The 2022 recommendations of the European Calcified Tissue Society (ECTS) suggest initiating anti-osteoporotic medication (AOM) in case of a T-score ≤ −2 and/or in case of a fragility fracture within less than 2 years. Therefore, this study aimed to evaluate the eligibility for AOM in a cohort of patients referred for bone health assessment after bariatric surgery. This observational, cross-sectional, and monocentric study conducted at Lille University Hospital evaluated the prevalence of AOM eligibility according to the ECTS criteria in postmenopausal women and men aged ≥50 years referred for bone health assessment after bariatric surgery, either Roux-en-Y gastric bypass or sleeve gastrectomy, at least 2 years after bariatric surgery. Between June 2019 and June 2023, all participants were referred for bone health assessment, including systematic screening using dual-energy X-ray (DXA) and a standardized questionnaire by a radiology technician. Data between June 2023 and May 2024 were retrospectively reviewed. Among 140 patients (120 women, with an average age of 59 (55–63) years) seen for bone health assessment between June 2019 and June 2023, 33 met the ECTS guidelines for AOM, indicating a prevalence of 24% (CI 95%: 17–31%). Most patients met the BMD T-score ≤ −2 criterion (
n
= 26/140, 19% (CI 95%: 12–25%)) and/or had a recent fragility fracture history (
n
= 14/140, 10% (CI 95%: 5–15%)). In this study, one-fourth of the participants were eligible for AOM according to the ECTS guidelines.