DEFICIENCIES, CARE, VITAMIN, OUTCOMES, INTERVENTION",
author = "Ablett, {Andrew D.} and Boyle, {Bonnie R} and Alison Avenell",
note = "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.",
year = "2019",
month = "4",
doi = "10.1007/s11695-018-03685-4",
language = "English",
volume = "29",
pages = "1327--1342",
journal = "Obesity Surgery",
issn = "0960-8923",
publisher = "Springer New York",
number = "4",

}

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 -