Cholecystectomy and the risk of osteoporosis and fractures: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Cholecystectomy is a common surgical procedure for gallbladder diseases. Removal of the gallbladder alters bile flow and may affect the absorption of fat-soluble vitamins, especially vitamin D, which could influence bone metabolism. However, epidemiological studies have yielded inconsistent findings regarding its association with osteoporosis and fractures. Objectives: To systematically evaluate the association between cholecystectomy and the risks of osteoporosis and fractures, and to examine potential effect modification by age. Design: Systematic review and meta-analysis of cohort studies. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, cohort studies published up to June 1, 2025, were identified through comprehensive searches of PubMed, Embase, and Web of Science. Eligible studies compared individuals who underwent cholecystectomy with non-surgical controls and reported outcomes of osteoporosis or fractures. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Subgroup analyses were conducted according to age and adjustment for confounders. Results: Four high-quality cohort studies, including more than 1.5 million participants, were eligible. Meta-analysis demonstrated a modest but statistically significant increase in fracture risk after cholecystectomy (pooled HR = 1.07; 95% CI, 1.05–1.10; I ² = 50%). The association was stronger among individuals younger than 50 years (pooled HR = 1.14; 95% CI, 1.12–1.16), while no significant association was found among those aged ⩾50 years. For osteoporosis, the pooled estimate was inconclusive due to substantial heterogeneity ( I ² = 97%) and limited data (HR = 1.09; 95% CI, 0.88–1.37). Conclusion: Cholecystectomy may be associated with a small increase in fracture risk, particularly among younger adults, although the absolute risk remains low. Evidence for osteoporosis is inconclusive due to high heterogeneity and limited studies. Further large-scale prospective studies are needed to clarify these associations and mechanisms. Trial registration: PROSPERO (CRD420251071872).
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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 | 0.008 | 0.018 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.034 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".