Johns Hopkins Hospital, Baltimore, MD, USA.
Osteoporos Int. 2014 Jan;25(1):151-8. doi: 10.1007/s00198-013-2463-x. Epub 2013 Aug 3.
The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics.
Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture.
We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985-2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model.
The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m(2), with an average age of 44 ± 10 years and 82% (212) females. Gastric bypass surgery was performed in 94% of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95% confidence interval (CI), 1.8-2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95% CI, 1.1-2.9), as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95% CI, 0.2-0.8) while prior fracture history was not associated with postoperative fracture risk.
Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.
减重手术是一种治疗肥胖相关并发症的常见方法。然而，减重手术后骨骼健康的变化及其对骨折风险的影响尚不清楚。
我们对明尼苏达州奥姆斯特德县的 258 名接受减重手术的患者进行了一项回顾性队列研究，这些患者在 1985 年至 2004 年间首次接受了减重手术。通过标准化发病率比（SIR）来表示骨折的相对风险，通过时间依赖性骨折回归模型获得的风险比（HR）来评估潜在的风险因素。
平均（±标准差）体重指数为 49.0 ± 8.4 kg/m2，平均年龄为 44 ± 10 岁，82%（212 例）为女性。94%的病例接受了胃旁路手术。中位随访时间为 7.7 年（范围为 6 天至 25 年），期间 79 例患者发生了 132 例骨折。任何部位骨折的相对风险增加了 2.3 倍（95%可信区间为 1.8-2.8），髋部、脊柱、腕部或肱骨的首次骨折风险增加（SIR 为 1.9；95%可信区间为 1.1-2.9），其他部位的首次骨折风险也增加（SIR 为 2.5；95%可信区间为 2.0-3.2）。术前活动状态较好与较低的年龄校正风险相关（HR 为 0.4；95%可信区间为 0.2-0.8），而既往骨折史与术后骨折风险无关。
减重手术伴随着显著的生化、激素和机械变化，与骨折风险增加相关。
