The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink

Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink
Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink

Conflicting results exist about the relationship between bariatric surgery and fracture risk. Also, prediction of who is at increased risk of fracture after bariatric surgery is not currently available. Hence, we used a combination of a self-controlled case series (SCCS) study to establish the association between bariatric surgery and fracture, and develop a prediction model for postoperative fracture risk estimation using a cohort study. Patients from UK Primary care records from the Clinical Practice Research Datalink GOLD linked to Hospital Episode Statistics undergoing bariatric surgery with body mass index (BMI) ≥30 kg/m 2 between 1997 and 2018 were included in the cohort. Those sustaining one or more fractures in the 5 years before or after surgery were included in the SCCS. Fractures were considered in three categories: (i) any except skull and digits (primary outcome); (ii) major (hip, vertebrae, wrist/forearm, and humerus); and (iii) peripheral (forearm and lower leg). Of 5487 participants, 252 (4.6%) experienced 272 fractures (of which 80 were major and 135 peripheral) and were included in the SCCS analyses. Major fracture risk increased after surgery, incidence rate ratios (IRRs) and 95% confidence intervals (CIs): 2.77 (95% CI, 1.34–5.75) and 3.78 (95% CI, 1.42–10.08) at ≤3 years and 3.1 to 5 years postsurgery when compared to 5 years prior to surgery, respectively. Any fracture risk was higher only in the 2.1 to 5 years following surgery (IRR 1.73; 95% CI, 1.08–2.77) when compared to 5 years prior to surgery. No excess risk of peripheral fracture after surgery was identified. A prediction tool for major fracture was developed using 5487 participants included in the cohort study. It was also internally validated (area under the receiver-operating characteristic curve [AUC ROC] 0.70) with use of anxiolytics/sedatives/hypnotics and female as major predictors. Hence, major fractures are nearly threefold more likely after bariatric surgery. A simple prediction tool with five variables identifies high risk patients for major fracture.

EPIDEMIOLOGY, FRACTURE RISK ASSESSMENT, GENERAL POPULATION STUDIES, NUTRITION, STATISTICAL METHODS
0884-0431
2153-2161
Robinson, Danielle E.
14bc241a-fdd7-44f9-96df-323cb9e82dff
Douglas, Ian
f13f8f08-61bc-4c8b-af5d-1375f1547a1c
Tan, Garry D.
1c089c08-9ef2-484e-b12b-3c9ba28e479b
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Strauss, Victoria Y.
7f805b15-394f-4a91-8dde-eb3cbae3036a
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Robinson, Danielle E.
14bc241a-fdd7-44f9-96df-323cb9e82dff
Douglas, Ian
f13f8f08-61bc-4c8b-af5d-1375f1547a1c
Tan, Garry D.
1c089c08-9ef2-484e-b12b-3c9ba28e479b
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Strauss, Victoria Y.
7f805b15-394f-4a91-8dde-eb3cbae3036a
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9

Robinson, Danielle E., Douglas, Ian, Tan, Garry D., Delmestri, Antonella, Judge, Andrew, Cooper, Cyrus, Kassim Javaid, M., Strauss, Victoria Y. and Prieto-Alhambra, Daniel (2021) Bariatric surgery increases the rate of major fracture: self controlled case series study in UK Clinical Practice Research Datalink. Journal of Bone and Mineral Research, 36 (11), 2153-2161. (doi:10.1002/jbmr.4405).

Record type: Article

Abstract

Conflicting results exist about the relationship between bariatric surgery and fracture risk. Also, prediction of who is at increased risk of fracture after bariatric surgery is not currently available. Hence, we used a combination of a self-controlled case series (SCCS) study to establish the association between bariatric surgery and fracture, and develop a prediction model for postoperative fracture risk estimation using a cohort study. Patients from UK Primary care records from the Clinical Practice Research Datalink GOLD linked to Hospital Episode Statistics undergoing bariatric surgery with body mass index (BMI) ≥30 kg/m 2 between 1997 and 2018 were included in the cohort. Those sustaining one or more fractures in the 5 years before or after surgery were included in the SCCS. Fractures were considered in three categories: (i) any except skull and digits (primary outcome); (ii) major (hip, vertebrae, wrist/forearm, and humerus); and (iii) peripheral (forearm and lower leg). Of 5487 participants, 252 (4.6%) experienced 272 fractures (of which 80 were major and 135 peripheral) and were included in the SCCS analyses. Major fracture risk increased after surgery, incidence rate ratios (IRRs) and 95% confidence intervals (CIs): 2.77 (95% CI, 1.34–5.75) and 3.78 (95% CI, 1.42–10.08) at ≤3 years and 3.1 to 5 years postsurgery when compared to 5 years prior to surgery, respectively. Any fracture risk was higher only in the 2.1 to 5 years following surgery (IRR 1.73; 95% CI, 1.08–2.77) when compared to 5 years prior to surgery. No excess risk of peripheral fracture after surgery was identified. A prediction tool for major fracture was developed using 5487 participants included in the cohort study. It was also internally validated (area under the receiver-operating characteristic curve [AUC ROC] 0.70) with use of anxiolytics/sedatives/hypnotics and female as major predictors. Hence, major fractures are nearly threefold more likely after bariatric surgery. A simple prediction tool with five variables identifies high risk patients for major fracture.

This record has no associated files available for download.

More information

Accepted/In Press date: 22 June 2021
e-pub ahead of print date: 25 June 2021
Additional Information: Funding Information: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB‐PG‐1215‐20017). GDT is supported by the NIHR Oxford Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. DPA is funded through a NIHR Senior Research Fellowship (Grant number SRF‐2018‐11‐ST2‐004). This work was supported by the NIHR Biomedical Research Centre, Oxford. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. This study was approved by the CPRD Independent Scientific Advisory Committee (protocol number 17_258R2A). The interpretation and conclusions contained in this study are those of the authors alone. Publisher Copyright: © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: EPIDEMIOLOGY, FRACTURE RISK ASSESSMENT, GENERAL POPULATION STUDIES, NUTRITION, STATISTICAL METHODS

Identifiers

Local EPrints ID: 450269
URI: http://eprints.soton.ac.uk/id/eprint/450269
ISSN: 0884-0431
PURE UUID: 74f16b26-6682-4adb-a45f-f947ca995ec5
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 19 Jul 2021 16:56
Last modified: 26 Nov 2021 02:40

Export record

Altmetrics

Contributors

Author: Danielle E. Robinson
Author: Ian Douglas
Author: Garry D. Tan
Author: Antonella Delmestri
Author: Andrew Judge
Author: Cyrus Cooper ORCID iD
Author: M. Kassim Javaid
Author: Victoria Y. Strauss
Author: Daniel Prieto-Alhambra

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×