John P Bilezikian

Columbia University, New York, New York, United States

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Publications (339)2260.73 Total impact

  • Barbara C Silva, John P Bilezikian
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    ABSTRACT: Parathyroid hormone (PTH) is essential for the maintenance of calcium homeostasis through, in part, its actions to regulate bone remodeling. While PTH stimulates both bone formation and bone resorption, the duration and periodicity of exposure to PTH governs the net effect on bone mass, that is whether it is catabolic or anabolic. PTH receptor signaling in osteoblasts and osteocytes can increase the RANKL/OPG ratio, increasing both osteoclast recruitment and osteoclast activity, and thereby stimulating bone resorption. In contrast, PTH-induced bone formation is explained, at least in part, by its ability to downregulate SOST/sclerostin expression in osteocytes, permitting the anabolic Wnt signaling pathway to proceed. The two modes of administration of PTH, that is, continuous vs. intermittent, can regulate, in bone cells, different sets of genes; alternatively, the same sets of genes exposed to PTH in sustained vs. transient way, will favor bone resorption or bone formation, respectively. This article reviews the effects of PTH on bone cells that lead to these dual catabolic and anabolic actions on the skeleton. Copyright © 2015. Published by Elsevier Ltd.
    Current Opinion in Pharmacology 06/2015; 22. DOI:10.1016/j.coph.2015.03.005 · 4.23 Impact Factor
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    ABSTRACT: Trabecular plate and rod microstructure plays a dominant role in the apparent mechanical properties of trabecular bone. With high-resolution computed tomography (CT) images, digital topological analysis (DTA) including skeletonization and topological classification was applied to transform the trabecular three-dimensional (3D) network into surface and curve skeletons. Using the DTA-based topological analysis and a new reconstruction/recovery scheme, individual trabecula segmentation (ITS) was developed to segment individual trabecular plates and rods and quantify the trabecular plate- and rod-related morphological parameters. High-resolution peripheral quantitative computed tomography (HR-pQCT) is an emerging in vivo imaging technique to visualize 3D bone microstructure. Based on HR-pQCT images, ITS was applied to various HR-pQCT datasets to examine trabecular plate- and rod-related microstructure and has demonstrated great potential in cross-sectional and longitudinal clinical applications. However, the reproducibility of ITS has not been fully determined. The aim of the current study is to quantify the precision errors of ITS plate-rod microstructural parameters. In addition, we utilized three different frequently used contour techniques to separate trabecular and cortical bone and to evaluate their effect on ITS measurements.
    Pattern Recognition Letters 04/2015; DOI:10.1016/j.patrec.2015.03.012 · 1.06 Impact Factor
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    ABSTRACT: The 2014 Santa Fe Bone Symposium provided a setting for the presentation and discussion of the clinical relevance of recent advances in the fields of osteoporosis and metabolic bone disease. The format included oral presentations of abstracts by endocrinology fellows, plenary lectures, panel discussions and breakout sessions, with ample opportunities for informal discussions before and after scheduled events. Topics addressed in these proceedings included a review of the important scientific publications in the past year, fracture prevention in patients with dysmobility and immobility, fracture liaison services for secondary fracture prevention, management of pre-menopausal osteoporosis, the role of bone microarchitecture in determining bone strength, measurement of microarchitecture in clinical practice and methods to improve the quality of bone density testing. This is a report of the proceedings of the 2014 Santa Fe Bone Symposium.
