John P Bilezikian

CUNY Graduate Center, New York City, New York, United States

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Publications (217)1190.49 Total impact

  • Aline G Costa, John P Bilezikian, E Michael Lewiecki
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    ABSTRACT: Introduction: Disorders with inactivating mutations of the SOST gene result in reduced or absent expression of sclerostin and are associated with high bone mass. Sclerostin is an important regulator of bone formation due to its inhibitory actions in the osteoanabolic Wnt signaling pathway. Advances in understanding the mechanisms of action of this signaling molecule have led to the development of a pharmacological inhibitor of sclerostin with potential clinical applications as an osteoanabolic drug for the treatment of osteoporosis. Areas covered: Romosozumab is the first humanized monoclonal sclerostin antibody to be tested in clinical trials. Similar to preclinical animal studies with sclerostin antibodies, initial clinical studies show that romosozumab increases bone formation and bone mineral density. Expert opinion: Blocking sclerostin action with romosozumab is a promising new therapeutic approach to osteoanabolic therapy of osteoporosis; efficacy and safety data on large controlled studies are awaited.
    Expert opinion on biological therapy 03/2014; · 3.22 Impact Factor
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    ABSTRACT: Dual-energy X-ray absorptiometry (DXA) is an inexpensive, noninvasive, widely available method for diagnosing osteoporosis, assessing fracture risk, and monitoring the effects of therapy. By diagnosing high-risk patients before a fracture occurs, clinicians can intervene early to reduce fracture risk. Appropriate use of DXA results in money saving for healthcare systems that might otherwise be spent for fracture-related care. Recent reports of studies evaluating DXA screening criteria and intervals for retesting have received considerable media coverage, sometimes suggesting that DXA is expensive, over-utilized, and unnecessary. This may lead to more patients who might benefit from early detection of osteoporosis remaining undiagnosed. We advocate for the use of current clinical practice guidelines with individualization of patient care factors to determine the optimal intervals for DXA testing.
    Current Osteoporosis Reports 03/2014;
  • Nelson B Watts, John P Bilezikian
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    ABSTRACT: Abstract Not Available.
    The Journal of clinical endocrinology and metabolism 01/2014; · 6.50 Impact Factor
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    ABSTRACT: The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the 2-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in post-menopausal women and in men with previous fragility fractures than their non-fractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) Efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment. © 2014 American Society for Bone and Mineral Research.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 01/2014; · 6.04 Impact Factor
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    ABSTRACT: The 2013 Santa Fe Bone Symposium included plenary sessions on new developments in the fields of osteoporosis and metabolic bone disease, oral presentations of abstracts, and faculty panel discussions of common clinical conundrums: scenarios of perplexing circumstances where treatment decisions are not clearly defined by current medical evidence and clinical practice guidelines. Controversial issues in the care of osteoporosis were reviewed and discussed by faculty and participants. This is a review of the proceedings of the Santa Fe Bone Symposium, constituting in its entirety an update of advances in the understanding of selected bone disease topics of interest and the implications for managing patients in clinical practice. Topics included the associations of diabetes and obesity with skeletal fragility, the complexities and pitfalls in assessing the benefits and potential adverse effects of nutrients for treatment of osteoporosis, uses of dual-energy X-ray absorptiometry beyond measurement of bone mineral density, challenges in the care of osteoporosis in the very elderly, new findings on the role of osteocytes in regulating bone remodeling, and current concepts on the use of bone turnover markers in managing patients with chronic kidney disease who are at high risk for fracture.
