Bone Health and Anti-Osteoporotic Medication Eligibility in Postmenopausal Women Undergoing Bariatric Surgery: The Impact of Age and Modifiable Risk Factors

INTRODUCTION: Postoperative complications after metabolic and bariatric surgery (MBS) increase with age, yet data on bone health in older postmenopausal women remain limited. The 2022 European Calcified Tissue Society (ECTS) position statement recommend anti-osteoporotic medication (AOM) for patients with a T-score ≤ −2 and/or a fragility fracture within the past two years. This study evaluated the prevalence of AOM eligibility according to age (< 60 vs. ≥ 60 years) in postmenopausal women and identified associated risk factors. MATERIALS AND METHODS: We conducted a cross-sectional, observational, single-center study at Lille University Hospital including postmenopausal women referred for bone health evaluation before or after MBS. AOM eligibility was defined according to the 2022 ECTS criteria. RESULTS: Among 306 postmenopausal women, 173 were < 60 years (group 1) and 133 were ≥ 60 years (group 2). Overall, 69 patients (22.5%) were eligible for AOM, with a significantly higher prevalence in women ≥ 60 years (30.1% vs. 16.8%, p = 0.006). In multivariate analysis, independent predictors of AOM eligibility were age ≥ 60 years (OR = 2.34, 95% CI: 1.19–4.61), active smoking (OR = 2.98, 95% CI: 1.27–7.02), reduced appendicular lean mass index (ALMI < 5.5 kg/m2; OR = 3.72, 95% CI: 1.78–7.78), and elevated iPTH (OR = 1.15, 95% CI: 1.05–1.25 per 10 ng/mL increase). CONCLUSION: Nearly one in five postmenopausal women undergoing MBS were eligible for AOM based on the ECTS position statement, with prevalence doubling after 60 years (OR = 2.34). Active smoking, secondary hyperparathyroidism, and low ALMI were key independent risk factors. These findings underscore the importance of systematic bone health assessment and early implementation of lifestyle interventions, alongside AOM, to reduce fracture risk in this vulnerable population.