Osteoporosis is often associated with primary care or orthopedic medicine, but it also affects many patients seen in surgical and specialty practices. As Dr. Sujata Gill, a board-certified and fellowship-trained surgeon with Bariatric Innovations of Atlanta, said, “Things like osteoporosis really affect the patients that I see every day.”
Nutrition, weight and nutrient absorption are closely tied to bone health, making osteoporosis especially relevant in bariatric care.
Osteoporosis is “a metabolic skeletal disease” that involves low bone density. Dr. Gill explained that it occurs because “the bone tissue’s microarchitecture has deteriorated.” When this happens, bones become weaker and more fragile, which is why the condition is so serious.
“Our bones become fragile, and then they can fracture,” she said. The most common fracture sites are the spine, wrists and hips.
How bone remodeling works
Bone health is shaped by a lifelong process called bone remodeling. In healthy individuals, bone breakdown and bone formation remain in balance.
“In a normal bone remodeling, you have a balance of the resorption and the formation of bone,” Dr. Gill said. Bone mass typically increases until the early 30s and then begins to decline naturally with age. She explained that osteoporosis develops when that balance is disrupted over time.
Dr. Gill emphasized one key takeaway: “Calcium is good and phosphates are bad.” Several organs help regulate this balance, including “your thyroid, your parathyroid, your kidney, your intestine,” she said.
Vitamin D plays a central role because it helps the body absorb calcium. “That’s why vitamin D is important,” Dr. Gill said, explaining, “If we don’t have vitamin D, then that affects our calcium level.”
Risk factors and related conditions
Most people have at least one risk factor for osteoporosis. According to Dr. Gill, these include:
- Aging
- Poor nutrition or low intake of calcium and vitamin D
- Family history and genetics
- Physical inactivity or immobility
- Smoking and alcohol use
- Certain medications
- Low body weight or undernourishment
Hormonal changes are especially important for women. “Estrogen is going to inhibit bone breakdown,” Dr. Gill explained, which is why postmenopausal women are at increased risk.
She also noted that other medical conditions can affect bone health, including endocrine disorders, kidney disease, gastrointestinal or liver disease, bone marrow conditions and rheumatologic diseases. Lifestyle factors such as excessive caffeine intake may also contribute.
How osteoporosis is diagnosed
Osteoporosis is often a silent disease. “By the time it kind of gets closer to end stage, then you might have the loss of height or the back pain or the hump,” Dr. Gill said. That is why she emphasized the importance of early screening.
The DEXA scan is the primary tool used to detect osteoporosis early. It “predicts your fracture risk,” Dr. Gill said, and helps monitor whether treatment is working over time.
Prevention and treatment strategies
“The goal is first to prevent,” Dr. Gill said. Preventing bone loss and avoiding fractures are the main priorities. She explained that treatment often begins with lifestyle changes, including regular weight-bearing exercise such as walking or jogging, limiting alcohol, avoiding smoking and maintaining proper nutrition.
Calcium and vitamin D supplementation, along with foods such as dairy products and dark leafy greens, are commonly recommended. Prescription medications may also be used when appropriate.
Dr. Gill stressed the importance of monitoring bone health in bariatric patients, noting that weight-loss surgery and medications such as proton pump inhibitors “can affect our absorption of important things,” including calcium and vitamin D. She said long-term follow-up is essential.
Her key message was clear: “Most of us have the risk factors for osteoporosis.” Addressing lifestyle, nutrition and preventive care early can make a lasting difference in protecting bone health.
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