    Journal of Clinical Densitometry 01/2014; · 1.71 Impact Factor
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    ABSTRACT: Hypoparathyroidism results in impaired mineral homoeostasis, including hypocalcaemia and hyperphosphataemia. Treatment with high-dose oral calcium and active vitamin D does not provide adequate or consistent control of biochemical indices and can lead to serious long-term complications. We aimed to test the efficacy, safety, and tolerability of once-daily recombinant human parathyroid hormone 1-84 (rhPTH[1-84]) in adults with hypoparathyroidism. In this double-blind, placebo-controlled, randomised phase 3 study (REPLACE), we recruited patients with hypoparathyroidism (≥18 months duration) aged 18-85 years from 33 sites in eight countries. After an optimisation period, during which calcium and active vitamin D doses were adjusted to achieve consistent albumin-corrected serum calcium, patients were randomly assigned (2:1) via an interactive voice response system to 50 μg per day of rhPTH(1-84) or placebo for 24 weeks. Active vitamin D and calcium were progressively reduced, while rhPTH(1-84) could be titrated up from 50 μg to 75 μg and then 100 μg (weeks 0-5). The primary endpoint was the proportion of patients at week 24 who achieved a 50% or greater reduction from baseline in their daily dose of oral calcium and active vitamin D while maintaining a serum calcium concentration greater than or the same as baseline concentrations and less than or equal to the upper limit of normal, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00732615. Between June 23, 2009, and Feb 28, 2011, 134 eligible patients were recruited and randomly assigned to rhPTH(1-84) (n=90) or placebo (n=44). Six patients in the rhPTH(1-84) group and seven in the placebo group discontinued before study end. 48 (53%) patients in the rhPTH(1-84) group achieved the primary endpoint compared with one (2%) patient in the placebo group (percentage difference 51·1%, 95% CI 39·9-62·3; p<0·0001). The proportions of patients who had at least one adverse event were similar between groups (84 [93%] patients in the rhPTH[1-84] group vs 44 [100%] patients in the placebo group), with hypocalcaemia, muscle spasm, paraesthesias, headache, and nausea being the most common adverse events. The proportions of patients with serious adverse events were also similar between the rhPTH(1-84) group (ten [11%] patients) and the placebo group (four [9%] patients). 50 μg, 75 μg, or 100 μg per day of rhPTH(1-84), administered subcutaneously in the outpatient setting, is efficacious and well tolerated as a PTH replacement therapy for patients with hypoparathyroidism. NPS Pharmaceuticals.
    The lancet. Diabetes & endocrinology. 12/2013; 1(4):275-83.
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    ABSTRACT: Major aims of the 5th Central and Eastern Europe (CEE) Summit on Osteoporosis held in Bratislava, Slovakia, on 2 and 3 December 2011, were to provide participants with state-of-the-art knowledge in the fields of osteoporosis research, diagnosis, and therapy and to evaluate, compare, and discuss the very heterogeneous health care situations and related challenges in the different countries in CEE and elsewhere. The summit was attended by 70 delegates from 15 countries. State-of-the-art lectures given by international authorities on osteoporosis covered a broad spectrum of topics ranging from osteoporosis in the male population, novel therapies in osteoporosis such as cathepsin K and sclerostin inhibitors, and the implementation and use of FRAX® in CEE, to an update on denosumab for the management of osteoporosis. Workshops organized to enable the exchange of individual experiences addressed the importance and current availability of osteology training for physicians and the impact of patient training programs on therapy compliance. Furthermore, the availability of and need for standardized quality controls and therapy guidelines in different CEE countries were discussed. Finally, based on a questionnaire, a very up-to-date analysis of all participating countries regarding incidences of osteoporosis, commonly used diagnostic and therapeutic measures, the number of specialists and specialized hospitals, and differences in the reimbursement situation in the different countries was generated and presented. On the whole, the very authentic contributions and the synergistic exchange of ideas allowed the identification of both positive developments as well as still existing issues and needs in diagnosis and therapy of osteoporosis.
    Archives of Osteoporosis 12/2013; 8(1-2):123.
  • Natalie E Cusano, John P Bilezikian
    Journal of comparative effectiveness research. 11/2013; 2(6):511-3.
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    ABSTRACT: Although high-resolution peripheral quantitative computed tomography (HRpQCT) and central quantitative computed tomography (QCT) studies have shown bone structural differences between Chinese American (CH) and white (WH) women, these techniques are not readily available in the clinical setting. The trabecular bone score (TBS) estimates trabecular microarchitecture from dual-energy X-ray absorptiometry spine images. We assessed TBS in CH and WH women and investigated whether TBS is associated with QCT and HRpQCT indices. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry, lumbar spine (LS) TBS, QCT of the LS and hip, and HRpQCT of the radius and tibia were performed in 71 pre- (37 WH and 34 CH) and 44 postmenopausal (21 WH and 23 CH) women. TBS did not differ by race in either pre- or postmenopausal women. In the entire cohort, TBS positively correlated with LS trabecular volumetric bone mineral density (vBMD) (r = 0.664), femoral neck integral (r = 0.651), trabecular (r = 0.641) and cortical vBMD (r = 0.346), and cortical thickness (C/I; r = 0.540) by QCT (p < 0.001 for all). TBS also correlated with integral (r = 0.643), trabecular (r = 0.574) and cortical vBMD (r = 0.491), and C/I (r = 0.541) at the total hip (p < 0.001 for all). The combination of TBS and LS aBMD predicted more of the variance in QCT measures than aBMD alone. TBS was associated with all HRpQCT indices (r = 0.20-0.52) except radial cortical thickness and tibial trabecular thickness. Significant associations between TBS and measures of HRpQCT and QCT in WH and CH pre- and postmenopausal women demonstrated here suggest that TBS may be a useful adjunct to aBMD for assessing bone quality.
