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When diet and exercise attempts haven’t worked, increasing numbers of overweight people have turned to bariatric, or weight-loss, surgery to shed pounds.

But research reported in 2009 pointed to an unintended result: One of every five people who had bariatric surgery had broken a bone within a few years.

Were the breaks a result of the surgery? Or of the weight loss that followed? Might they have been related to something going on in the body, either before or after the surgery? Or might something else altogether have been at work?

The answers remain unclear.

The finding came from an early analysis of data from a study by researchers from the Mayo Clinic, in Rochester, Minn. The study included 97 people, most middle-age and mostly women. All had had bariatric surgery — either stapling of the stomach, called gastric bypass, or stomach banding, called gastric band surgery. In the next seven years, 21 of them had 31 fractures.

The researchers compared the fracture rate for the people in the study with the rate for residents of Olmsted County, Minn., and found that people who had undergone weight-loss surgery were nearly twice as likely to have broken a bone for the first time as were those in the general population. The rate for specific sites was higher, with the risk for fracturing a foot, for instance, nearly four times higher among people who’d had bariatric surgery than in the general population.

The researchers did not determine what caused the increase in broken limbs. Their research, presented at a meeting in June of the Endocrine Society, continues and, through a Mayo Clinic spokesman, they declined further comment.

Until more findings are in, experts can only speculate about the cause and advise people who have had or plan to have bariatric surgery to pay close attention to bone health.

Dr. John Wilder Baker, director of the medical weight-loss program and co-director for the bariatric surgery program at Baptist Health in Little Rock, Ark., said that people in the study might have been deficient in vitamin D before the surgery.

Many people don’t include enough dairy products in their diet and so are lacking in vitamin D and calcium, both important for bone strength, said Baker, who is also president of the American Society for Metabolic and Bariatric Surgery and was familiar with the Mayo research.

Weight-loss surgery, he said, could bring about changes in absorption of calcium. “With gastric bypass, there could be some malabsorption of calcium,” he said.

“Before and after gastric bypass, patients are routinely told to take at least 1,200 milligrams of calcium daily, and usually 800 milligrams of D, but that may not be enough,” Baker said.

Monitoring patients closely is crucial, he said. “No matter which surgery [of several bariatric surgery options] they have had done, they need to be monitored for calcium, vitamin D levels and parathyroid hormones long term,” he said. Parathyroid hormones help increase calcium levels in the blood.

An orthopedic surgeon also familiar with the study said that it’s important to remember that the research was reported at a preliminary stage.

“I would be very careful drawing too much from one study,” said Dr. Leon Benson, a professor of orthopedic surgery at the University of Chicago, a hand surgery consultant at the Illinois Bone and Joint Institute and a spokesman for the American Academy of Orthopaedic Surgeons.

Benson said he has not noticed an increase in fracture patients with a history of bariatric surgery.

As for the mechanism, he speculated, like Baker, that the higher fracture rate could be linked to absorption issues.

Another possibility? “Maybe the patients lost enough weight [that] it changes body image and they have balance issues,” Benson said.

For now, people who’ve had bariatric surgery “should be as careful as they can to avoid preventable fractures,” he said. “That means paying close attention to their physician’s advice about their intake of calcium and vitamin D as well as their advice about exercise, which can help keep bones strong.”

When it comes to talking about sex, parents are a few paces behind their kids.

Too often, the birds-and-the-bees conversation occurs after, and not before, kids start experimenting sexually, possibly in risky ways, reports a study in the January issue of Pediatrics.

This revelation comes despite American Academy of Pediatrics recommendations that health-care providers and parents talk to their kids about sex and sexuality early in life.

“Parents are a little behind the 8 ball. They underestimate their children’s sexual knowledge and interest and behaviors,” said Dr. Lawrence Friedman, director of adolescent medicine at the University of Miami Miller School of Medicine.

“It’s a hard subject for many parents to broach, but the level of sexual activity in many kids has moved up in terms of initiation. It’s younger,” added Alan Hilfer, director of psychology at Maimonides Medical Center in New York City. “Talking about it is very helpful in terms of disease prevention, unwanted pregnancy and even issues around relationships.”

Although there were suspicions that parents lagged behind their kids, previous studies had asked adults to remember when they first had sex and when their parents talked to them, said study author Megan Beckett, a social scientist with the Rand Corp. in Santa Monica, Calif.

For this study, Beckett and her colleagues surveyed 141 middle-class and upper middle-class parents and their children, aged 13 to 17, in more of a real-time scenario. “We went back about four times over a year’s period,” Beckett said.

Starting with questions about girls bodies and menstruation, the research team asked parents and children about kissing and handholding, birth control, refusing sex, oral sex and intercourse, all related to different developmental stages of the kids.

More than half of children had experienced genital touching before “the talk” about birth control, sexually transmitted diseases (STDs) and condom use, the researchers found.

“More than 40 percent of adolescents are having intercourse before parents have talked to them about STD symptoms, condom use, choosing birth control and what to do if your partner refuses to use a condom,” Beckett said. “That’s a pretty large number.”

About two-thirds of boys said they had not talked with a parent about how to use a condom before having intercourse.

And conversations with boys almost always took place later than talks with girls.

“This is a flag to not put it off, and this is especially the case with boys,” Beckett said.

Denial, naivety and any number of other emotions on the part of the parents may be playing into this trend, Friedman said.

“They reminisce that when they were in the seventh grade, they didn’t do that kind of thing,” he said. “The fact of the matter is that this is 25 years later, and this is what is going on. You have to be knowledgeable and prepared to prepare children for when they become teenagers and have to confront sexual kinds of activities.”

Other experts agree. “We live in an R-rated society, and our kids need our PG guidance,” said Dr. Frank Biro, head of adolescent medicine at Cincinnati Children’s Hospital. “If you want to instill knowledge and values, then you need to be talking to your kids earlier, not later.”

Here are some tips on when and how to talk to your kids:
Figure that the age you think is appropriate is probably too old. “If parents think that they should broach the topic at x age, they should subtract two years and do it at that age instead,” Friedman said.
Talk to your physician and scour resources from the Internet, libraries and schools about how to broach the subject and what to say.
Take the lead. “Don’t expect your child to come and ask an important question about a topic that they’re embarrassed about or that they don’t know their parents would be willing to talk to them about,” Friedman said. “This will also help gauge how knowledgeable their teenager or child is.”
After you’ve talked, “step back and ask your kids questions and pay attention to what they’re interested in,” Hilfer said.
Make sure your conversation is developmentally appropriate to the child, Biro said. Talking about fellatio with a 6-year-old is probably not appropriate. Talking about boys liking girls and handholding would be for kids 8 or 9 years or possibly even 6 years old. “If you haven’t talked to your kids by the time they’re 12, you need to get on the stick,” said Hilfer.