Background

Bariatric surgeries remain the most effective treatment for morbid obesity and obesity-related comorbidities1. Yet, despite substantial and durable weight loss and improvement in cardiometabolic profiles, an increasing body of evidence demonstrates that bariatric procedures exert a negative effect on bone density, microarchitecture, and strength, leading to an increased risk for fracture. Among the two most common bariatric procedures, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), studies have shown declines in hip bone density ranging 5% to 11% within the first post-operative year2. Further, one recent study showed that total hip bone density declined 9% at 24-months following RYGB and SG procedures, suggesting that bone loss may persist even after weight loss plateaus3. Several potential mechanisms may underpin this adverse skeletal effect, including diminished mechanical loading, alterations in body composition, nutrient deficiencies, and neurohormonal factors. This presentation provides an understanding of the skeletal effects of bariatric procedures and clinical relevance, the potential underlying mechanisms,and the effect of interventions to mitigate fracture risk.