Bariatric Surgery Increases the Risk of Fracture: a Meta-analysis
Notice bibliographique
Résumé
Background Overweight and obesity are major risk factors for many chronic diseases, with the prevalence of overweight/obesity among Chinese adults reaching 50.7% in 2018. Bariatric surgery is one currently available treatment for obesity, but whether it increases the risk of fracture is still controversial. Objective To analyze whether weight-loss surgery will increase the risk of fracture. Methods PubMed, Embase, and Cochrane Library databases were searched for studies (cohort studies, case-control studies, and randomized controlled trial) about the risk of fracture and bariatric surgery published between January 2010 and November 2021. The Newcastle-Ottawa scale (NOS) and Jadad scale were used to evaluate the methodological quality of the studies. RevMan 5.3 and Stata 12.0 were used for data analysis. The Begg's test and Egger's test were conducted to assessing the potential publication bias. Compare the association of bariatric surgery with risk of fracture by comparing risk of fracture between patients with and without bariatric surgery. Results A total of 15 studies were included, including 12 cohort studies, two case-control studies, and one randomized controlled trial, all of which were of high quality. Twelve studies compared the risk of fracture between patients with bariatric surgery and those without, 10 of which enrolled patients with bariatric surgery (surgery group, n=137 239) and obese patients without bariatric surgery (obesity group, n=159 066) with no differences in baseline BMI, showing large heterogeneity (P<0.01, I2=94%). Meta-analysis using a random-effects model showed that there was no significant intergroup difference in fracture risk between the two groups〔RR (95%CI) =1.21 (1.00, 1.46), P=0.05〕. Four studies enrolled patients with bariatric surgery (n=14 796) and non-obese patients without bariatric surgery (n=132 124) with significant differences in baseline BMI, showing slight heterogeneity (P=0.26, I2=25%), and a higher risk of fracture was found in those with bariatric surgery revealed by meta-analysis using a fixed effects model〔RR (95%CI) =1.73 (1.59, 1.89), P<0.01〕. The level of heterogeneity decreased significantly after removing 4 of the 10 studies with high heterogeneity with no intergroup difference in baseline BMI (P=0.24, I2=25%), and a higher risk of fracture was found in patients with bariatric surgery indicated by meta-analysis using a fixed effects model〔RR (95%CI) =1.38 (1.31, 1.46), P<0.01〕. Subgroup analysis showed that the risk of fracture was similar in the surgery group and the obesity group within two years〔RR (95%CI) =1.05 (0.89, 1.24), P=0.56〕 and during two to five years〔RR (95%CI) =1.16 (1.00, 1.35), P=0.05〕, but it was higher in the former group five years after surgery〔RR (95%CI) =1.50 (1.23, 1.84), P<0.001〕. The risk of fracture was higher in patients with Roux-en-Y gastric bypass than that of those with adjustable gastric banding〔RR (95%CI) =1.31 (1.15, 1.50), P<0.01〕 or with sleeve gastrectomy〔RR (95%CI) =1.77 (1.55, 2.02), P<0.01〕. The risk of fracture was lower in patients with gastric banding than that of those with gastric bypass〔RR (95%CI) =0.54 (0.41, 0.71), P<0.01〕. Both Begg's test and Egger's test showed that publication bias was less likely in the studies (P=0.631, 0.720) . Conclusion Fracture risk is increased by bariatric surgery, which is not influenced by obesity. High risk of fracture did not appear until five years after the operation, with Roux-en-Y gastric bypass and gastric bypass were associated with higher fracture risk.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,016 | 0,056 |
| Bibliométrie | 0,006 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».