Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink

Danielle E Robinson, Ian Douglas , Garry D Tan, Antonella Delmestri, Andrew Judge, Cyrus Cooper, Muhammad Kassim Javaid, Victoria Y Strauss, Daniel Prieto-Alhambra

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)

Abstract

Conflicting results exist about the relationship between bariatric surgery and fracture risk. Also, prediction of who is at increased risk of fracture post bariatric surgery is not currently available. Hence, we used a combination of a self-controlled case series (SCCS) study to establish the association between bariatric surgery and fracture, and develop a prediction model for post-operative fracture risk estimation using a cohort study. Patients from UK Primary care records from the Clinical Practice Research Datalink GOLD linked to Hospital Episode Statistics undergoing bariatric surgery with BMI≥30kg/m2 between 1997 and 2018 were included in the cohort. Those sustaining 1+ fracture/s in the 5 years before or after surgery were included in the SCCS. Fractures were considered in 3 categories: 1) Any except skull and digits (primary outcome), 2) major (hip, vertebrae, wrist/forearm and humerus) and 3) peripheral (forearm and lower leg). Of 5487 participants, 252 (4.6%) experienced 272 fractures (of which 80 were major and 135 peripheral) and were included in the SCCS analyses. Major fracture risk increased after surgery, incidence rate ratios (IRRs [95% CIs]) 2.77 (1.34, 5.75) and 3.78 (1.42, 10.08) at ≤3 years and 3.1-5 years post-surgery when compared to 5 years prior to surgery, respectively. Any fracture risk was higher only in the 2.1-5 years following surgery (IRR 1.73 (1.08, 2.77)) when compared to 5 years prior to surgery. No excess risk of peripheral fracture after surgery was identified. A prediction tool for major fracture was developed using 5487 participants included in the cohort study. It was also internally validated (AUC ROC 0.70) with anxiolytics/sedatives/hypnotics use and female as major predictors. Hence, major fractures are nearly three-fold more likely after bariatric surgery. A simple prediction tool with 5 variables identifies high risk patients for major fracture.
Original languageEnglish
Pages (from-to)2153-2161
Number of pages9
JournalJournal of Bone and Mineral Research
Volume36
Issue number11
Early online date25 Jun 2021
DOIs
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB‐PG‐1215‐20017). GDT is supported by the NIHR Oxford Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. DPA is funded through a NIHR Senior Research Fellowship (Grant number SRF‐2018‐11‐ST2‐004). This work was supported by the NIHR Biomedical Research Centre, Oxford. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. This study was approved by the CPRD Independent Scientific Advisory Committee (protocol number 17_258R2A). The interpretation and conclusions contained in this study are those of the authors alone.

Funding Information:
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1215-20017). GDT is supported by the NIHR Oxford Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. DPA is funded through a NIHR Senior Research Fellowship (Grant number SRF-2018-11-ST2-004). This work was supported by the NIHR Biomedical Research Centre, Oxford. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. This study was approved by the CPRD Independent Scientific Advisory Committee (protocol number 17_258R2A). The interpretation and conclusions contained in this study are those of the authors alone.

Publisher Copyright:
© 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords

  • epidemiology
  • general population studies
  • fracture risk assessment
  • nutrition
  • statistical methods

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