TABLE 2.
Guidelines for Serum Calcium, 25 (OH) Vitamin D, PTH, and BMD Screening and Monitoring Postbariatric Surgery
| CPG | Calcium | 25 OH Vitamin D | PTH | BMD |
|---|---|---|---|---|
| AACE/TOS/ASMBS/OMA/ASA (2019)53 | Baseline: All | Baseline: All | Baseline: NA | Baseline: Same as the NOF indications |
| Follow-up: All at each visit* | Follow-up: RYGB and BPD/DS at 1, 3, and 6–12 months thereafter | Follow-up: RYGB and BPD/DS at 1, 3, and 6–12 months thereafter | Follow-up: All at 2 years* | |
| BOMS (2014, 2020)54,55 | Baseline: All | Baseline: All | Baseline: All | Baseline BPD/DS: Consider in specific patient groups |
| Follow-up: All at 3, 6, 12 months then annually | Follow-up: All at 3, 6, 12 months then annually | Follow-up: All if not checked before surgery | Follow-up: NA | |
| IDE (2014)56 | Baseline: NA† | Baseline: NA | Baseline: NA | Baseline: All |
| Follow-up RYGB: annually | Follow-up RYGB: annually | Follow-up RYGB: annually | Follow-up: NA‡ | |
| BPD: at 1, 4, and 12 months then annually | BPD: at 1, 4, and 12 months then annually | BPD: at 1, 4, and 12 months then annually | ||
| OBN (2016)57 | Baseline: All | Baseline: All | Baseline: All | NA |
| Follow-up: All at 6, 12 months then annually up to 5 years | Follow-up: All at 3, 6, 12 months then annually up to 5 years | Follow-up: All at 6, 12 months then annually up to 5 years | ||
| ASMBS (2020)58 | Baseline: All | Baseline: All | Baseline: All | Baseline: Same as the NOF indications |
| Follow-up: All at least annually§ | Follow-up: All every 3–6 months in the first year and then annually | Follow-up: All at least annually | Follow-up: RYGB, BPD-DS at 2 years§,‖,¶ |
*The AACE/TOS/ASBMS/OMA/ASA guidelines recommend 24-hour calcium urine excretion after BPD or to evaluate for bone loss.
†The IDE guidelines recommend routine preoperative assessment, but do not specify the specific tests.
‡The IDE guidelines include monitoring bone alkaline phosphatase at 1, 4, and 12 months post-BPD, and annually thereafter.
§The ASBMS guidelines recommend consideration of 24-hour urinary calcium in relationship to dietary intake preoperatively, and postoperatively to monitor bone loss.
‖The ASBMS guidelines state agreement with bone density monitoring recommendations set forth by the AACE/TOS/ASBMS/OMA/ASA Clinical Practice Guidelines.
¶The ASBMS guidelines include recommendations to monitor for bone loss with C-terminal telopeptide of type 1 collagen (CTX) in perimenopausal and postmenopausal women and patients at risk for osteoporosis.
AACE/TOS/ASMBS/OMA/ASA, American Association of Clinical Endocrinologists, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists; AGB, Adjustable Gastric Band; ASBMS, American Society for Metabolic and Bariatric Surgery; BMD, bone mineral density; BOMSS, British Obesity and Metabolic Surgery Society; BPD/DS, biliopancreatic diversion/duodenal switch; CPG, Clinical Practice Guidelines; ES, Endocrine Society; IDE, Interdisciplinary European; NOF, National Osteoporosis Foundation; OBN, Ontario Bariatric Network; PTH, parathyroid hormone; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.