    Journal of Clinical Densitometry 09/2013; · 1.71 Impact Factor
  • Luigi Gennari, John P Bilezikian
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    ABSTRACT: Over the last decade, the increasingly significant problem of osteoporosis in men has begun to receive much more attention than in the past. In particular, recent observations from large scale population studies in males led to an advance in the understanding of morphologic basis of growth, maintenance and loss of bone in men, as well as new insights about the pathophysiology and treatment of this disorder. While fracture risk consistently increases after age 65 in men (with up to 50 % of cases due to secondary etiologies), osteoporosis and fractures may also occur in young or middle aged males in the absence of an identifiable etiology. For this category (so called idiopathic osteoporosis), there are still major gaps in knowledge, particularly concerning the etiology and the clinical management. This article provides a summary of recent developments in the acquisition and maintenance of bone strength in men, as well as new insights about the pathogenesis, diagnosis, and treatment of idiopathic osteoporosis.
    Current Osteoporosis Reports 09/2013;
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    ABSTRACT: Context:Transient and permanent postoperative hypoparathyroidism are recognized complications of neck surgery. Postoperative hypoparathyroidism is usually considered permanent when it persists for six months; in rare cases, recovery of hypoparathyroidism through one year has been described. Recovery of hypoparathyroidism years after diagnosis has not previously been reported.Objective:To report four patients being treated with PTH(1-84) in a research protocol who recovered from postoperative hypoparathyroidism many years after onset.Methods:Recovery from hypoparathyroidism was established by: 1) Serum calcium and PTH levels within the normal range off PTH(1-84) treatment for at least 1 week; 2) Requirement for daily calcium supplementation reduced to ≤ 1 g; 3) No supplemental active vitamin D therapy.Results:Hypoparathyroidism developed in 3 subjects after repeated neck surgery for primary hyperparathyroidism and in 1 subject after total thyroidectomy for Graves' disease. Parathyroid tissue autotransplant was performed in two of the four subjects. Two had undetectable PTH levels at study entry while the other 2 subjects had detectable, although low, PTH levels. Hypoparathyroidism had been present for at least 8 years and in one case for 16 years. The recovery of parathyroid function followed treatment with PTH(1-84) for 36 to 63 months.Conclusions:Although it remains relatively rare, this report documents recovery of long-term postoperative hypoparathyroidism many years after the initial diagnosis. A potential role for exogenous PTH is intriguing with several plausible mechanisms.Précis:We report four patients with recovery of postoperative hypoparathyroidism 8 to 16 years after their initial diagnosis.
    The Journal of clinical endocrinology and metabolism 09/2013; · 6.50 Impact Factor
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    ABSTRACT: Context:Chinese-American women have bone microarchitectural features that confer greater bone stiffness compared to white women, but the physiology underlying these findings has not been investigated.Objective:The purpose of the study was to assess racial differences in serum sclerostin and bone turnover markers (BTMs), and to explore their associations with each other, volumetric bone mineral density (BMD), and bone microarchitecture in Chinese-American and white women.Design and Setting:We conducted a cross-sectional study at a university hospital.Participants:We studied 138 women.Results:Serum osteocalcin was 19-28% lower in pre- and postmenopausal Chinese-American vs white women, respectively (both P < .01). C-Terminal telopeptide of type I collagen (CTX) level was 18-22% lower in pre- and postmenopausal Chinese-American vs white women (both P < .05). Pre- vs postmenopausal differences in osteocalcin and CTX were greater in white vs Chinese-American women. Sclerostin levels were similar in both races, but BTMs were differentially associated with sclerostin by race and menopausal status. BTMs were not correlated with sclerostin in Chinese-Americans. CTX and bone-specific alkaline phosphatase were positively associated with sclerostin (r = 0.353, r = 0.458; both P < .05) in white premenopausal women. In contrast, in postmenopausal white women, the associations of sclerostin with amino-terminal propeptide of type I procollagen, isoform 5b of tartrate-resistant acid phosphatase, and CTX were negative (all P < .05). Adjusting for covariates, sclerostin was positively associated with areal BMD in both races.Conclusions:Lower BTMs in Chinese-American women and greater age-related differences in BTMs among white women provide a physiological framework to account for racial differences in BMD, microarchitecture, and fracture.
