Bariatric Surgery and Your Bones

Here at Diabetes Flashpoints, we’ve discussed bariatric (weight-loss) surgery several times over the years — starting with cases both for and against the surgery, and covering topics such as whether its effects on diabetes are permanent and whether children should have the surgery. Most recently, we discussed the relative merits of gastric bypass and gastric banding operations — a discussion that may take on more urgency in light of a new study on bariatric surgery and bone fractures.

The study, published last month in the journal Medicine, compared two groups of people in Taiwan: those who underwent bariatric surgery (2,064 people), and a group of similarly obese people who didn’t have the surgery (5,027 people). As noted in a Reuters article on the study, members of the surgery group were found to be 21% more likely to break a bone within five years than members of the no-surgery group.


But an important distinction was found within the surgery group, as well. Participants who underwent a “malabsorptive” type of surgery — one that restricts the body’s absorption of nutrients, such as gastric bypass — were even likelier to experience bone fractures. Within a 12-year period, these participants were 47% more likely to have a fracture than members of the no-surgery group. Participants who underwent a type of surgery that simply restricted how much they could eat, such as gastric banding, were no more likely than members of the no-surgery group to develop fractures during this period.

Based on this study alone, it might seem like gastric banding is the better option. But gastric banding hasn’t been shown to be as effective as gastric bypass at causing weight loss, or at causing resolution of diabetes symptoms. And according to at least one study, gastric banding resulted in more complications during a six-year follow-up period: A failure rate (meaning weight was regained, or the procedure was reversed) of 48.3% versus 12.3%, and a long-term complication rate of 41.6% versus 19%. Complications of gastric banding may include slipping or erosion of the band, resulting in the need for another surgery to remove or replace the device.

What’s your take on gastric bypass versus gastric banding — would you rather have a procedure that’s reversible and less invasive, even if it’s less effective and more prone to certain complications? Is a higher risk of bone fractures a decent price to pay for significant weight loss, and possible resolution of diabetes symptoms? If you’ve had either type of surgery, do you ever wish you’d had the other instead? Leave a comment below!