Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?
While long-term GH replacement in GHD individuals increased BMD (after an initial decline at 6 months point), I am not aware of any placebo-controlled study that convincingly showed an effect on fractures.
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
I am not aware of a well done study in this regard, but oral contraceptives containing estrogen induce growth hormone resistance and may lower IGF-1, but the beneficial effect of estrogen on bone density would almost certainly outweigh any negative effects caused by lowering the IGF-1.
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
The strict answer to this question, including "all patients hospitalized with acute MI" is no based on the results of the recently reported EMPACT-MI trial. In this study of more than 6000 patients empagliflozin did not significantly improve a composite endpoint of hospitalization for heart failure ...
How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?
This is not all that uncommon. The first thing I do is ask if they have fractured since we started the therapy. If not, I relax a little. This is a nice scenario for using bone turnover markers as part of initial work up. If PINP goes up by >10 I am happy that an anabolic drug is working... more you...
How do you choose between antithyroid drugs, RAI, and surgery for hyperthyroidism patients with existing cardiovascular disease, given their varying effects on cardiovascular outcomes?
This recent JAMA study (Chiung-Hui Peng et al., PMID 38436957), and others like it (e.g., Okosieme et al., PMID 30827829) show higher mortality rates and CV disease in patients receiving ATDs vs RAI, or better outcomes with surgery vs both RAI and ATDs (Liu et al., PMID 35822337). The main reason ap...
Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?
It is a good question and it does depend on what is contributing to the FRAX score. If it is due to being on medications like prednisone or having a strong family history for early-onset fractures, it is reasonable to consider osteoporosis therapy. Age is also a significant factor. For the same bone...
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
While there are no published clinical trials treating AFF with anabolics, we have considerable experience taking care of AFF's. Between myself and two ANP's doing strictly bone health with a large group of orthos who manage a large percentage of fractures in the Phoenix valley, we unfortunately stil...
Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?
I think the cardiovascular safety data is complex. I have reviewed the data and have heard several good presentations at bone meetings. I am of the opinion that if someone has had an event such as an MI even more than two years ago, I would likely not prescribe romosozumab. We have two other anaboli...
Should patients with hypothyroidism hold their morning levothyroxine dose before going to the lab to check free T4/TSH?
There exists a lack of consensus regarding the optimal timing for thyroid blood tests in relation to levothyroxine administration. Given the 7-9 days half-life of T4 and the approximately 4-5 half-lives required for clearance from the system, the timing of levothyroxine intake doesn't significantly ...
When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?
Bemepedoic acid is approved in the US for use as an adjunct to statin therapy in patients with established ASCVD (secondary prevention) or those with heterozygous Familial Hypercholesterolemia who require additional LDL- cholesterol reduction. More recently it has also been approved for primary prev...