The incidence of fractures following bariatric surgery: A systematic review
Bibliographic record
Abstract
ABSTRACT Introduction: The effects of bariatric surgery on improvement of the metabolic syndrome is well-described, but its effect on intrinsic bone fragility and fracture propagation is unclear. Therefore, the aims of this systematic review of the literature were to examine (1) the incidence of fracture following bariatric surgery, (2) the association of fracture with the specific bariatric surgical procedure, and (3) site-specific types of fractures associated with bariatric surgery. Methods: A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were gastric bypass, sleeve gastrectomy and fracture. Results: Eight studies were included (n = 42,567 patients). This included no randomized controlled trials. The average patient age was 43.3 years and 24.9% of patients were male. The average follow-up time was 3.7 years. 1960 patients had at least one fracture, and the total number of fractures encountered was 2326. Overall, 4.6% of patients who underwent bariatric surgery suffered from a fracture post-operatively. The operation associated with the greatest risk of fractures post-operatively was following a biliopancreatic diversion (10.66%), followed by restrictive procedures such as adjustable gastric band and sleeve gastrectomy (5.71%), with the Roux-en-Y gastric bypass having the lowest risk (2.66%). Of the fractures encountered, 1458 (63.08%) were of the lower extremity and pelvis and 763 (33.01%) were of the upper extremity. Only 90 (3.89%) axial skeleton fractures were reported. Conclusions: The overall risk of sustaining a fracture of any type after undergoing bariatric surgery is approximately 5 percent after an average follow up of 3.7 years. The greatest risk of fractures is associated with the biliopancreatic diversion surgery, with the Roux-en-Y gastric bypass being the most favorable. Fractures following bariatric surgeries tend to occur mostly in the lower extremity and pelvis. Highlights:
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.011 | 0.013 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".