    Endocrine Research 03/2015; DOI:10.3109/07435800.2015.1005746 · 1.41 Impact Factor
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    ABSTRACT: Context: The fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism (PHPT) has recently suggested that skeletal and renal imaging be routinely conducted. So far, no study has systematically assessed this issue. Objective: To evaluate the prevalence of kidney stones (KS), and vertebral fractures (VFs) in a cohort of patients with PHPT utilizing non-invasive imaging technology. Design: Prospective study evaluating patients consecutively diagnosed with PHPT in a single center over a five-year period (2009-2013). Setting: Referral Center. Patients: One-hundred-forty patients with PHPT [127 women (18 pre- and 109 postmenopausal) and 13 men; mean age 63.2±11 yrs] Main Outcomes Measures: The prevalence of KS by abdominal ultrasound, osteoporosis by DXA (Lumbar spine, femoral neck, total hip and distal 1/3 radius) and VFs by vertebral spine X-ray with attention to those categorized as symptomatic or asymptomatic. Results: Fifty-five percent of all subjects had KS by ultrasound, 62.9% had osteoporosis by T-score at any site and 35.1% had VFs by X-ray. There was no difference in the incidence of VFs and densitometric osteoporosis between symptomatic and asymptomatic patients (VFs: 34.4% vs 34.7%; osteoporosis by DXA: 59.4% vs 65.8%), while more KS were detected in symptomatic (78%) than asymptomatic (35.5%). Twenty-two percent of patients classified as asymptomatic at baseline without osteoporosis by DXA were found to have KS and/or VFs. Conclusions: Nephrolithiasis and VFs are common in asymptomatic subjects with PHPT. The results provide evidence in support of recent recommendations that a more proactive approach be taken to detect silent bone and stone disease in asymptomatic PHPT.
    Journal of Clinical Endocrinology &amp Metabolism 02/2015; 100(4):jc20143708. DOI:10.1210/jc.2014-3708 · 6.31 Impact Factor
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    ABSTRACT: Objective: Primary hyperparathyroidism (PHPT) is diagnosed by the presence of hypercalcemia and elevated or non-suppressed parathyroid hormone (PTH) levels. Although surgery is usually curative, some individuals fail or are unable or unwilling to undergo parathyroidectomy. In such individuals, targeted medical therapy may be of value. Cinacalcet normalized calcium and lowered PTH in patients with PHPT in several phase 2 and open-label studies. We compared cinacalcet and placebo in subjects with PHPT unable to undergo parathyroidectomy. Design: Phase 3, double-blind, multi-centred, randomized, placebo-controlled study. Methods: Sixty-seven subjects (78% women) with moderate PHPT were randomized (1:1) to cinacalcet or placebo for ≤28 weeks. Main outcome measure: Achievement of a normal mean corrected total serum calcium concentration of ≤10.3 mg dl-1 (2.575 mmol l-1). Results: Baseline median (Q1, Q3) serum PTH was 164.0 (131.0, 211.0) pg ml-1 and mean (SD) serum Ca was 11.77 (0.46) mg dl-1. Serum Ca normalized (≤10.3 mg dl-1) in 75.8% of cinacalcet- vs. 0% placebo-treated subjects (p<0.001). Corrected serum Ca decreased by ≥1.0 mg dl-1 from baseline in 84.8% of cinacalcet- vs. 5.9% of placebo-treated subjects (p<0.001). Least squares mean (SEM) plasma PTH change from baseline was 23.80% (4.18%) (cinacalcet) vs. 1.01% (4.05%) (placebo) (p<0.001). Similar numbers of subjects in the cinacalcet and placebo groups reported adverse events (27 vs. 20) and serious adverse events (3 vs. 4). Most commonly reported AEs were nausea and muscle spasms. Conclusions: These results demonstrate that cinacalcet normalizes serum calcium in this PHPT population and appears to be well tolerated.
  • Natalie E Cusano, John P Bilezikian
    JAMA The Journal of the American Medical Association 12/2014; 312(24):2680-1. DOI:10.1001/jama.2014.9195 · 30.39 Impact Factor
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    ABSTRACT: Daily 20-mg and once-weekly 56.5-mg teriparatide (parathyroid hormone 1–34) treatment regimens increase bone mineral density (BMD) and prevent fractures, but changes in bone turnover markers differ between the two regimens. The aim of the present study was to explain changes in bone turnover markers using once-weekly teriparatide with a simulation model. Temporary increases in bone formation markers and subsequent decreases were observed during once-weekly teriparatide treatment for 72 weeks. These observations support the hypothesis that repeated weekly teriparatide administration stimulates bone remodeling, replacing old bone with new bone and leading to a reduction in the active remodeling surface. A simulation model was developed based on the iterative remodeling cycle that occurs on residual old bone. An increase in bone formation and a subsequent decrease were observed in the preliminary simulation. For each fitted time point, the predicted value was compared to the absolute values of the bone formation and resorption markers and lumbar BMD. The simulation model strongly matched actual changes in bone turnover markers and BMD. This simulation model indicates increased bone formation marker levels in the early stage and a subsequent decrease. It is therefore concluded that remodeling-based bone formation persisted during the entire treatment period with once-weekly teriparatide.