    The Journal of clinical endocrinology and metabolism 09/2013; · 6.50 Impact Factor
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    ABSTRACT: In this review, we consider new concepts in the assessment of fracture risk and pharmacologic therapy for osteoporosis. We discuss trabecular bone score, a new imaging technology that adds information that cannot be obtained by only measuring bone mineral density by dual-energy x-ray absorptiometry. We also discuss innovations in antiresorptive, osteoanabolic, and combination therapy; and newer therapeutic classes, including cathepsin K inhibitors and antisclerostin antibodies. We do not cover agents that have not yet been studied in human clinical trials or that are no longer under active investigation.
    Clinical obstetrics and gynecology 09/2013; · 2.06 Impact Factor
  • Endocrine Practice 09/2013; · 2.49 Impact Factor
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    ABSTRACT: Abstract Background: Osteoporosis is a widespread but largely preventable disease. Improved adherence to screening and treatment recommendations is needed to reduce fracture and mortality rates. Additionally, clinicians face increasing demands to demonstrate proficient quality patient care aligning with evidence-based standards. Methods: A three-stage, clinician-focused performance improvement (PI) continuing medical education (CME) initiative was developed to enhance clinician awareness and execution of evidence-based standards of osteoporosis care. Clinician performance was evaluated through a retrospective chart analysis of patients at risk or with a diagnosis of osteoporosis. Results: Seventy-five participants reported their patient practices on a total of 1875 patients before and 1875 patients after completing a PI initiative. Significant gains were made in the use of Fracture Risk Assessment Tool (FRAX) (stage A, 26%, n=1769 vs. stage C, 51%, n=1762; p<0.001), assessment of fall risk (stage A, 46%, n=1276 vs. stage C, 89%, n=1190; p<0.001), calcium levels (stage A, 62%, n=1451 vs. stage C, 89%, n=1443; p<0.001), vitamin D levels (stage A, 79%, n=1438 vs. stage C, 93%, n=1439; p<0.001), and medication adherence (stage A, 88%, n=1136 vs. stage C, 96%, n=1106; p<0.001). Conclusions: Gains in patient screening, treatment, and adherence were associated with an initiative promoting self-evaluation and goal setting. Clinicians must assess their performance to improve patient care and maintain certification. PI CME is a valid, useful educational tool for accomplishing these standards.
    Journal of Women s Health 09/2013; · 1.42 Impact Factor
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    ABSTRACT: Asian women have lower rates of hip and forearm fractures compared to other racial groups despite lower areal BMD. We have demonstrated microarchitectural differences, including greater cortical thickness (Ct.Th) and cortical volumetric BMD (Ct.BMD), in Chinese-American versus white women. Yet, it is not known whether greater Ct.BMD in Chinese-American women is due to greater tissue mineral density (TMD) or reduced cortical porosity (Ct.Po). Using an advanced segmentation algorithm based on high-resolution peripheral quantitative computed tomography images, we tested the hypothesis that Chinese-American women have better cortical skeletal integrity due to lower Ct.Po and higher Ct.TMD compared with white women. 78 Chinese-American women (49 pre- and 29 postmenopausal) and 114 white women (46 pre- and 68 postmenopausal) were studied. Premenopausal Chinese-American vs. white women had greater Ct.Th, Ct.BMD and Ct.TMD at both the radius and tibia; and decreased Ct.Po (p < 0.05). A similar pattern was observed between postmenopausal Chinese-American and white women. As expected, postmenopausal versus premenopausal women had lower Ct.BMD at the radius and tibia in both races (p < 0.001). Ct.Po largely increased between pre- and post-menopausal women, while Ct.TMD decreased by 3-8% (p < 0.001) in both races. Age-related differences in Ct.Po and Ct.TMD did not differ by race. In summary, both reduced Ct.Po and greater Ct.TMD explain higher Ct.BMD in Chinese-American versus white women. Thicker and preserved cortical bone structure in Chinese-American women may contribute to greater resistance to fracture compared to white women.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 08/2013; · 6.04 Impact Factor
