Table 1. Fracture risk after bariatric surgery.
| Author, Origin, Year | Type of study | Inclusion criteria | Types of bariatric surgeries performed in the intervention groups | Risk ratio (95% CI) – Fracture |
|---|---|---|---|---|
| Lalmohamed, UK, 2012 (98) | Retrospective cohort | BMI ≥ 30 kg/m2 with bariatric surgery record | Adjustable gastric banding Gastric bypass Others |
0.89 (0.60-1.33) |
| Nakamura, USA, 2014 (59) | Retrospective cohort | Patients undergoing bariatric surgery. Pathological fractures were excluded | Gastric bypass Others |
2.3 (1.8-2.8) – Any site |
| Douglas, UK, 2015 (99) | Retrospective cohort | Patients registered in the database with bariatric surgery and obese patients matched without surgery | Gastric band Gastric bypass VG Others |
1.26 (0.79-2.01) |
| Lu, Taiwan, 2015 (60) | Retrospective cohort | Prevalent morbid obesity, excluding patients with a previous diagnosis of fracture or osteoporosis | Malabsorptive procedures Restrictive procedures |
1.21 (1.01-1.44) –Any fracture 1.47 (1.01-2.15) –Malabsorptive procedures x control 1.17 (0.97-1.41) –Restrictive procedures x control |
| Rousseau, Canada, 2016 (61) | Retrospective cohort | Severe obesity undergoing bariatric surgery | Adjustable gastric banding VG Gastric bypass Biliopancreatic diversion |
1.44 (1.29-1.59) – Bariatric group x Non obese control 1.38 (1.23-1.55) – Bariatric group vs. obese control |
| Axelsson, Sweden, 2018 (58) | Retrospective cohort | BMI ≥ 30 kg/m2 undergoing bariatric surgery divided into groups with and without diabetes and compared to obese controls | Gastric bypass with and without diabetes | 1.26 (1.05-1.53) – with diabetes 1.32 (1.18-1.47) – without diabetes |
| Fashandi, USA, 2018 (56) | Retrospective cohort | Patients undergoing bariatric surgery and corresponding cohort of non-surgical obesity | RYGB Gastric banding VG Others |
2.36 (1.72-2.23) – Bariatric surgery x control 2.17 (1.04-4.52) – RYGB x VG |
| Javanainen, Finland, 2018 (57) | Retrospective cohort | BMI ≥ 35 kg/m2, ages 18 to 65 years, and previous failed weight loss attempts through non-surgical obesity programs (bariatric surgery patients) | RYGB VG |
5.49 (1.76-17.15) – Bariatric surgery x control |
| Ahlin, Sweden, 2020 (64) | Non randomized interventional study | Age 37-60 years and BMI > 34 kg/m2 for men and > 38 kg/m2 for women | Adjustable or nonadjustable gastric banding Vertical banded gastroplasty Gastric bypass |
2.58 (2.02-3.31) – Gastric bypass x control 2.15 (1.66-2.79) - Gastric bypass x Vertical banded 1.20 (1.00-1.43) – Vertical banded gastroplasty x control |
| Khalid, EUA, 2020 (63) | Retrospective cohort | Patients classified as eligible for bariatric surgery who did not undergo bariatric surgery or underwent RYGB or VG | RYGB VG |
1.79 (1.55-2.06) – RYGB x VG 0.95 (0.84-1.07) – RYGB x control 0.53 (0.46-0.62) – VG x control |
| Paccou, France, 2020 (62) | Retrospective cohort | Patients undergoing bariatric surgery, aged between 40 and 65 years, BMI ≥ 40 kg/m2, were matched with controls | VG Gastric bypass Vertical banded gastroplasty Gastric banding |
1.22 (1.08-1.39) – Bariatric surgery x control 1.70 (1.46-1.98) – Gastric bypass x control 0.95 (0.79-1.14) – VG x control |
| Zhang 2020 (100) | Meta-analysis | Studies with obese patients (BMI ≥ 30 kg/m2) undergoing bariatric surgery compared to a control group, with assessment of bone fracture outcome | Malabsorptive procedures Restrictive procedures |
1.41 (1.22-1.63) |
| Chaves 2021 (65) | Meta-analysis | Studies with patients ≥ 18 years, BMI ≥ 30 kg/m2 and minimum follow-up of one year, compared to a non-surgical control group, matched by at least sex and age | Malabsorptive procedures Restrictive procedures |
1.20 (1.15-1.26) |
| Chin, Taiwan, 2021 (97) | Retrospective cohort | Obese patients, aged between 18 and 55 years, divided into two groups | Malabsorptive procedures Restrictive procedures |
1.693 (1.077-2.661) – Bariatric surgery x general population 0.774 (0.539-1.110) – Bariatric surgery x non-surgical group |
| Saad 2022 (66) | Meta-analysis | Studies in adults (> 18 years) with obesity (BMI ≥ 30 kg/m2), undergoing different types of bariatric surgery | Malabsorptive procedures Restrictive procedures |
1.61 (1.42-1.83) |
CI: confidence interval; BMI: body mass index; RYGB: Roux-en-Y gastric bypass; VG: vertical gastrectomy or sleeve; DM: diabetes mellitus.