Surgery for Obesity and Related Diseases · Nov 2026
Changes of bone turnover markers after bariatric surgery in premenopausal women: A systematic review
By Zareshahi N, Rahmanian A, Rahimi M et al.
Background Bariatric surgery is highly effective for severe obesity, but its impact on bone health varies across surgical techniques. Malabsorptive procedures may accelerate bone turnover and reduce bone mineral density (BMD), while restrictive procedures are generally less disruptive. Clarifying procedure-specific skeletal outcomes is crucial for personalized patient management. Methods We reviewed studies published from 2000 to August 2025 in PubMed, Scopus, and Web of Science, including adults undergoing Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD), sleeve gastrectomy (SG), adjustable gastric banding (AGB), or vertical banded gastroplasty (VBG). Outcomes included BMD, bone turnover markers, serum calcium, vitamin D, and parathyroid hormone (PTH). Data were synthesized qualitatively to assess procedure-specific effects and site-specific differences. Results Twenty-four studies (16–366 participants) were included. Malabsorptive procedures (BPD, RYGB) caused pronounced increases in bone turnover, persistent secondary hyperparathyroidism, vitamin D deficiency, and substantial BMD loss at cortical-rich sites, particularly the hip and femoral neck (ranging from approximately 5% to 10% at 12 months; exceeding 10% for BPD in long-term follow-up). SG led to moderate bone turnover increases and modest hip BMD declines (approximately 3–5%), with lumbar spine largely preserved. Restrictive procedures (AGB, VBG) induced minimal changes, though bone turnover markers increased modestly, indicating weight loss alone affects remodeling. Individual factors—baseline vitamin D, sex, and supplement adherence—modulated these effects. Conclusion Bariatric surgery exerts distinct, procedure-dependent skeletal effects, with malabsorptive operations posing the greatest risk. Recognizing this gradient enables tailored monitoring and supplementation strategies to mitigate fracture risk and optimize long-term bone health.