What is your approach to treating osteoporosis in patients post bariatric surgery?  

While there is no guidance from the bariatric surgeons, I tend to avoid oral bisphosphonates in all patients with prior bariatric surgery. I am worried about the pill getting stuck independent of the type of surgery. Since we have IV bisphosphonates and denosumab I have good alternatives to oral bis...

We also cannot forget the possibility of osteomalacia in these patients. We must watch the vitamin D levels like a hawk and insist on lifelong supplementation with calcium and vitamin D. When you see a roux-en-Y patient with diffuse body pain, joint pains, or muscle weakness, always check their vit...

I share Dr. @Krohn’s concern and also wonder about the actual absorption of medications in this situation. To that end, I tend to favor parenteral therapy for osteoporosis and use markers of bone metabolism in those patients who would rather take oral therapy than parenteral therapy to assist ...