Severely obese patients undergoing weight loss surgery are more likely to have increased fracture risks both before and after the surgical procedure, finds a study. The study, published in the journal The BMJ, suggested that fracture risk assessment and management should be part of weight loss care and obesity may not be as protective for fracture as originally thought. The researchers speculated that the increased fracture risks are due to falls and obesity related conditions, such as type 2 diabetes, as well as anatomical changes, and nutritional deficiencies induced by weight loss surgery. The study examined the incidence and sites of fracture in severely obese patients who had undergone weight loss surgery and compared them to obese and non-obese controls matched for sex and age. For the study, data was analysed on 12,676 patients, 38,028 obese and 126,760 non-obese people. Before surgery, 10.5 per cent patients in the weight loss surgery group had at least one fracture compared with 8.1 per cent obese and 6.6 per cent non-obese people in the control groups. After a follow-up, 4.1 per cent of the weight loss surgery patients had at least one fracture compared with 2.7 per cent of obese and 2.4 per cent of non-obese groups. These increased fracture risks remained high even after adjusting for fracture history, number of comorbidities, material and social deprivation, and area of residence. The post-operative fracture risk changed from a pattern associated with obesity in the distal lower limb fracture, to a pattern typical of osteoporosis in the upper limb, clinical spine, pelvis, hip and femur.