Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.
Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
J Bone Miner Res. 2018 Dec;33(12):2122-2131. doi: 10.1002/jbmr.3553. Epub 2018 Aug 13.
Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38,971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31,213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation 1-year postsurgery was investigated. During a median follow-up time of 3.1 (interquartile range [IQR], 1.7 to 4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (hazard ratio [HR] 1.26; 95% CI, 1.05 to 1.53; and HR 1.32; 95% CI, 1.18 to 1.47; respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. © 2018 American Society for Bone and Mineral Research.
胃旁路手术是治疗肥胖最常见和最有效的减肥手术。胃旁路手术会导致骨质流失，但手术后骨折风险的研究还不够充分。此外，胃旁路手术与糖尿病患者骨折风险的关系尚未研究，糖尿病是骨折的一个危险因素，并受手术影响。在这项使用瑞典国家数据库的回顾性队列研究中，确定了 38971 名接受胃旁路手术的肥胖患者，其中 7758 名患有糖尿病，31213 名没有。通过多变量 1:1 倾向评分匹配，确定了等量的均衡对照。使用 Cox 比例风险和灵活参数模型研究了骨折风险和跌倒损伤风险。根据手术后 1 年的体重减轻和钙及维生素 D 补充程度，研究了骨折风险。在中位数为 3.1（四分位距[IQR]，1.7 至 4.6）年的随访期间，使用多变量 Cox 模型，胃旁路手术与糖尿病和非糖尿病患者的任何骨折风险增加相关（风险比[HR]1.26；95%CI，1.05 至 1.53；和 HR 1.32；95%CI，1.18 至 1.47；分别）。使用灵活参数模型，骨折风险似乎随时间增加。胃旁路手术后，无骨折的跌倒损伤风险也增加。手术后体重减轻较大或钙和维生素 D 补充不足与骨折风险增加无关。总之，胃旁路手术与骨折风险增加相关，这种风险似乎随时间增加，与手术后的体重减轻程度或钙和维生素 D 补充无关。手术后跌倒损伤风险增加，可能导致骨折风险增加。
