Impact of sleeve gastrectomy on bone metabolism in obese patients: from mechanisms to clinical prevention

In recent years, the global incidence of obesity has continued to rise, making obesity and its associated complications a serious threat to human health. Bariatric surgery, represented by sleeve gastrectomy (SG), has emerged as a crucial intervention for the treatment of obesity and related metabolic comorbidities. However, accumulating evidence indicates that bariatric surgery exerts multiple adverse effects on bone tissue, characterized by significantly increased bone resorption, decreased bone mineral density (BMD), and a consequent elevation in fracture risk. This review summarizes the effects of SG on BMD, bone turnover markers (BTMs), and bone microarchitecture in obese individuals, and comprehensively discusses the underlying mechanisms as well as corresponding clinical prevention strategies.