Bariatric surgery, commonly known as weight-loss surgery, is a surgical procedure that assists individuals who suffer from obesity to lose weight.

Over the years, bariatric surgery has evolved to become one of the most efficient methods to reduce weight in obese individuals. However, weight loss due to bariatric surgery can affect bone health and increase the risk of fractures in the long term. This article examines how bariatric surgery affects the risk of fractures.

The Link Between Bariatric Surgery and Fracture Risk

Obesity is a significant risk factor for bone loss and fractures. However, the relationship between bariatric surgery and fracture risk is complex.

The relationship between weight loss and fracture risk is well established, and it is a well-known fact that bariatric surgery leads to significant weight loss. Over the years, several studies have examined the long-term fracture risk in individuals who have undergone bariatric surgery.

One of the major mechanisms behind increased fracture risk in individuals who have undergone bariatric surgery is changes in bone metabolism, especially in the first few years post-surgery.

Bariatric surgery leads to rapid weight loss, which can trigger hormonal changes in the body affecting gut hormones. The altered gut hormone levels and changes in insulin sensitivity post-operation lead to increased bone turnover, and as a result, an increase in bone loss. This condition can further lead to an increase in fracture risk.

Types of Bariatric Surgery and Fracture Risk

Bariatric surgery is of different types, and the type of bariatric surgery that an obese individual undergoes plays a significant role in determining the long-term risk of fractures.

Studies have shown that some procedures, such as Roux-en-Y gastric bypass (RYGB), are more likely to increase the risk of fractures compared to Sleeve gastrectomy (SG) and Laparoscopic adjustable gastric banding (LAGB).

RYGB involves the surgical reduction of the size of the stomach and redirecting the lower intestine to the smaller stomach pouch.

Following the procedure, patients are at significant risk of fractures due to the development of significant and rapid weight loss, often leading to the development of vitamin D deficiency, which further contributes to increased fracture risk. On the other hand, SG, which removes a large percentage of the stomach and leaves a small, tube-like section in place, has a lower incidence of fractures.

However, patients who undergo SG may still need post-operative monitoring for vitamin D and calcium deficiency.

Vitamin D and Calcium Deficiency

Vitamin D and calcium are essential factors required for the development and maintenance of healthy bones, and bariatric surgeries are known to cause deficiencies in these nutrients.

Deficiencies in vitamin D and calcium are often more pronounced in RYGB procedure compared to SG and LAGB.

Deficiency in vitamin D and calcium following bariatric surgery prevents the normal regulation of bone metabolism, leading to an imbalance between bone-building and bone-breakdown cells.

Osteoporosis, a common condition characterized by low bone density and increased fracture risk, is a common side effect of vitamin D and calcium deficiency caused by bariatric surgery.

Role of Physical Activity

The role of physical activity in minimizing fracture risk following bariatric surgery cannot be overemphasized. Physical activity is often recommended as an essential part of bariatric surgery recovery.

Studies have shown that low-impact exercises, such as walking, jumping jacks, and dancing, can help to reduce bone loss and improve bone density in bariatric surgery patients.

Incorporating physical activity helps to increase muscle strength that supports the bones, reduces the risk of falls, and improves overall health.

Physical activity also increases the absorption of calcium and promotes vitamin D synthesis in the skin, further reducing the risk of fractures among bariatric surgery patients.

Bone Density Testing

Bone density testing is essential in determining the risk of fractures in individuals who have undergone bariatric surgery.

DEXA scanning is a non-invasive technique used to measure bone density in different parts of the body, and it is often recommended for patients who have undergone bariatric surgery.

Bone density testing can help detect bone loss at an early stage, enabling healthcare professionals to take preventive measures to reduce the risk of developing bone fractures.

Regular monitoring of bone density levels using DEXA scan is an essential part of managing the long-term health of patients who have undergone bariatric surgery.

Dietary Modifications

Dietary modifications are necessary to ensure sufficient intake of vitamins and minerals essential for bone health following bariatric surgery.

Vitamin D and Calcium supplementation are often recommended for RYGB procedure, while SG and LAGB, patients may only need to take supplements if laboratory results indicate deficiencies.

Incorporating foods rich in calcium and vitamin D, such as dairy products, dark green vegetables, and nuts is also important in reducing the risk of fractures.

Healthcare providers may also recommend limiting the intake of foods that may interfere with nutrient absorption, such as caffeine, alcohol, and processed sugars, among others.

Conclusion

While bariatric surgery is an effective way to lose weight, it also increases the risk of fractures in the long term. Increased bone loss caused by hormonal changes and vitamin D and calcium deficiency is the primary cause of increased fracture risk.

However, measures such as postoperative physical activity, regular bone density testing, and dietary modifications are vital in reducing the risk of fractures in individuals who have undergone bariatric surgery.