As the weekend gets closer, Coeur d'Alene and Post Falls are replete with Ironman contestants. Those trim bikers and runners - not all of them young - remind the rest of us of what is possible with determination and discipline.

Inspiring, yes. Tiring to imagine, well, yes.

I should lose a few pounds and get to the gym more often, but it's frustrating. Middle age makes getting results harder, especially for women. Rather than emulate an Ironman with all its attendant sacrifices, considerably more challenging for those who are obese rather than merely overweight, bariatric surgery is becoming increasingly popular. It's also, apparently, risky. As a new study warns, with bariatric surgery/gastric bypass comes notable bone loss, something else middle aged and older women have to carefully guard against.

Exercise is looking better and better.

Previous research linked loss in bone mineral density with the period of weight loss following bariatric surgery. What's new is the discovery by a medical team at Massachusetts General Hospital in Boston that this bone loss is continuing up to two years after surgery, and after weight loss has stabilized. Their research, sponsored by the National Institutes of Health, was presented to the International Society of Endocrinology this week.

If you're wondering about calcium and vitamin D, those levels were investigated and found to be at healthy levels in the same post-surgical patients who had the bone loss. This suggests the problem is not related to the weight loss, but to some other aspect of the surgery. Endocrinologist and lead study investigator Dr. Elaine Yu called the bone loss "substantial" and believes that although so far osteoporosis has not been reported, patients may be at increased risk of bone fracture and breakage.

The density loss was notable at the spine and hip. Research continues, as it is not yet known how long this bone density may decrease or what the possible causes may be. Suspects include major hormonal shifts (in gastrointestinal and fat hormones) resulting from surgery.

The researchers plan to investigate possible causes of the bone loss observed. Yu speculated that major changes in gastrointestinal and fat hormones, which occur almost immediately after bariatric surgery, could affect bone. Meanwhile Dr. Yu recommended that bone health be closely monitored in post-bariatric surgery patients.

Sholeh Patrick is a columnist for the Hagadone News Network. Contact her at sholeh@cdapress.com.