From the Research
Bisphosphonate therapy is indicated after a gastric sleeve procedure to prevent bone loss and reduce the risk of fractures, as evidenced by a pilot randomized controlled trial that showed the feasibility and tolerability of risedronate in preventing surgical weight-loss-associated bone loss 1. The use of bisphosphonates after gastric sleeve surgery is crucial in maintaining bone health, as bariatric surgery can lead to increased skeletal fragility and fracture risk.
- Patients should wait at least 30 minutes after taking the medication before eating or drinking anything other than water, and should remain upright during this time to prevent esophageal irritation.
- Common bisphosphonates include alendronate (Fosamax) 70mg weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) 5mg IV yearly for those who cannot tolerate oral medications.
- After gastric sleeve, absorption of oral medications may be reduced, so IV formulations might be more effective.
- Patients should begin bisphosphonate therapy only after adequate calcium (1200-1500mg daily) and vitamin D (800-1000 IU daily) supplementation has been established, as these are essential for bone health.
- Bisphosphonates work by inhibiting osteoclast activity, reducing bone resorption and increasing bone mineral density, which is particularly important after bariatric surgery since rapid weight loss and altered nutrient absorption can accelerate bone loss.
- Regular bone density monitoring is recommended, typically starting 1-2 years after surgery and continuing periodically thereafter. The most recent and highest quality study, a pilot randomized controlled trial, supports the use of bisphosphonates after gastric sleeve surgery, with risedronate being a viable option 1. Although other studies have investigated the use of bisphosphonates in different contexts, such as gastric cancer patients undergoing gastrectomy 2, or the comparative safety of sleeve gastrectomy and gastric bypass 3, the pilot randomized controlled trial provides the most relevant and up-to-date evidence for the use of bisphosphonates after gastric sleeve surgery. Additionally, a study on zoledronic acid for prevention of bone loss in patients receiving bariatric surgery suggests that a single dose of zoledronic acid prior to surgery may transiently mitigate high bone turnover in the acute postoperative period, but further studies are needed to confirm these findings 4.