According to an editorial, this study represents an important contribution to the evidence supporting the long term management of patients after bariatric surgery. However, limitations in the design prevent any confident answer as to whether bariatric surgery does increase the risk of fractures. It notes however, that as long as the understanding of bone physiology after bariatric surgery remains limited, and the clinical consequences of physiological alterations remain untested by appropriate prospective studies, guidelines on nutritional supplementation should continue to be followed that include the best available evidence.