BACKGROUND Previous studies have reported an increased fracture risk after bariatric surgery. OBJECTIVE To investigate the association between different bariatric surgery procedures and fracture risk. METHODS Incidence rates and hazard ratios for fracture events were analysed in the Swedish Obese Subjects study; an ongoing, nonrandomized, prospective, controlled intervention study. Hazard ratios were adjusted for risk factors for osteoporosis and year of inclusion. Information on fracture events were captured from the Swedish National Patient Register. The current analysis includes 2007 patients treated with bariatric surgery (13.3% gastric bypass, 18.7% gastric banding, and 68.0% vertical banded gastroplasty) and 2040 control patients with obesity matched on group level based on 18 variables. Median follow-up was between 15.1 and 17.9 years for the different treatment groups. RESULTS During follow-up, the highest incidence rate for first-time fracture was observed in the gastric bypass group (22.9 per 1000 person-years). The corresponding incidence rates were 10.4, 10.7 and 9.3 per 1000 person-years for the vertical banded gastroplasty, gastric banding and control groups, respectively. The risk of fracture was increased in the gastric bypass group compared with the control group (adjusted hazard ratio [adjHR] 2.58; 95% confidence interval [CI] 2.02-3.31; P < 0.001), the gastric banding group (adjHR 1.99; 95%CI 1.41-2.82; P < 0.001), and the vertical banded gastroplasty group (adjHR 2.15; 95% CI 1.66-2.79; P < 0.001). CONCLUSIONS The risk of fracture is increased after gastric bypass surgery. Our findings highlight the need for long-term follow-up of bone health for patients undergoing this treatment.

中文翻译：

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瑞典肥胖受试者的三项减肥手术后的骨折风险：一项长达26年的受控干预研究随访。

背景技术先前的研究报道了减肥手术后骨折风险增加。目的探讨减肥手术方法与骨折风险之间的关系。方法在瑞典肥胖受试者研究中分析了骨折事件的发生率和危险比。正在进行的，非随机，前瞻性，受控干预研究。针对骨质疏松症和纳入年份的危险因素调整了危险比。有关骨折事件的信息是从瑞典国家患者登记簿中获得的。目前的分析包括2007年接受减肥手术治疗的患者（13.3％的胃绕道手术，18.7％的胃束带术和68.0％的垂直束带胃成形术）以及2040例根据18个变量在小组水平上匹配的对照组肥胖患者。中位随访时间在15.1至17。不同治疗组为9年。结果在随访中，胃旁路组首次骨折的发生率最高（每1000人年22.​​9例）。垂直束带胃成形术，胃束带成形术和对照组的相应发病率分别为每1000人年10.4、10.7和9.3。与对照组相比，胃搭桥术组的骨折风险比对照组高（调整后的危险比[adjHR]为2.58； 95％置信区间[CI]为2.02-3.31； P <0.001）； ％CI 1.41-2.82； P <0.001）和垂直条带化胃成形术组（adjHR 2.15； 95％CI 1.66-2.79； P <0.001）。结论胃旁路手术后骨折的风险增加。