Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is the newly approved oral PCSK9 Inhibitor, Lipfendra, as clinically efficacious as injectable versions of the drug such as Repatha?
While this new cholesterol-lowering agent, enlicitdie, has been shown to be very effective, we cannot say it is "as efficacious" as PCSK9 monoclonal antibodies. The studies were done in different populations, with different baseline LDL levels, different potential concomitant medications, etc. The o...
How would you define failure of anabolic therapy for severe osteoporosis and when would you consider ordering a second round of Evenity or PTH analogue therapy?
“Failure” of any therapy is often in the eyes of the beholder. The most efficient way to determine if there is anabolic activity is to measure a serum PINP (does not need fasting) and, for the PTH anabolic recheck, the PINP 2-3 months later. IF the delta is >10, you can be confident there is more pr...
Can you use bisphosphonates in a patient with osteoporosis who has had prior avascular necrosis of TMJ due to steroid use?
Due to the rarity of medication-related osteonecrosis of the jaw (MRONJ) and significantly high fracture risk from osteoporosis, prior history of osteonecrosis is not considered an absolute contraindication for bisphosphonate use. The clinical picture is important in weighing this decision. If the p...
In patients with osteoporosis at high fracture risk, what factors most influence your decision to prescribe teriparatide versus abaloparatide?
Both abaloparatide and teriparatide are very effective anabolic agents to reduce vertebral and nonvertebral fracture risk in patients with osteoporosis (although clinical trials did not demonstrate reduction of hip fracture risk). The two agents are more similar than different and both induce an an...
Should a different weight-based dosing algorithm for levothyroxine therapy be considered in women versus men given higher incidence of iatrogenic thyrotoxicosis in women?
I do not. For the majority of my patients, my starting dose is 1.6 mcg/kg, which is in the ATA guidelines (1.6-1.8 mcg/kg has been recommended as the starting dose in many publications). There have been some studies that show using ideal body weight is a better predictor of LT4 dose, and others tha...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
How do you approach osteoporosis screening in men?
While osteoporosis is more prevalent in postmenopausal women, it is often under-recognized in men. The risk of mortality after hip fracture is higher in men, and that risk may extend over 10 years after injury. Men who sustain a wrist fracture are more likely to have severe osteoporosis and a higher...
How has your approach to de-escalating a conversation with a distressed or angry family member evolved over your career?
My approach to de-escalating conversations with distressed or angry family members has shifted from trying to solve the problem immediately to first understanding the emotion driving the conflict. Early in my career, I often responded by providing more medical information, assuming that greater clar...
What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?
The biggest difference between osteoporosis and CKD-MBD has to do with the underlying bone mineral laboratories. Generally, with osteoporosis, bone chemistries are relatively normal; there may be a decrease in Vit D. However, with CKD-MBD, there is usually an increase in PTH, potentially abnormaliti...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...