It is evident that obesity is a global problem. In the United States about 40% of the population is obese. There are many different treatment options for people who are overweight or obese, but for extreme obesity bariatric surgery has been proven to be the most effective.
There are a few different types of bariatric surgery methods. The most common is the Vertical Sleeve Gastrectomy. In this method, 80% of the stomach is removed. Another method is the Roux en Y method. This used to be the most common, however, this is becoming less popular. This method bypasses the duodenum and creates a 30-mL (1/2 to 1 oz) stomach.
Bariatric surgery does have many advantages, such as long-term weight loss and favorable hormonal and metabolic changes (including reduced diabetes, hypertension, and sleep apnea), however it also has many disadvantages. Some disadvantages include the irreversibility of these methods, the short-term complication rates, and potential for long-term nutrient deficiencies. In addition, there is few studies about the effect of bariatric surgeries on bone and skeletal fractures.
Two studies (Nakamura et al. and Lu et al.) that were conducted found that after several years post-surgery there is an increase in the number of fractures in the clavicle, feet and toes, as compared to non-bariatric patients. So why are they getting fractures? Is it bone dependent, meaning that the quality of bone is affected? Or is bone-independent, meaning that bariatric patients just have an increased risk for falling?
Well, utilizing tools like the DEXA, which measures area bone mineral density, and Computed Tomography, which provides 3D measurements that the DEXA does not have, it was found that there was decrease in bone density. In addition to that, post-surgery bone formation increased, however, bone reabsorption also increased much more. Therefore, there was a decrease in bone density and size which leads to fracture. While the mechanism is not known, some possibilities are: hormones (parathyroid hormone, estrogen), diet, and muscle loss.
So, what can be done by health professionals? Supplementation is very important for bariatric patients. They should have 1200-1500 mg of calcium a day, and most should come from their diet. Their protein requirement is 60-90 g per day and their vitamin D requirements can be greater than 3000 IUs a day. In addition to supplementation, antireabsorptive therapies may be helpful. Most importantly, monitoring. Health professionals should conduct DEXA scans biannually, and vigilantly monitor older populations and children’s bone densities.
Overall, bariatric surgery can be a great way to lose weight quickly and long-term. However, there is not enough research currently on the relationship to bones and skeletal fractures, and future studies need to be conducted. Hopefully, in the future, there are clear recommendations and guidelines created for bariatric patients as a way to prevent fractures in this population.
- Kindler, Joseph. Bariatric Surgery and Skeletal Fracture. Seminar. 26 October 2016.