What Every Bariatric Patient Should Know About Bone Health

Posted by Whitney Marema, APRN on 19th Sep 2023

What Every Bariatric Patient Should Know About Bone Health

Bone health is something that should be on your radar if you have had bariatric surgery, especially gastric bypass or any other malabsorptive procedure. BUT, even in sleeve, it should be monitored. The last thing you want is to be thinner, but with bone pain and bone fractures! Women are particularly at risk for osteopenia and osteoporosis after menopause if not taking hormone replacement.

Just as with iron, calcium is a mineral. Minerals need strong stomach acid in order to break down the molecule to allow for proper absorption. Both bypass AND sleeve produce a significant decrease in stomach acid, therby making calcium breakdown and absorption a potential issue.

But there’s more to know than just taking supplements and eating dairy!

First and most importantly, is knowing that a serum calcium level on general blood work (in the comprehensive metabolic profile) is NOT an accurate depiction of your body’s intake of calcium or bone health. This serum calcium is regulated by the kidneys because it is a crucial mineral in things like the heart conduction system. Therefore, the kidneys will steal calcium from other places in the body (BONE) in order to keep serum calcium normal and prevent heart arrhythmias or nerve and muscle conduction issues.

So, a more reliable marker of adequate calcium intake and absorption is a marker called parathyroid hormone. (PTH). This marker regulates calcium in the blood and when elevated, means there is bone breakdown in order to extract calcium to be used for vital functions like heart, nerves, and muscle conduction. In a bariatric patient, an elevated PTH marker likely means that you are not getting enough calcium or vitamin D. When PTH is on the lower to mid range of normal, this signifies that bone is likely NOT being broken down.

It's important no not only do I order this marker, but compare it over time. An increasing value (even if still in the normal range) means that bone health may be starting to suffer.

The next important piece of knowledge here is that there are OTHER important minerals and vitamins besides calcium that are vital to our bone health. Vitamin D is the gatekeeper of calcium absorption, and when vitamin D is low…. You can take all the calcium you want, and it will not be absorbed for use in bone. IN FACT, you may need to DECREASE calcium dosage in people with low vitamin D levels. Yes, because if someone is taking high dose calcium, and the gatekeeper vitamin D is down, then the calcium goes to harden other things. Things like arterial plaques, stool, and formation of kidney stones. So, vitamin D should be monitored and supplemented to mid-range on the reference range. You will need to consult with your doctor as to what vitamin D level is healthy for you.

Magnesium is a bone powerhouse. It is the sister to calcium and necessary for its absorption. This is a mineral that is commonly low or deficient in Americans. Magnesium has so many benefits including bone health, stress and energy support, digestive health, restful sleep, and muscle relaxation. Try Building Blocks “Cal-Mag Absorb” which combines calcium AND magnesium WITH stomach acid factors for increased absorption, and see the benefit of everything from muscle relaxation to easy sleep and regular bowel habits.*

The last (but not least) topic of importance here is that of bone density testing and the use of bisphosphonates for the diagnosis of osteoporosis or osteopenia. The American Society for Bariatric Surgery 2020 guidelines talk about this and say that bone density testing should be performed in bariatric patients at baseline (before or soon after surgery) and every 2 years in those at risk. They also state that the use of bone resorption medications should only be considered after optimizing calcium and vitamin D levels and if they need to be used, extreme caution should be used in ORAL forms of these medications due to increased risk of anastomotic ulcers in bariatric patients taking these in pill forms. It is recommended that if bisphosphonates need to be used after WLS, that they be given in IV forms.

The best medicine when it comes to bone health is good prevention. That means taking good quality supplements and having your levels monitored at least annually, and a bone density scan is likely a good idea.

This blog is for educational and informational purposes only. This information is not intended to replace professional medical advice, diagnosis, or treatment. You should not use this information to diagnose or treat any health problems or illnesses without consulting your medical practitioner. Always seek the advice of your own medical practitioner or other qualified health provider with any questions you may have regarding your specific health situation.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.