Bariatric Surgery, Physical Activity, and Fracture Risk
Abstract
In a large retrospective cohort study using Swedish national databases, Axelsson and colleagues recently showed that gastric bypass surgery was associated with an increased risk of fractures, which appeared to become significant over time and is consistent with longer-term results of another recent study in the US. Fracture risk after bariatric surgery is a timely and important issue, and these significant findings, including an increased risk of falls, should be considered when reviewing the latest meta-analysis on this topic. Here, I would like to discuss two commonly proposed mechanisms of bone loss after bariatric surgery, reduced mechanical loading and calcium/ vitamin D malabsorption, on the basis of the authors’ results. As has been previously pointed out, no relationship between weight loss and fracture risk was observed. This does not necessarily suggest that reduced mechanical loading is not the mechanism by which gastric bypass surgery resulted in an increased risk of fractures because mechanical loading during physical activity is engendered not only by gravitational force but also by muscle contraction. Of note, effects of skeletal loading essentially depend on mechanical strain-related stimuli; for example, strain rate is one of the key determinants and bones respond to dynamic, but not static, mechanical loading. Accordingly, longer-term bone loss compared with weight loss and bone loss in the non-weight-bearing regions can be both explained, at least in part,…
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