Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you regularly do bone density testing to screen for osteoporosis in men with rheumatoid arthritis without any other risk factors?
An important comorbidity in RA is fragility fractures. These patients are at higher risk of OP because of increased pro-inflammatory cytokines and glucocorticoid treatment. OP screening strategies are both feasible and effective in RA patients and recommended by most specialty organizations. Both me...
In which osteoporosis patients would you consider starting with anabolic therapy over antiresorptive therapy?
Anabolic therapies including teriparatide (PTH-analog), abaloparatide (PTHrP-analog), and romosozumab (anti-sclerostin) are all indicated for patients with osteoporosis and high fracture risk. Although denosumab (anti-RANKL) is an antiresorptive agent, it also leads to significant bone gain similar ...
When treating patients with low bone mineral density, when/how do you monitor bone turnover markers (NTX, CTX, etc)?
It is a bit difficult to answer this question without more information. If you are monitoring a patient during a drug holiday, I would order a CTX-1 and PINP when discontinuing the bisphosphonate and then again after one year. If the levels have increased over 50% from the year before that would tri...
What agent would you choose for a patient who needs osteoporosis therapy after a bisphosphonate holiday?
This is a question of high clinical importance but with a lack of good controlled data. First and foremost, a holiday should be viewed as a temporary discontinuation of therapy. Anecdotally, I would say about 30% of my patients need to go back on therapy. There is a lack of data to support clinical ...
Would you consider an osteoporosis medication in a pre-menopausal/young patient with a low Z score and an ongoing risk factor for secondary osteoporosis such as chronic antiepileptic treatment?
Osteoporosis prevention is always difficult in young patients with risk factors. For young premenopausal women or men below 40, I extrapolate from glucocorticoid-induced osteoporosis (GIOP) guidelines. If Z scores are below -3 and/or there is a history of fragility fracture(s), then treatment with O...
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...