Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is romosozumab an option in a patient who has completed 2 years of teriparatide therapy and has a fracture while on denosumab?
Romosozumab would be an excellent option in this setting. Although both teriparatide and romosozumab are anabolic agents, they have different MOAs and there is no cumulative time limit of therapy as there would be in the case of additional therapy with abaloparatide. At the completion of therapy wit...
How do you manage post-menopausal osteoporosis in a patient with stable bone density and no fractures after three years of holiday after giving zoledronic acid?
If the BMD is stable at three years of a post-treatment holiday, I would simply continue the holiday for another 1-2 years. The majority of post-menopausal women were able to achieve 5 years of treatment holiday before BMD dropped to baseline. Repeat the bone density measurement each year or two and...
Are stress-dose steroids indicated in patients with adrenal insufficiency receiving radiation therapy?
I am not aware of any direct analysis or study that has addressed this question specifically for patients undergoing radiation treatment, but I can comment on the present indications for perioperative stress-dose glucocorticoids in adrenally insufficient patients, from which certain inferences to Ra...
For patients with cancer receiving a bone-modifying agent (bisphosphonate or denosumab) who suffer a fracture requiring stabilization or reconstruction, how do you manage the bone-modifying agent peri-operatively?
There’s been suggestion that administering bone-modifying agents may delay or impair fracture healing, but it has not been borne out by the literature. The half-life in bone is actually quite long so whether treatment interruption makes a difference is questionable. Also, since most patients receive...
How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?
Overall, there are minimal data in pediatric populations, but the data from adult populations suggests that in the vast majority of cases, it is safe from a VTE standpoint to administer estrogen therapy in male-to-female transgender patients. The current formulations of estrogen that are recommende...
How do you incorporate denosumab into the surgical management of giant cell tumor of bone?
Denosumab forever. Giant cell tumors of bone have a clonal cancer component and then osteoclasts that are hypnotized by the cancer. Denosumab works on the osteoclasts so they quit listening to the cancer and then the whole thing turns to bone. Denosumab does not kill anything and the cancer cells ar...
How would you approach patient with metastatic anaplastic thyroid cancer with NGS revealing only ARID1A mutation?
It would be helpful to have the results of the entire NGS panel. Was ARID1A the only mutation noted on comprehensive tumor NGS? Was there any suggestion of MSI? ARID1A mutations usually result in either loss or decreased function of ARID1A which is a tumor suppressor. In-vitro and in-vivo data for P...
For patients on a bone-modifying agent for osteoporosis/severe osteopenia in the context of adjuvant AI therapy, how do you manage the bone-modifying agent once their AI course is complete?
In this case, I would be guided by the bone density (DXA) scan, if there is still osteoporosis or severe osteopenia, I would continue the BMA and repeat the DXA scan in one or two years. If the DXA shows improvement, I would discontinue the BMA, knowing that one can re-institute at a later date. Sev...
Would you consider using teriparatide beyond a cumulative maximum of two years now that the black box warning regarding osteosarcoma has been removed?
This is a very good question. Early studies with PTH compounds for osteoporosis showed you could give it for three years and still have an effect on increasing bone mass. The black box warning was for osteosarcomas that occur in young adults and children, and the black box warning was also for indiv...
Do you approach therapy differently for patients with a diagnosis of osteoporosis based on a fragility fracture rather than based on bone mineral density on DXA (assuming no secondary causes of osteoporosis)?
This is an interesting question but the question does not define the bone density results in the individual(s) in question with a history of a fragility fracture. There are people who sustain such fractures with normal bone densities and of course, many individuals sustain fragility fractures with l...