Bone Health after bariatric surgery

Overweight and obesity strains your joints and makes them weak and painful. Constant pain reduces mobility and worsens the obesity. Obesity alone have been associated with altered levels of calcium, vitamin D and parathyroid hormone in all ages.

Shedding extra kilos will make your joints stronger, helps in getting relief in aches and also reduces risks of fracture specially the hip joint. Losing weight also decreases the possibility of getting a joint transplant done.

Bariatric surgery is a proven tool to help obese people get all these benefits and improve quality of life.

Despite the undoubted health benefits, bariatric surgery requires an extensive preoperative nutritional assessment and also calls for a life-long commitment from the patient for follow-up to focus on weight loss maintenance and compliance to aftercare recommendations.  In general, gastric bypass procedures will have greater potential risk of micronutrient deficiency than a gastric sleeve.

All patients preparing for bariatric surgery should be screened for the presence of vitamin D deficiency and hyperparathyroidism. DEXA scan for all obese patients is not recommended, however women aged more than 65 years or younger post-menopausal females and men 70 years or older may be advised by the bariatric surgeon based on their clinical risk factor profile.

After bariatric surgery calcium and vitamin D deficiency may develop due to reduced dietary intake and decreased intestinal absorption, though research studies do not conclusively support any increased incidence of osteoporosis or increased fracture risk after bariatric surgery.

I always advise my bariatric surgery patients to include naturally rich or fortified food sources in their diet to get enough of calcium and vitamin D. To get good amounts of calcium including milk and milk products, fish, green leafy vegetables, ragi, kidney beans and almonds in the daily diet is a good idea.

For vitamin D, fortified dairy products and cereals, fish (sardines, salmon and mackerel) and egg yolks makes a great choice, also exposing to the sun between 10am to 3pm for 15 to 30 minutes in minimal clothing is good to produce vitamin D in the skin.

Regular, long-term follow-up and nutritional supplementation is important to prevent and overcome already existing deficiencies and should be provided according to the type of procedure and the individual patient’s risk for bone loss.

People undergoing bariatric surgery require 1200–2400mg calcium per day, depending on type of procedure, to be taken into 2–3 divided doses. In our practice we prefer Calcium Citrate Malate (CCM) tablets in chewable form as it  possesses highest bioavailability and doesn’t require stomach acid for absorption.

To prevent vitamin D deficiency 60,000 IU of vitamin D is required once a week for 8 weeks. Severe deficiencies can be treated with higher doses up to 60,000 IU 3 times a day. Vitamin D supplements are easily available in different forms such as powder, syrup or soft gels, any of them can be taken.

It is important to stay in to stay in regular touch with your bariatric surgeon and dietician for annual monitoring of bone loss and to correct the causes in time to prevent further damage.

Healthy bones are happy bones….

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