Sleeve gastrectomy beats RYGB in reducing fracture risk in obese patients

Patients with severe obesity who underwent sleeve gastrectomy (SG) had a significantly lower risk of fracture compared with those who underwent Roux-en-Y gastric bypass (RYGB) and those who did not undergo surgery, according to a recent study.

“Specifically, SG might be the best option for weight loss in patients in whom fractures could be a concern, [as] an equal risk of fracture [was observed between those who underwent] … RYGB [and bariatric-eligible patients who did not undergo surgery],” said the researchers.

Using Medicare Standard Analytic Files derived from Medicare parts A and B records from January 2004 to December 2014, the researchers retrospectively analysed 49,113 bariatric-eligible patients with obesity who underwent either RYGB or SG and who did not undergo surgery. Baseline characteristics were equally matched across all groups. [JAMA Network Open 2020;doi:10.1001/jamanetworkopen.2020.7419]

A total of 1,382 fracture events were reported, with 522 patients having vertebral fractures.

At 3 years following bariatric surgery, those who underwent SG had a significantly lower rate of fracture compared with those who underwent RYGB and those who did not undergo surgery (1.8 percent vs 3.2 percent and 3.4 percent, respectively; p<0.001 for both).

With regard to site-specific fracture risk, when compared with those who did not undergo surgery, patients who underwent SG were less likely to experience fractures of the humerus (odds ratio [OR], 0.57) radius or ulna (OR, 0.38), pelvis (OR, 0.34), hip (OR, 0.49), and vertebrae (OR, 0.60), as well as total fracture (OR, 0.60).

Moreover, those who underwent RYGB had a significantly greater risk of total fracture (OR, 1.79; p=0.001) and humeral fracture (OR 1.60; p<0.001) than those who had SG.

On the other hand, there were no significant differences in the odds of developing humeral (OR, 0.91), radial or ulnar (OR, 0.90), pelvic (OR, 0.92), hip (OR, 1.06), or vertebral fractures (OR, 0.91) between patients who underwent RYGB and those who did not undergo surgery.

“The present study … found that obesity conferred a significantly greater risk of all fracture types and fractures overall [in bariatric-eligible surgery patients but did not undergo] compared with patients undergoing SG, and similar risks … [in] patients undergoing RYGB, providing evidence for a potential protective effect of weight loss against the risk of fractures,” the researchers said.

“Furthermore, SG was found to be more protective against fracture compared with RYGB,” the researchers highlighted.