    12/2014; DOI:10.1038/boneres.2014.43
  • Natalie E Cusano, Mishaela R Rubin, John P Bilezikian
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    ABSTRACT: Hypoparathyroidism is a rare disease characterized by hypocalcemia and insufficient circulating levels of parathyroid hormone (PTH). Conventional therapy includes calcium and active vitamin D supplementation, often in large doses. Therapy with calcium and vitamin D, however, does not address certain problematic aspects of the disease, including abnormal bone metabolism and reduced quality of life. Hypoparathyroidism is the only classic endocrine deficiency disease for which the missing hormone, PTH, is not yet an approved treatment. PTH(1-84) may soon become a therapeutic option for patients with hypoparathyroidism. PTH(1-84) has been demonstrated to maintain serum calcium while reducing or eliminating requirements for calcium and active vitamin D supplementation. Data from bone densitometry, bone turnover markers and histomorphometry of bone biopsy specimens show positive structural and dynamic effects on the skeleton. PTH replacement therapy may also be associated with improved quality of life. PTH(1-84) replacement therapy for hypoparathyroidism is promising, although further acquisition of long-term data is needed.
    Expert Review of Endocrinology &amp Metabolism 10/2014; 10(1). DOI:10.1586/17446651.2015.971755
  • Cristiana Cipriani, John P Bilezikian
    Endocrine Practice 10/2014; 1(-1):1-8. DOI:10.4158/EP14313.CO · 2.59 Impact Factor
  • Neil Binkley, Robert Adler, John P Bilezikian
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    ABSTRACT: Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured body mineral density (BMD) (g/cm(2)), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are "normal." This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.
    Current Osteoporosis Reports 09/2014; DOI:10.1007/s11914-014-0242-z
  • Natalie E. Cusano, Mishaela R. Rubin, John P. Bilezikian
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    ABSTRACT: Hypoparathyroidism is a disease characterized by hypocalcemia and insufficient parathyroid hormone (PTH). It is a rare disorder that has been given an orphan disease designation in the United States and European Union. Hypoparathyroidism is the only endocrine deficiency disease for which the missing hormone, PTH, is not yet an approved therapy. Conventional therapy includes calcium and active vitamin D supplementation, often in large doses. Although serum calcium can be controlled with conventional therapy, it can be a challenge and, moreover, does not address other aspects of the disease, such as abnormal skeletal features and reduced quality of life. This review focuses on PTH replacement therapy in hypoparathyroidism, utilizing the full-length molecule PTH(1-84) as well as the fully active but truncated form PTH(1-34). PTH therapy addresses some aspects of the disease not ameliorated with conventional therapy.
    Best Practice & Research: Clinical Endocrinology & Metabolism 09/2014; DOI:10.1016/j.beem.2014.09.001 · 4.91 Impact Factor
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    ABSTRACT: Objective: Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines. Participants: Participants, representing an international constituency, with interest and expertise in various facets of asymptomatic PHPT constituted four Workshop Panels that developed key questions to be addressed. They then convened in an open 3-day conference September 19-21, 2013, in Florence, Italy, when a series of presentations and discussions addressed these questions. A smaller subcommittee, the Expert Panel, then met in closed session to reach an evidence-based consensus on how to address the questions and data that were aired in the open forum. Evidence: Preceding the conference, each question was addressed by a relevant, extensive literature search. All presentations and deliberations of the Workshop Panels and the Expert Panel were based upon the latest information gleaned from this literature search. Consensus Process: The expert panel considered all the evidence provided by the individual Workshop Panels and then came to consensus. Conclusion: In view of new findings since the last International Workshop on the Management of Asymptomatic PHPT, guidelines for management have been revised. The revised guidelines include: 1) recommendations for more extensive evaluation of the skeletal and renal systems; 2) skeletal and/or renal involvement as determined by further evaluation to become part of the guidelines for surgery; and 3) more specific guidelines for monitoring those who do not meet guidelines for parathyroid surgery. These guidelines should help endocrinologists and surgeons caring for patients with PHPT. A blueprint for future research is proposed to foster additional investigation into issues that remain uncertain or controversial.
