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Bariatric surgery: Think about osteomalacia too
Anastasia Mocritcaia1, Chafik Chacur1, Helena Flórez1,2
1Rheumatology Department, Metabolic Bone Diseases Unit, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Archives of Osteoporosis
|October 14, 2025
Summary
Nearly 9% of patients with prior bariatric surgery (BS) may have osteomalacia, not just osteoporosis. Elevated total alkaline phosphatase (TAP) signals this condition, requiring specific high-dose calcium or parenteral vitamin D treatments.
Area of Science:
- Endocrinology
- Bone Metabolism
- Gastroenterology
Background:
- Bariatric surgery (BS) is linked to osteoporosis and fractures.
- Osteomalacia can develop post-BS and be misdiagnosed as osteoporosis.
Purpose of the Study:
- To determine osteomalacia prevalence in patients with prior BS.
- To identify clinical characteristics of these patients.
Main Methods:
- Retrospective analysis of 46 patients with prior BS.
- Diagnosis of osteomalacia based on bone biopsy or clinical criteria (low calcium/phosphate, elevated TAP, or radiology).
Main Results:
- 8.7% of patients had osteomalacia, predominantly women post-malabsorptive surgery.
- All showed elevated TAP and parathyroid hormone; most had hypocalcemia and low vitamin D.
- Bone scans were consistent with osteomalacia; all had osteoporosis, many with fractures.
Conclusions:
- Osteomalacia affects nearly 9% of osteoporosis patients with prior BS.
- Elevated TAP is a key indicator for osteomalacia.
- This diagnosis necessitates tailored treatment, potentially including high-dose calcium or parenteral vitamin D.
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