Bariatric Surgery Increases Fracture Risk

[WASaBubbleButt 41]

Bariatric Surgery Increases Fracture Risk

6/12/09

mayo Clinic researchers are reporting that persons who undergo bariatric surgery may have a greater chance of experiencing broken bones, especially in their hands and feet. The study is based on a review of nearly 100 surgical cases at Mayo spanning 21 years and presented at the Endocrinology Society Annual Meeting in Washington, D.C.

"We knew there was a dramatic and extensive bone turnover and loss of bone density after bariatric surgery," says Jackie Clowes, M.D., Ph.D., a Mayo rheumatologist and senior author on the study. "But we didn't know what that meant in terms of fractures."

The research team worked with Rochester Epidemiology Project records to develop the chart review of 97 of the 292 patients who underwent the bariatric procedure between 1984 and 2004. The findings, adjusted for age and gender factors, showed 21 individuals experienced 31 fractures within an average of seven years after surgery. Fractures were reported in the hip, spine and humerus (upper arm bone), with the majority of fractures in the hands and feet.

"We've shown that risk of fractures after this type of weight loss surgery is clinically significant," says Elizabeth Chittilapilly Haglind, M.D., Mayo endocrinologist and lead author, who is presenting today. "More research is needed to confirm our findings and understand the specific risk factors and mechanisms involved."

Others on the Mayo team were Kurt Kennel, M.D.; Maria Collazo-Clavell, M.D.; Sara Achenbach; Elizabeth Atkinson; and L. Joseph Melton, M.D.

Source:

Robert Nellis

Mayo Clinic

[WASaBubbleButt 41]

I do wish this study would explain *which* WLS they studied, some? All? I can see where this would be an issue with bypass and DS as they malabsorb Calcium but does this include bands and sleeves? Did I miss something?

[Jachut 487]

I'd guess it would be a factor with ALL surgeries.

Firstly, being obese is bad for your health, and losing weight improves your profile on a lot of those scores, but it is also a stressful, traumatic process for the body and yo definitely are way better off to never get fat in the first place.

Second, i dont think the quality of the diet after any bariatric surgery is optimum. You cannot live youre entire life on restricted calories and not expect restricted nutrition to follow. You only have to read the "what did you eat today threads" to see that. Regardless of the whole protein/carb debate, people simply cannot focus on their Protein, and not lose sight of Calcium, or focus on their calcium, and not lose sight of Protein, or focus on getting enough fish and Omega 3's and forget to eat enough vegetables, the list goes on. If you are only eating 1000 calories a day, you are clearly NOT going to get everythign you need, unless you are a perfect eater.

And science has not been able to show that replacing intake in the form of supplements is really that effective. You may not develop a deficiency but to date we cannot replicate the complex relationships and syndergies between various phytonutrients contained in our food. Eating an orange is WAY different to swallowing a Vit. C pill.

However, I think any study never addresses the full picture.

So, you're more likely to break a bone. Whilst you may not relish the thought of breaking a hip at 80, its better than dying of a stroke at 65, isnt it? Or losing both your legs to diabetes at 50? And whilst most women cannot get full, complete and thorough nutrition on 1000 calories a day long term, how many of those women were formerly scarfing down 3000 calories a day of pure crap?

There's also measures you can take to protect your bone density, such as running (YAY), and other weight bearing exercise, strength training, and most of us really COULD down a glass of milk or so a day as well.

[MacMadame 81]

My feeling is that my Calcium related numbers are much better NOW than they were pre-op because I've improved my Vitamin D numbers and stopped taking the blood pressure meds which were depleting the calcium in my blood. (PTH was fine though.)

I think if you are conscientious about your labs, you can avert most of this stuff.

Plus most of us will end up on more than 1000 calories a day long term. I'm already up to 1400 most days.

[Jachut 487]

I'd also guess the proportion of bariatric patients who actually KNOW how to eat properly and who DEDICATE themselves to it are not the majority. We're talking a huge population with a lifetime of disordered eating behind them. Its not like they've performed these surgeries on normal weight people with healthy food relationships and seen the effect it has on bone density is it? How much of our previous lifestyle is to blame, how much is actual weight loss to blame, and how much is after surgery lifestyle to blame?

I once said to someone studies schmudies and made them REALLY mad (fancy that!) but really, they mean little. We can only do the best we can from this point on, cant we?

[Malaika 50]

I'd also guess the proportion of bariatric patients who actually KNOW how to eat properly and who DEDICATE themselves to it are not the majority. We're talking a huge population with a lifetime of disordered eating behind them. Its not like they've performed these surgeries on normal weight people with healthy food relationships and seen the effect it has on bone density is it? How much of our previous lifestyle is to blame, how much is actual weight loss to blame, and how much is after surgery lifestyle to blame?

I once said to someone studies schmudies and made them REALLY mad (fancy that!) but really, they mean little. We can only do the best we can from this point on, cant we?

I agree with you because for every study you can find an opposing view.

I've always said we do the best we can do with what we know and when we know better, we do better.

[Elisabethsew 50]

I think the causative factor here is the use of PPIs. GI doctors are unified in their insistance that people on PPIs supplement with Calcium. They need to specify that it should be calcium citrate and that Vitamin D should be supplemented as well. It would be interesting to know how many people in the study were on PPIs and how many supplemented with calcium and/or Vitamin D.

[DeannaS 0]

PPI??????? Are you talking about proton pump inhibitors?

[WASaBubbleButt 41]

PPI??????? Are you talking about proton pump inhibitors?

Yup, that would be it! Nexium, Nexium mups, Protonix, Prevacid, and Prilosec.

Might be one more, I'm drawing a blank.

[Elisabethsew 50]

Yup, that would be it! Nexium, Nexium mups, Protonix, Prevacid, and Prilosec.

Might be one more, I'm drawing a blank.

Aciphex, Tagamet, Zantac... soooooooo many... LOL.

[WASaBubbleButt 41]

Aciphex, Tagamet, Zantac... soooooooo many... LOL.

PPIs???

Is Tagamet and Zantac a PPI?

[cajun 46]

Aciphex is a ppi.

Tagamet and Zantac are not ppi's, they are H2 blockers.

[cajun 46]

there are some more interesting studies on this subject at

Gastric Bypass Surgery for Morbid Obesity Leads to an Increase in Bone Turnover and a Decrease in Bone Mass -- Coates et al. 89 (3): 1061 -- Journal of Clinical Endocrinology & Metabolism