Objectives To estimate fracture risk in patients receiving bariatric surgery versus matched controls.Design Population based, retrospective cohort study. Setting Use of records from the United Kingdom General Practice Research Database, now known as the Clinical Practice Research Datalink (from January 1987 to December 2010).Participants Patients with a body mass index of at least 30, with a record of bariatric surgery (n=2079), and matched controls without a record (n=10 442). Each bariatric surgery patient was matched to up to six controls by age, sex, practice, year, and body mass index. Patients were followed from the date of bariatric surgery for the occurrence of any fracture. We used time dependent Cox regression to calculate relative rates of fracture, adjusted for disease and previous drug treatment, and time-interaction terms to evaluate fracture timing patterns.Main outcome measure Relative rates of any, osteoporotic, and non-osteoporotic fractures.Results Mean follow-up time was 2.2 years. Overall, there was no significantly increased risk of fracture in patients who underwent bariatric surgery, compared with controls (8.8 v 8.2 per 1000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33). Bariatric surgery also did not affect risk of osteoporotic and non-osteoporotic fractures. However, we saw a trend towards an increased fracture risk after three to five years following surgery, as well as in patients who had a greater decrease in body mass index after surgery, but this was not significant. ConclusionBariatric surgery does not have a significant effect on the risk of fracture. For the first few years after surgery, these results are reassuring for patients undergoing such operations, but do not exclude a more protracted adverse influence on skeletal health in the longer term. IntroductionObesity is an increasing public health problem worldwide. The prevalence of obesity (body mass index >30), among middle aged Europeans has been estimated as 15-20%. 1 Data for the prevalence of morbid obesity (body mass index >40) are lacking in Europe. In the United States, at least 5% of the population is morbidly obese.2 It is now recognised that surgical treatment is the most effective route to weight loss for people with morbid obesity, accompanied by reduction of mortality and improvement of comorbid conditions. [3][4][5] Bariatric surgical procedures (conventionally grouped as restrictive or malabsorptive) negatively affect bone remodelling, as suggested by studies on bone resorption markers, and bone mineral density. Restrictive procedures, such as vertical banded gastroplasty and laparoscopic adjustable banding, have been consistently reported to increase bone resorption, [6][7][8][9][10][11] an increase that is similar in magnitude to that observed in other forms of weight reduction. 8 The mechanisms behind the increase in bone resorption after weight loss are not fully understood, but two factors seem to be involved.Firstly, reduced fat volume may lead to a reductio...

OBJECTIVETo assess the risk of colorectal cancer associated with type 2 diabetes, as compared with a nondiabetic reference population, and to study additional associations between treatment stage and duration of obesity and colorectal cancer risk. RESEARCH DESIGN AND METHODSWe conducted an observational population-based cohort study within the Clinical Practice Research Datalink (1987Datalink ( -2012. All patients ( ‡18 years) with at least one prescription for an antidiabetic drug (n = 300,039) were matched (1:1) by birth year, sex, and practice to a comparison cohort without diabetes. Cox proportional hazards models were used to derive adjusted hazard ratios (HRs) for colorectal cancer associated with type 2 diabetes. Within the diabetic cohort, associations of colorectal cancer with treatment stages and duration of obesity (BMI ‡30 kg/m 2 ) were studied. RESULTSAfter a median follow-up of 4.5 years, 2,759 cases of colorectal cancer were observed among the diabetic study population. Type 2 diabetes was associated with a 1.3-fold increased risk of colorectal cancer (HR 1.26 [95% CI 1.18-1.33]). Among diabetic patients, no association was found with treatment stages. A trend of increased colorectal cancer risk was observed with longer duration of obesity. Risk of colorectal cancer was significantly increased for patients with recorded duration of obesity of 4-8 years ) and >8 years (1.28 [1.11-1.49]). CONCLUSIONSType 2 diabetes is associated with a moderately increased risk of colorectal cancer. Among diabetic patients, an increased risk was observed for patients who suffered from obesity for a total duration of 4 years or more.Colorectal cancer is the third most common cancer in men and the second in women (1). Individuals with type 2 diabetes appear to have an increased risk of developing colorectal cancer compared with their nondiabetic counterparts (2). The global increase in incidence of type 2 diabetes, with an estimated total of 347 million adults suffering from type 2 diabetes in 2008 (3), warrants further examination of the potential link between type 2 diabetes and colorectal cancer.Observational cohort studies have found that colorectal cancer is more common in people with metabolic disturbances (4,5). Shared risk factors for colorectal cancer

The risk of, in particular AAU, but also of psoriasis and IBD, is significantly increased in patients with AS compared with controls. Hazard patterns are different for each of the EAMs.

Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We conducted a population-based cohort study using data from the UK General Practice Research Database linked to the National Hospital Registry (1997Registry ( -2008. Incident MS patients (n ¼ 5565) were matched 1:6 by year of birth, sex, and practice with patients without MS (controls). Cox proportional-hazards models were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5-and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost threefold increased risk of hip fracture [HR ¼ 2.79, 95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR ¼ 1.35, 95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR ¼ 1.85, 95% CI 1.14-2.98) or antidepressants (HR ¼ 1.79, 95% CI 1.37-2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated in patients with MS, especially those prescribed GCs or antidepressants. ß

We found that incretin use was not associated with pancreatic cancer after adjustment for the severity of the underlying Type 2 Diabetes Mellitus (T2DM). The elevated risk of pancreatic cancer in those recently initiating incretin agents is likely to be caused by protopathic bias or other types of unknown distortion. The presence of considerable confounding by disease severity and the lack of a duration-of-use relationship do not support a causal explanation for the association between incretin agents and pancreatic cancer.