Introduction-Roux-en-Y gastric bypass (RYGB) is a well-established treatment for morbid obesity and type 2 diabetes. The effects of RYGB on bone metabolism and bone health are largely unknown.Objective-Determine the changes in osteoclast function and bone density 1 year after RYGB as compared with a control group undergoing a diabetes support and education program (DSE).Design-A prospective cohort study with patients matched for weight and age assigned to RYGB or DSE. Setting-Large academic institution.Patients or Other Participants-Patients with type 2 diabetes mellitus and morbid obesity (body mass index greater than 35 kg/m 2 ).Intervention-Subjects either received laparoscopic RYBG or DSE, which consisted of nutritional, exercise, and dietary counseling performed by a certified diabetic educator and a nutritionist three times over a year.Main Outcome Measure-Osteoclast activity, bone mineral density.Results-One year after, intervention subjects undergoing RYGB have a 280% increase in osteoclast activity as compared with a 7.6% increase in the DSE control group (P < 0.001). Furthermore, there was a statistically significant increase in sclerostin levels in subjects undergoing RYGB compared with an increase in the control group. The total bone mineral density Laurel L Tangalakis,

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