SSAT - ROUX-EN-Y GASTRIC BYPASS IS ASSOCIATED WITH INCREASED RISK OF OSTEOPOROTIC FRACTURES AT 10-YEARS POST-SURGERY: RESULTS OF A MULTINATIONAL MULTICENTER ANALYSIS

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ROUX-EN-Y GASTRIC BYPASS IS ASSOCIATED WITH INCREASED RISK OF OSTEOPOROTIC FRACTURES AT 10-YEARS POST-SURGERY: RESULTS OF A MULTINATIONAL MULTICENTER ANALYSIS
Donghyun Ko^*³, Do Han Kim², Wilhelm S. Basegoda⁴, Jose A. Porres⁵, Paul T. Kr�ner⁶, Christopher C. Thompson¹
¹Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; ²Mount Sinai Morningside Hospital, New York, NY; ³Bridgeport Hospital, Bridgeport, CT; ⁴University of South Alabama, Mobile, AL; ⁵Universidad Francisco Marroquin Facultad de Medicina, Guatemala City, Guatemala Department, Guatemala; ⁶Riverside Health System, Newport News, VA

Introduction
As the epidemic of obesity continues to advance, metabolic surgery has become an attractive resource to address the issue. Procedures such as Roux-en-y gastric bypass (RYGB), are linked to micronutrient and other nutritional deficiencies. The absorption of calcium may be impaired, which is paramount for bone mineral density, potentially leading to increased risk of osteoporosis and its complications. The aim of this study was to explore the occurrence of osteoporosis-related fractures in patients with and without history of RYGB using a large multinational database.

Methods
A retrospective cohort study was performed using large population-based data from the TriNetX platform. Patients with history of RYGB since January 1, 2014, were identified. This group was matched with patients without history of RYGB according to age, gender, demographics, comorbidities, and medication by using 1:1 propensity matching. All outcomes were measured at 10 years post-surgery. Cox regression was used to yield hazard ratios (HR) and 95% confidence intervals (95%CI). The primary outcomes were risk of major osteoporotic fractures, spine fracture, and femur fracture. Secondary outcomes were risk of all-cause mortality, osteoporosis, and vitamin D deficiency.

Results
A total of 44,277 patients were identified as having prior RYGB. Of these 42,888 were matched to the above-mentioned patients without previous history of RYGB. Patients with history of RYGB had significantly higher risk of major osteoporotic fractures (HR, 1.21; 95%CI, 1.09-1.34), spine fracture (HR, 1.19; 95% CI, 1.03-1.37), and vitamin D deficiency (HR, 1.80; 95% CI, 1.73-1.86). Lower risk of all-cause mortality was observed in this specific group (HR, 0.45; 95% CI, 0.42-0.49). No patients had diagnosed osteoporosis in our study (Table 1).

Discussion
Patients with history of RYGB for obesity have increased odds of major osteoporotic fractures at 10 years post-surgery compared to matched patients with no history of RYGB. This was particularly seen for spinal fractures. This is despite a lower 10-year mortality seen in patients with history of RYGB, which may be explained by improvement of this cohort�s metabolic and cardiovascular comorbidities associated with weight loss. This study underscores the importance of long-term follow-up and instituting preventive measures in patients with history of RYGB. Future studies should consider the underlying specific factors that amplify the progression of osteoporosis in patients with a history of RYGB.

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