Experts from CHU de Quebec Research Center and Laval University, Quebec City, Canada, have recently concluded a groundbreaking study about weight reducing bariatric surgery outcomes. Contradicting the popularity of the surgery, the experts have established a link between the surgery and increased post-surgery risk of limb fracture.
Bariatric surgery options are linked with improved health and better mobility. But surprisingly, this study has made the previous research work dubious, which had favored the surgery over the years. In this study, obese people were found to be at a higher risk of lower limb fracture and lower risk of upper limb fracture prior to surgery.
However, post-surgery the risk of lower limb fracture reduced but the risk of upper limb fracture increased. Moreover, the risk of spine, hipbone and femur fractures also increased. The findings of this significant study were published recently by the British Medical Journal.
In this retrospective cohort study, the experts observed people who underwent bariatric surgery between 2001 and 2014 against control group of obese people and non-obese people who did not undergo the surgery for fracture risk, through healthcare administrative database. The research compared pre-operation and post-operation occurrences and sites of fracture to reach an accurate association as hypothesized.
In addition, disease comorbidities, socio-economic backgrounds and lifestyle of the participants were also recorded. Out of 12,676 patients who underwent the surgery, 10.5% patients were at a risk of fracture, as opposed to the obese control group with a risk of 6.6% and non-obese control group with a risk of 4.1%. People who underwent this surgery, at an average, were increasingly susceptible to fracture 4.4 years after the surgery.
While the findings of this study may not line with what the earlier studies, it has not nullified the advantages of all types of bariatric surgical procedures.
Over the years, obesity has emerged as a global epidemic which has posed increasingly hard challenges to medical experts. In the United States alone, 68.8% of the adult population qualifies as overweight which increases their likelihood of developing severe ailments like cardiovascular diseases, strokes, hypertension problems and diabetes.
To restrict the alleviated numbers of these severe ailments, health experts and patients often shift to surgical procedures.
These obesity reducing surgical procedures include treatment options of adjustable gastric band, Roux-en-Y gastric bypass, vertical sleeve gastrectomy and biliopancreatic diversion.
The findings of increased facture risk coincided with only biliopancreatic diversions, while no definitive link could be established with other surgical procedures.
What Is Biliopancreatic Diversion And How does It Increase Fracture Risk?
It is a complex bariatric surgery in which a large portion of stomach is cut off and the route of food is modified to ensure less food absorption in the small intestines. The smaller stomach is linked to a short portion of duodenum which is directly linked to the lower part of the small intestines.
In addition to this, secretion of bile and digestive juices is also altered. This alternation in the natural mechanism of digestive system leads to a person feeling full after consuming small food quantities. And the food digestion leading to nutrient absorption is significantly decreased to help people reduce weight.
Theoretically, the surgery looks feasible and promising towards attaining a better health after weight reduction. But, the surgery and resulting changes in nutrient absorption adversely affect bone metabolism. Abnormalities in mineral metabolism which leads to vitamin D deficiency and secondary hyperparathyroidism (high parathyroid concentration, causing loss of calcium and bone weakening) are primary reasons of increased fracture risks of this procedure.
Will The Study Results Outweigh The Advantages Of Bariatric Surgical Options?
The study has stirred confusion amongst people who have been considering this option to lead a healthier life. Researchers of the study have agreed to the limitations of their study which catered to a smaller pool of participants and had no prior backing from similar researchers. However, paying with limb fractures for obesity-free life is not a favorable bargain.
Another study conducted in April this year suggested improvement in pain management and physical function following bariatric surgery. In this longitudinal study, people from 10 hospitals in the US were followed-up for three years after the surgery. Out of 2,221 participants, majority reported improvement in physical function, pain and walk time over a three-year period. Interestingly, the percentage of these improvements fluctuated over time and the seemed to decline with time in many cases.
Furthermore, studies have also showed how bariatric surgeries have helped people return to their normal lifestyle by improving their psychological health. A meta-analysis carried out earlier this year found that 23% patients reported depression and 17% reported binge eating prior to the surgery. The researchers observed that after the surgery, the people showed fewer symptoms of depression, better self-esteem, reduced binge eating and better interpersonal skills. This indicated the positive effects of obesity reducing surgery not only on physical but also on mental health.
The health advantages of bariatric surgeries are difficult to be negated by just one piece of evidence. However, further studies can be designed to find the validity of the hypothesis which links the surgery to increased fracture risk. In the meanwhile, the doctors should formulate a guideline for patients undergoing the surgery about optimal physical activity and mineral supplementations for healthy bones.
A detailed discussion with orthopedist can be carries out to analyze individual profiles before and after the surgery to pinpoint risk factors. In case the study has made you apprehensive about the surgery, you can look at other bariatric options which did not show an association with fracture risk.