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French study: broken bones after obesity surgery

Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study.

Overview

Paccou et al.. J Bone Miner Res 2020 · PMID 32187759 · DOI 10.1002/jbmr.4012

Serious osteoporotic fractures increased after gastric bypass (about 70% more) but not after sleeve.

Does the study support the specific claim? Partly · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Fracture risk by operation
How was the study done?: National cohort
How many people, animals or samples were studied?: 81,984
What was actually found?: Bypass HR 1.70; sleeve not increased
How large was the observed effect?: HR 1.22 overall
What do the results mean in everyday life?: Bone risk depends on operation
What are the study's limitations?: Administrative data
What does it say about Elawady's specific claim?: Limits the claim for sleeve
Do the results apply to Germany and Europe?: Directly European
What can explicitly not be concluded from this study?: Very long-term risk

Is the risk of major osteoporotic fracture increased after bariatric surgery, and does it differ by procedure?

Study design: Cohort study – French national inpatient database matched cohort (1:1)
Population: Patients 40-65 y with BMI >=40, 2010-2014, and matched controls
Country: France
Period: 2008-2018
Sample size: 81,984 (40,992 surgical, 40,992 controls)
Inclusion and exclusion criteria: Matched on age, sex, Charlson index, year, obesity class

Exposure / intervention: Bariatric surgery by type
Comparator: Matched obese controls
Endpoints: Major osteoporotic fracture (hip, humerus, wrist/forearm, clinical spine)
Statistical methods: Cox regression

Results: MOF 2.30 vs 1.93 per 1000 patient-years; HR 1.22 (1.08-1.39) for any surgery. Increased risk only after gastric bypass: HR 1.70 (1.46-1.98); not after sleeve gastrectomy or other procedures.
Absolute risks: About 0.4 extra fractures per 1000 patient-years overall.
Authors' conclusion: In patients aged 40-65, gastric bypass but not sleeve gastrectomy increased the risk of major osteoporotic fracture.

CI log-symmetric (stats/I-BAR-123_paccou_2020.py).

Sleeve-specific fracture data: no increase, whereas bypass increased fractures.

Follow-up limited; sleeve HR not in abstract.

French data.

Supports procedure-dependence of fracture risk.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	some concerns
Precision of results	moderate
Directness	direct
Reproducibility	partly replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Long-term sleeve fracture risk.