Lalmohamed, UK, 2012 (9898 Lalmohamed A, de Vries F, Bazelier MT, Cooper A, van Staa TP, Cooper C, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2012;345:e5085) |
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 (5959 Nakamura KM, Haglind EGC, Clowes JA, Achenbach SJ, Atkinson EJ, Melton LJ, et al. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int. 2014;25(1):151-8.) |
Retrospective cohort |
Patients undergoing bariatric surgery. Pathological fractures were excluded |
Gastric bypass Others |
2.3 (1.8-2.8) – Any site |
Douglas, UK, 2015 (9999 Douglas IJ, Bhaskaran K, Batterham RL, Smeeth L. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care. PLoS Med. 2015;12(12):e1001925.) |
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 (6060 Lu CW, Chang YK, Chang HH, Kuo CS, Huang CT, Hsu CC, et al. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore). 2015;94(48):e2087.) |
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 (6161 Rousseau C, Jean S, Gamache P, Lebel S, Mac-Way F, Biertho L, et al. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ. 2016;354:i379.) |
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 (5858 Axelsson KF, Werling M, Eliasson B, Szabo E, Näslund I, Wedel H, et al. Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. J Bone Miner Res. 2018;33(12):2122-31.) |
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 (5656 Fashandi AZ, Mehaffey JH, Hawkins RB, Schirmer B, Hallowell PT. Bariatric surgery increases risk of bone fracture. Surg Endosc. 2018;32(6):2650-5.) |
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 (5757 Javanainen M, Penttilä A, Mustonen H, Juuti A, Scheinin T, Leivonen M. A Retrospective 2-Year Follow-up of Late Complications Treated Surgically and Endoscopically After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) for Morbid Obesity. Obes Surg. 2018;28(4):1055-62.) |
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 (6464 Ahlin S, Peltonen M, Sjöholm K, Anveden Å, Jacobson P, Andersson-Assarsson JC, et al. Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow-up of a controlled intervention study. J Intern Med. 2020;287(5):546-57.) |
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 (6363 Khalid SI, Omotosho PA, Spagnoli A, Torquati A. Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity. JAMA Netw Open. 2020;3(6):e207419.) |
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 (6262 Paccou J, Martignène N, Lespessailles E, Babykina E, Pattou F, Cortet B, et al. Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res. 2020;35(8):1415-23.) |
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 (100100 Zhang Q, Dong J, Zhou D, Liu F. Comparative risk of fracture for bariatric procedures in patients with obesity: A systematic review and Bayesian network meta-analysis. Int J Surg. 2020;75:13-23.) |
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 (6565 Chaves Pereira de Holanda N, de Lima Carlos I, Chaves de Holanda Limeira C, Cesarino de Sousa D, Serra de Lima Junior FA, Telis de Vilela Araújo A, et al. Fracture Risk After Bariatric Surgery: A Systematic Literature Review and Meta-Analysis. Endocr Pract. 2022;28(1):58-69.) |
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 (9797 Chin WL, Chi PJ, Hung WC, Lin CW, Chen CY, Chen JH. Bariatric Surgery Decreases the Risk of Non-traffic Accident-Related Fractures in Patients with Obesity: Real-world Data from Taiwan. Obes Surg. 2021;31(5):2231-40.) |
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 (6666 Saad RK, Ghezzawi M, Habli D, Alami RS, Chakhtoura M. Fracture risk following bariatric surgery: a systematic review and meta-analysis. Osteoporos Int. 2022;33(3):511-26.) |
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) |