Meta-analysisindependent cross-checkabstract checked I-BAR-124 standard review

Meta-analysis: fractures by type of operation

Fracture risk following bariatric surgery: a systematic review and meta-analysis.

Overview

Saad et al.. Osteoporos Int 2022 · PMID 34988627 · DOI 10.1007/s00198-021-06206-9

Fractures were about 45% more frequent after bypass-type operations, but not after restrictive ones such as 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 type
How was the study done?: Meta-analysis
How many people, animals or samples were studied?: 19 studies
What was actually found?: Malabsorptive +45%; restrictive no increase
How large was the observed effect?: RR ~1.45
What do the results mean in everyday life?: Bone risk depends on operation
What are the study's limitations?: Heterogeneous
What does it say about Elawady's specific claim?: Partly supports claim
Do the results apply to Germany and Europe?: Applicable
What can explicitly not be concluded from this study?: Sleeve-only long-term

Does fracture risk after bariatric surgery differ by procedure type compared with obese controls?

Study design: Meta-analysis – Systematic review and meta-analysis (observational studies and trials)
Population: Adults after bariatric surgery
Country: Multinational
Period: Search to October 2020
Sample size: 4 trials and 15 observational studies
Inclusion and exclusion criteria: Adults; observational and interventional

Exposure / intervention: Malabsorptive or restrictive bariatric surgery
Comparator: Obese controls, restrictive procedures, non-surgical weight loss
Endpoints: Any and site-specific fracture
Statistical methods: Random-effects relative risks

Results: At >2 y follow-up, any fracture 45% higher after malabsorptive procedures vs obese controls (P<0.001) and 61% higher vs restrictive (P=0.04). Risk of any and site-specific fracture not increased after restrictive procedures vs obese controls.
Absolute risks: not reported in abstract
Authors' conclusion: Fracture risk seems to increase after malabsorptive but not restrictive surgeries; evidence has limitations.

Relative effects only; CIs not given in abstract for main RR.

Sleeve (restrictive) not associated with increased fractures; bypass (malabsorptive) is.

Restrictive group mixes banding and sleeve.

International.

Supports procedure-dependence.

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

Sleeve-only long-term data.