Bariatric Surgery Ups the Risk of Major and Any Fracture, but Not Peripheral Fracture

Pavankumar Kamat


July 15, 2021


  • Patients with obesity had an increased risk of major and any fracture, but not peripheral fracture within 5 years of bariatric surgery.

Why this matters

  • Findings suggest that patients undergoing bariatric surgery should be evaluated for their risk of fracture.

  • Future studies are warranted to determine the risk-benefit of calcium and vitamin D supplementation following bariatric surgery.

Study design

  • Researchers performed 2 retrospective studies (1 self-controlled case series [SCCS] and 1 cohort) involving 5487 participants with obesity (age, ≥18 years; body mass index, ≥30 kg/m2) who underwent bariatric surgery, identified from the UK Clinical Practice Research Datalink (CPRD).

  • Funding: National Institute for Health Research.

Key results

  • In SCCS analyses:

    • Compared with 5 years before bariatric surgery, the relative incidence of major fractures was higher in the 5 years after surgery (incidence rate ratio [IRR], 2.70; 95% CI, 1.31-5.57).

    • The relative incidence of major fractures (IRR, 4.98; 95% CI, 1.94-12.78) and any fractures (IRR, 1.73; 95% CI, 1.08-2.77) was higher at 2-5 years post-surgery.

    • The relative incidence of peripheral fracture did not increase in the 5 years post-surgery.

  • In the cohort study:

    • Female gender (adjusted OR [aOR], 3.32; 95% CI, 1.18-9.36) was the strongest predictor of major fracture, followed by the use of anxiolytics/sedatives/hypnotics (aOR, 2.56; 95% CI, 1.29-5.05) and age (aOR, 1.23 per 5-year increase; 95% CI, 1.09-1.40).


  • Retrospective design.


Robinson DE, Douglas I, Tan GD, Delmestri A, Judge A, Cooper C, Javaid MK, Strauss VY, Prieto-Alhambra D. Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink. J Bone Miner Res. 2021 Jun 25 [Epub ahead of print]. doi: 10.1002/jbmr.4405. PMID: 34173277.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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