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    ABSTRACT: Context:Normocalcemic primary hyperparathyroidism is typically identified after referral to a specialty clinic. At diagnosis, patients demonstrate features seen in hypercalcemic primary hyperparathyroidism. Normocalcemic hypoparathyroidism has been discovered following hypocalcemia unmasked after bisphosphonate administration.Objective: We hypothesized that screening unselected, non-referral populations, such as The Osteoporotic Fractures in Men (MrOS) study and Dallas Heart Study (DHS), would identify asymptomatic subjects with normocalcemic hyperparathyroidism and hypoparathyroidism.Methods:Normocalcemic hyperparathyroidism was defined as serum PTH greater than the upper reference range with normal albumin-adjusted serum calcium, excluding common secondary causes [renal failure (estimated glomerular filtration rate <60 mL/min), 25-hydroxyvitamin D <20 ng/mL, thiazide use], and normocalcemic hypoparathyroidism as PTH below the reference range with normocalcemia. Cross-sectional data was obtained from MrOS, and longitudinal data (baseline and 8 years) from DHS.Results:In 2364 men from MrOS, we identified 9 with normocalcemic hyperparathyroidism (prevalence 0.4%) and 26 with normocalcemic hypoparathyroidism (1.1%). In 3450 men and women from DHS, we identified 108 with normocalcemic hyperparathyroidism (3.1%) and 68 with normocalcemic hypoparathyroidism (1.9%). Of the 108 normocalcemic hyperparathyroid subjects, 64 had follow-up data. Hypercalcemic primary hyperparathyroidism developed in 1 subject while 13 (0.6% of the follow-up cohort) showed persistently elevated PTH levels with normocalcemia. Of the 26 normocalcemic hypoparathyroid subjects with follow-up data, none developed overt hypoparathyroidism and 2 (0.09%) had persistent evidence of normocalcemic hypoparathyroidism.Conclusions:This study documents normocalcemic primary hyperparathyroidism and hypoparathyroidism identified among community-dwelling individuals. Larger studies are needed to determine the true prevalence and natural history of these parathyroid disorders.
    The Journal of clinical endocrinology and metabolism 05/2013; · 6.50 Impact Factor
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    ABSTRACT: Context:Complaints from hypoparathyroid patients often reflect a reduction in quality of life (QOL), yet little data exist characterizing these complaints or the potential effects of PTH therapy to ameliorate them.Objective:We tested the hypothesis that PTH(1-84) therapy improves QOL in hypoparathyroidism.Design:Fifty-four hypoparathyroid subjects received open-label rhPTH(1-84). Before and during PTH(1-84), subjects completed the RAND 36-Item Health Survey, a measure of health-related QOL covering 8 domains of physical and mental health.Results:At baseline, subjects scored significantly lower than the normative reference range in all 8 domains (T-scores -1.35 to -0.78; p<0.001 for all). With PTH(1-84), the total score improved as early as month 1 and remained higher through 1 year (400 ± 200 to 478 ± 230; p=0.001). The overall mental component summary score improved (204 ± 110 to 247 ± 130; p=0.001), as did 3 mental health domains (vitality, social functioning, mental health), all within 1 month (T-scores improving from -1.3 to -0.7, -1.0 to -0.6, -0.9 to -0.3, respectively; p<0.05 for all). The overall physical component summary score also increased by 1 month and remained higher at 1 year (196 ± 110 to 231 ± 130; p=0.003) as did 2 physical health domains (physical functioning and general health: T-scores improving from -0.8 to -0.4, -1.2 to -0.8, respectively; p<0.01 for both).Conclusions:These data suggest that hypoparathyroidism is associated with compromised QOL. Along with improved biochemical control, these results indicate that PTH(1-84) treatment of hypoparathyroidism improves physical and mental functioning.
