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Restrictive techniques, such as sleeve gastrectomy, Society, and American Society for Metabolic and
on the other hand reduce the total amount of Bariatric Surgery AACE/TOS/ASMBS guidelines [7]
gastric acid required for lowering the pH for optimal recommends performing certain laboratory tests
absorption of other essential vitamins and minerals. every three months in the first year after surgery,
RYGB and biliopancreatic diversion can thus cause and every 3–12 months thereafter, depending on
malabsorption of calcium (25%–50%) and vitamin D symptoms.
(>50%). Numerous reported cases clearly show the Postoperatively, many bariatric patients require
risk of metabolic bone disease occurring from as early chewable or liquid supplements to facilitate adequate
as 8 weeks until 32 years after bariatric surgery. A absorption.
recent study found that losing 0.7 kg/week was more
detrimental to bone than a slower loss of 0.3 kg/
week due to the activation of the calcium–PTH axis. References:
After bariatric surgery, many patients rapidly lose 50– 1. Ribaric G, Buchwald JN, McGlennon TW, Diabetes and Weight in Com-
100 kg of their weight; this weight loss combined with parative Studies of Bariatric Surgery vs Conventional Medical Thera-
py: A Systematic Review and Meta-Analysis, Obes Surg Volume 2014,
severely restricted oral intake of all the nutrients that 24(3):437-455.
includes proteins, calcium, and vitamins predisposes 2. Alexander Chadt, PhD, Stephan Scherneck, PhD, et al, Molecular Links
them to furthering the development of metabolic between obesity and Diabetes: “Diabesity”, 2014
bone disease.
3. Emmeline de Gruchy and Vinay S Eligar, Review of the Pharmacological
In addition to gut hormones, locally synthesized Interventions and Bariatric Surgery for Diabesity, MoJ Drug Des Develop
hormones such as the estrogens, known to impact The 2017, 1(1):00005.
bone health were also altered post operatively. As 4. Saadi J.S. Aljadir, bariatric/Metabolic Surgery for Diabesity..!, Endocrinol
weight decreases and adipose stores are depleted, Metab int J 2016, 3(2):00043.
the levels of estrogen decrease in both men and 5. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A
women resulting in decreased impact of estrogen on Joint Statement by International Diabetes Organizations, Diabetes Care
bone. Estrogen may also affect bone metabolism by 2016;39:861-877.
6. Anwar A Jammah, Endocrine and Metabolic Complications after Bariatric
Surgery, Saudi J Gastroenterol 2015, Sept-Oct; 21(5): 269-277.
7. Mechanick JI, Kushner RF, et al. ; American Association of Clinical Endo-
crinologists; Obesity Society; American Society for Metabolic and Bariatric
Surgery. American Association of Clinical Endocrinologists, The Obesity
Society, and American Society for Metabolic and Bariatric Surgery medical
guidelines for clinical practice for the perioperative nutritional, metabolic,
and nonsurgical support of the bariatric surgery patient. (v).Obesity (Silver
Spring) 2009;17(Suppl 1):S1–70.

direct effects on vitamin D and calcium metabolism.
The investigations generally should include serum
and urine calcium, 25-hydroxyvitamin D, alkaline

phosphatase, and serum intact PTH levels.
Complications may be seen as early as 8 weeks
after bariatric surgery in the form of secondary
hyperparathyroidism and osteomalacia. The American
Association of Clinical Endocrinologists, The Obesity

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