The risk of osteoporosis is not increased after cholecystectomy: A nationwide cohort study

Cholecystectomy alters bile flow and quality which might compromise the absorption of vitamin D and vitamin K which are important for bone health. We aimed to assess the risk of osteoporosis after cholecystectomy. Methods: We performed a nationwide, register-based, cohort study using individual-level data from the Danish Health Registers. Individuals who had cholecystectomy performed between 1995 and 2017 were included as were five sex- and aged-matched controls for each case. We assessed fractures, ICD diagnosis of osteoporosis and osteoporosis treatments. We defined a composite endpoint for osteoporosis consisting of 1) hip or spine fractures, 2) ICD diagnosis of osteoporosis or 3) osteoporosis treatments. Results: We included 149.968 cases and 727.456 controls that were followed for a median of 9 years (inter-quartile range 4–15 years). In the cholecystectomy cohort, 6.4 % reached the composite endpoint compared to 6.6 % in the reference population (HR 0.98 (0.96–1.03)). In age-stratified analyses, minor risk increases were observed in the cholecystectomy cohort compared to the reference population in the composite endpoint for osteoporosis (age group ≤30 years, 0.8 % vs. 0.6 %, HR 1.42 (1.19–1.71)), fractures rates (≤30 years incidence rate ratio (IRR) 1.38 (1.32–1.43), age group 31–50 years IRR 1.10 (1.08–1.43)) and ICD osteoporosis diagnosis (≤30 years, 0.3 % vs. 0.2 % HR 1.40 (1.04–1.87)). Conclusion: The risk of osteoporosis was similar in patients with prior cholecystectomy and controls. In younger subgroups, the risk of osteoporosis and fractures was slightly increased but absolute risks were low. These findings do not support that cholecystectomy leads to any major calcium-metabolic disturbances.