    The Journal of clinical endocrinology and metabolism 04/2013; · 6.50 Impact Factor
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    ABSTRACT: In primary hyperparathyroidism (PHPT), protracted elevation of serum parathyroid hormone (PTH) is held to be associated with cortical, but not trabecular, bone loss. However, an alternative explanation for the apparent preservation of trabecular bone is fragmentation of the cortex by intracortical remodeling. The cortical fragments resemble trabeculae and so may be erroneously included in the quantification of 'trabecular' bone density. To test this hypothesis, we compared bone microarchitecture in 43 patients with untreated PHPT (mean 62.9years, range 31-84) with 47 healthy age-matched controls and 25 patients with surgically treated PHPT (63.6years, 30-82). Images of the distal radius and tibia were acquired using high-resolution peripheral quantitative CT and analysed using StrAx1.0, a new software program that quantifies bone morphology in-vivo. Results were expressed as the mean number of standardized deviations (SD) from the age-specific mean (Z scores, mean±SEM). In subjects with PHPT, total tibial cortical area was reduced -0.26±0.08 SD; p=0.002). Cortical volumetric bone mineral density (vBMD) was reduced (-0.29±0.06 SD; p<0.001) due to higher cortical porosity (0.32±0.06 SD; p<0.001) and lower tissue mineralization density (-0.21±0.06 SD; p=0.002). Medullary area was increased (0.26±0.08 SD; p=0.002) and trabecular vBMD was reduced (-0.14±0.04 SD; p<0.001). In subjects who underwent successful parathyroidectomy, cortical area (-0.18±0.10 SD; NS) and medullary area (0.18±0.10 SD; NS) did not differ from controls. Cortical vBMD was reduced (-0.15±0.05 SD; p=0.003) due to high porosity (0.15±0.05 SD; p=0.006), values numerically lower than in untreated PHPT. Tissue mineralization density (-0.26±0.04 SD; p<0.001) and trabecular vBMD were reduced (-0.16±0.04 SD, p<0.001). The results were similar in the distal radius. In PHPT, chronically elevated endogenous PTH does not spare trabecular bone; it causes bone loss and microarchitectural deterioration in both cortical and trabecular compartments of bone.
    Bone 03/2013; · 3.82 Impact Factor

Publication Stats

6k Citations
1,190.49 Total Impact Points

Institutions

  • 2005–2014
    • CUNY Graduate Center
      New York City, New York, United States
  • 2013
    • Park Nicollet Health Services
      Minneapolis, Minnesota, United States
  • 2009–2013
    • McMaster University
      • Department of Medicine
      Hamilton, Ontario, Canada
    • CARDIO MD
      Newark, New Jersey, United States
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2006–2013
    • Universidade Católica de Brasília
      Brasília, Federal District, Brazil
    • University of Vermont
      Burlington, Vermont, United States
  • 2005–2013
    • Università degli Studi di Siena
      • Department of Medicine, Surgery and Neuroscience
      Siena, Tuscany, Italy
  • 1984–2013
    • Columbia University
      • • Department of Medicine
      • • College of Physicians and Surgeons
      New York City, NY, United States
  • 2012
    • University of Cambridge
      • Department of Medicine
      Cambridge, ENG, United Kingdom
  • 2005–2012
    • New Mexico Clinical Research and Osteoporosis Center
      Albuquerque, New Mexico, United States
  • 2003–2012
    • Mayo Foundation for Medical Education and Research
      • • College of Medicine
      • • Division of Endocrinology, Diabetes, Metabolism, and Nutrition
      Scottsdale, AZ, United States
  • 2011
    • Massachusetts General Hospital
      • Division of Endocrinology
      Boston, MA, United States
    • University of California, Los Angeles
      • Department of Orthopaedic Surgery
      Los Angeles, CA, United States
  • 2008–2011
    • GlaxoSmithKline plc.
      Londinium, England, Belgium
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
    • Beth Israel Medical Center
      New York City, New York, United States
    • University of California, Berkeley
      • Department of Mechanical Engineering
      Berkeley, CA, United States
  • 2003–2011
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Division of Endocrinology and Metabolism
      • • Department of Epidemiology and Biostatistics
      San Francisco, CA, United States
  • 2010
    • Universidade Federal do Paraná
      Curityba, Paraná, Brazil
    • The University of Hong Kong
      • Department of Medicine
      Hong Kong, Hong Kong
  • 2005–2009
    • Università degli Studi di Brescia
      • • Department of Clinical and Experimental Sciences
      • • Department of Medicine and Surgery
      Brescia, Lombardy, Italy
  • 2006–2007
    • University of Wisconsin, Madison
      • Department of Medicine
      Madison, MS, United States
  • 2004–2007
    • Saint Francis Hospital And Medical Center, Hartford, Ct
      Hartford, Connecticut, United States
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States