Long-Term RNY/Gastric Bypass Complications?

ONE GASTRIC BYPASS PATIENT ASKED"
What are the main complications with RNY/gastric bypass long-term?

It would seem that the malabsorption issue could affect osteoporosis rates for instance due to less calcium being absorbed. I understand the need for supplementation i.e. calcium, iron, b vitamins, etc... to help prevent peripheral neuropathy, anemia, osteoporosis.

What I am trying to ask is what are the observed long-term complications with gastric bypass i.e. more than 10 years out? It seems that gastric procedures are becoming more common place to perform. I understand RMAP did at least one published study. What increased risk for osteoporosis is there? I am asking in part due to evidence showing up that the biphosphonates (i.e. alendronate AKA Fosamax) can cause osteonecrosis of the jaw.

Another concern would be fish oil. Fish oil has been touted to help with cardiac (heart healthy) and other applications as well. Do doctors simply increase the recommended dose for medications that are not well absorbed? I can think of levothyroxine (thyroid medication) and others that simply can be ordered in an increased dose based on lab work. Are providers recommending taking medications such as iron or others that need a more acidic environment to absorb well to take vitamin c with those medications? I am trying to look up medical articles about this and will post if I can find useful information.

THE INITIAL REPLY:
Here is the link to the article that was published in the New England Journal or Medicine. http://content.nejm.org/cgi/content/full/357/8/753 After reviewing your e mail with Dr. ******* he wanted to mention: The main long-term complications we see in Gastric Bypass is a deficiency in thiamine, folate, B-12 if patients do not follow the guidelines and do not take their supplements. I'm not aware of any evidence to show increase in osteoporosis- more research is needed. Fish oil and other supplements should be well absorbed in usual doses. More recent iron supplements such as Repliva have better absorption because of acidic supplement in tablets. I hope this answers your questions.

I WANTED TO ADD ON TO THAT:
For what it's worth:
* The body normally doesn't do a good job of calcium absorption. With gastric bypass patients, obviously that is even more true. With that said, it is important to keep up with your calcium after the surgery. If you do not, calcium deficiency can occur. When that happens, your body pulls the calcium it needs from your bones and teeth and the result can be osteoporosis. So yes, you are at more of a risk. But only if you don't follow the guidelines set forth. If you take your calcium as you are instructed, you'll be fine.
* I find that as long as I take my supplements (all supplements), my levels are fine. I apply that logic to your question on Fish oil. I'm a big believer in taking usual doses unless it turns out that you need to add a bit more. But you find that out by how well you end up absorbing the B12 and other supplements that you check periodically. For example, I know many who take 1,000mcg of B12 daily to keep their levels up. Me, I only take 500 mcg 3-4 times a week and my levels are very high (as they should be). Of course that most likely has to do with how much B12 I get in my daily diet.

I think you get my jist here. All in all the surgery is the best thing I have ever done for myself. If I had a choice to do it again or go a different route, I would do it again in a heartbeat. No hesitation whatsoever.
Sean