MedicalResearch.com Interview with:
Elaine W. Yu, MD, MMSc
Assistant Professor, Harvard Medical School
Director, Bone Density Center
Endocrine Unit, Massachusetts General Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Roux-en-Y gastric bypass (RYGB) is a popular surgical weight loss procedure. We have previously shown that gastric bypass leads to rapid high-turnover bone loss.
Bariatric procedures are being increasingly performed in older adults, and the clinical consequences of gastric bypass-associated skeletal changes in this vulnerable population have been unclear to date. Thus, we used Medicare claims data to investigate fracture risk among older adults after gastric bypass, and in comparison to adults who received another bariatric procedure called adjustable gastric banding (AGB), which is thought to have fewer negative bone effects.
In our analysis, we found that patients undergoing Roux-en-Y gastric bypass were 73% more likely to fracture than those undergoing AGB. Importantly, we found that hip fracture risk increased nearly 180% after RYGB, and that fracture rates in patients aged 65 or older were similar to the overall group.
MedicalResearch.com: What should readers take away from your report?
Response: Skeletal health is an important part of long-term care for patients undergoing Roux-en-Y gastric bypass and should be part of the conversation with patients who are seeking bariatric surgery, especially among older patients who are inherently at higher fracture risk due to age. Although bariatric surgery has many impressive benefits, patients and providers should review bone health and discuss strategies to minimize bone loss.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies to assess the safety and efficacy of osteoporosis medications in this patient population are warranted. Furthermore, additional data are required to investigate fracture outcomes after other popular bariatric procedures, such as sleeve gastrectomy.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was funded by the Clinical Scientist Development Award from the Doris Duke Charitable Foundation that was awarded to the PI (Elaine Yu). The authors have no other relevant disclosures.
Yu EW, Kim SC, Sturgeon DJ, Lindeman KG, Weissman JS. Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries. JAMA Surg. Published online May 15, 2019. doi:10.1001/jamasurg.2019.1157
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