An increasing number of patients worldwide suffer from bone fractures that occur after low intensity trauma. Such fragility fractures are usually associated with advanced age and osteoporosis but also with long-term immobilization, corticosteroid therapy, diabetes mellitus, and other endocrine disorders. It is important to understand the skeletal origins of increased bone fragility in these conditions for preventive and therapeutic strategies to combat one of the most common health problems of the aged population. This review summarizes current knowledge pertaining to the phenomenon of micropetrosis (osteocyte lacunar mineralization). As an indicator of former osteocyte death, micropetrosis is more common in aged bone and osteoporotic bone. Considering that the number of mineralized osteocyte lacunae per bone area can distinguish healthy, untreated osteoporotic and bisphosphonate-treated osteoporotic patients, it could be regarded as a novel structural marker of impaired bone quality. Further research is needed to clarify the mechanism of lacunar mineralization and to explore whether it could be an additional target for preventing or treating bone fragility related to aging and various endocrine diseases.
Petar Milovanovic and Björn Busse
Martine Cohen-Solal, Thomas Funch-Brentano and Pablo Urena
Mineral and bone diseases (MBD) are predominant in patients with chronic kidney disease (CKD) and leads to several bone manifestations, from pain to skeletal fractures. Cumulative traditional clinical risk factors, such as age and gender, in addition to those related to CKD, enhances the risk of comorbidity and mortality related to fractures. Despite great advances in understanding MBD in CKD, clinical and biological targets are lacking, which leads to under-management of fractures. Optimal PTH control results in a net improvement in defining the levels of bone remodeling. In addition, circulating biomarkers such as bone-specific alkaline phosphatase and cross-linked collagen type I peptide will also additional information about bone mineralization and evaluation of fracture risk. Imaging techniques will facilitate to characterize the patient at risk by the use of the measurement of bone mineral density by DEXA or by high peripheral computed tomography which allow the discrimination of trabecular and cortical bone. We here reviewed the literature related to the epidemiology and pathophysiological role of mineral and biochemical factors involved in CKD-MBD with a special focus in fracture risk. We also provide an algorithm that could be used for the management of bone diseases and the treatment decision. Finally, the combined expertise of clinicians from various disciplines is crucial for the best prevention of fractures.
Anna Olsson-Brown, Rosemary Lord, Joseph Sacco, Jonathan Wagg, Mark Coles and Munir Pirmohamed
Intoduction: Immune checkpoint inhibitors can lead to thyroid dysfunction. However the understanding of the clinical phenotype of ICI-induced thyroid dysfunction in the real-world population is limited. The purpose of this study was to characterise the clinical patterns of dysfunction and evaluate the demographic, biochemical and immunological features associated with this patient cohort.
Materials and Methods: To characterise the longitudinal clinical course of thyroid dysfunction in patients from a single, UK regional cancer centre a retrospective review of patients was conducted. Inclusion criteria included all patients treated with antiPD-1 checkpoint inhibitors (ICI), either as monotherapy (pembrolizumab/nivolumab) or in combination with a CTLA-4 inhibitor (ipilimumab). Patterns of toxicity were evaluated together with assessment of antibody titres.
Results: Over 16 months, thyroid dysfunction was seen in 13/90 and 3/13 patients treated with anti-PD1 monotherapy, and in combination with the anti-CTLA4 ICI ipilimumab, respectively. Patients either developed hyperthyroidism followed by hypothyroidism 12/16 or de novo hypothyroidism 4/16. Most patients were female (n=11). All patients required thyroid replacement therapy. There was no relationship between clinical pattern of dysfunction and the presence of thyroid autoantibodies.
Conclusions: There are two distinct patterns of thyroid dysfunction in ICI-treated patients. Patients with thyroiditis develop subsequent hypothyroidism in the vast majority of cases. The potential benefit from steroids or other therapy to manage the hyperthyroid phase remains unclear. Early detection of these patients through appropriate monitoring will improve clinical management and early hormone replacement reducing the symptomatic burden of hypothyroidism.
issues per year; fast review and processing times continue to be combined with an ambitious acceptance rate. Endocrine Connections covers original high-quality basic, translational and clinical research or review articles, covering all aspects of
Jens Sandahl Christiansen
) and the Society for Endocrinology (SfE), working together to further research, education and clinical practice in endocrinology. The journal will publish original quality research and reviews in all areas of endocrinology, with a focus on papers that
Ling-Jun Li, Izzuddin M Aris, Lin Lin Su, Yap Seng Chong, Tien Yin Wong, Kok Hian Tan and Jie Jin Wang
1999 WHO guideline via a 75 g oral glucose tolerance test ( 20 ). We conducted the study according to the tenets of the Declaration of Helsinki and obtained approval by the SingHealth Centralized Institutional Review Board and the National Health
consciousness. Authors of this Emergency Guidance were also authors on the Society for Endocrinology’s UK Guidelines for the management of pituitary apoplexy, published in 2011 and reviewed with no necessary changes in 2014 ( 8 ). Each guidance document has
Raymond J Rodgers, Jodie C Avery, Vivienne M Moore, Michael J Davies, Ricardo Azziz, Elisabet Stener-Victorin, Lisa J Moran, Sarah A Robertson, Nigel K Stepto, Robert J Norman and Helena J Teede
articles include articles containing primary data and review articles. Why is PCOS under-represented in diabetes journals? Without knowing the rates of submission and acceptance for relevant journals, it is not possible to assess where the
Daiki Kobayashi, Nagato Kuriyama, Keita Hirano, Osamu Takahashi and Hiroshi Noto
Introduction Previous systematic reviews and meta-analyses have reported that diabetic patients have a higher risk of developing malignancies compared to nondiabetic patients ( 1 , 2 , 3 , 4 ). Based on these reports, diabetic patients may
Lili Liu, Zhuo Shao, Ying Xia, Jiabi Qin, Yang Xiao, Zhiguang Zhou and Zubing Mei
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) ( 20 ). Literature-search strategy Relevant studies published before July 16, 2018 were selected from PubMed, EMBASE and the Cochrane Library. There was no restriction in