    Journal of Clinical Endocrinology &amp Metabolism 08/2014; 99(10):jc20141413. DOI:10.1210/jc.2014-1413 · 6.31 Impact Factor
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    ABSTRACT: Objective: This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. Participants: This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. Evidence: Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. Consensus Process: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. Conclusions: 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism)is increasing,data on the clinical presentation and natural history of this phenotypeare limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current datadonot support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomicalor functional abnormalities. 6) Some patients with mildPHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.
    Journal of Clinical Endocrinology &amp Metabolism 08/2014; 99(10):jc20141415. DOI:10.1210/jc.2014-1415 · 6.31 Impact Factor
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    ABSTRACT: Context: We previously reported on four patients treated with PTH(1-84) who recovered from postoperative hypoparathyroidism many years after onset. Because vascular endothelial growth factor (VEGF) has been shown to be necessary for the induction of PTH-mediated angiogenesis, we postulated a possible role for VEGF in the recovery of parathyroid function in these subjects. Objective: Our objective was to measure VEGF levels in subjects with hypoparathyroidism who regained parathyroid gland function and matched controls. Setting and Design: Subjects with hypoparathyroidism who regained parathyroid gland function were each matched to two hypoparathyroid controls by postoperative etiology, age (within 5 y), menopausal status, and duration of hypoparathyroidism. We measured serum VEGF levels at baseline and through 48 months of PTH(1-84) therapy. Results: VEGF levels increased after the initiation of PTH(1-84) therapy for the entire cohort, from 309.7 ± 162 pg/ml at baseline to 380.2 ± 178 pg/ml at 12 months (P = .03). Levels trended downward thereafter. There were no significant differences in VEGF levels between the subjects with recovery of parathyroid function and the matched controls. Conclusions: PTH(1-84) alters serum VEGF levels in subjects with hypoparathyroidism. Additional investigation is necessary to understand the mechanisms by which some subjects with postoperative hypoparathyroidism recover parathyroid gland function.
    Journal of Clinical Endocrinology &amp Metabolism 08/2014; 99(10):jc20141500. DOI:10.1210/jc.2014-1500 · 6.31 Impact Factor
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    ABSTRACT: Objective: Primary hyperparathyroidism (PHPT) is one of the most frequently diagnosed endocrine disorders, but few studies focused on hospital management of the disease in Europe. We investigated the frequency of hospital admission for diagnosis and surgical treatment for PHPT in Italy. Design: retrospective study. Methods: We retrieved data from the "Record of Hospital Discharge" (SDO) of the Italian Health Ministry, from the year 2006 to 2011 and analyzed the codes corresponding to PHPT-related diagnoses and surgical procedures. Results: Overall, 46,275 hospitalization episodes for PHPT were identified during the entire period [69% in women and 31% in men); mean age 63.3±39.8 years]. Patients' mean age significantly increased during the years (p<0.001). The mean length of stay was 8.2±10.5 days (28% of the episodes requiring less than 3 days of stay). Admissions for surgical procedures were 12,457 accounting for 26.9% of the total hospitalizations. There was a trend to a significant increase in the percentage of surgery (p<0.05). The mean hospitalization rate for PHPT was 12.9/100,000 inhabitants/year and the trend showed a significant decrease during the period 2006-2011 (p<0.0001). The mean hospitalization rate for PHPT surgery was 3.65/100,000 per year, significantly increasing over time (p<0.001). Conclusions: PHPT considerably influences the Italian Hospital healthcare system. We observed a tendency to a decrease in the frequency of hospitalization during the period 2006-2011, most probably because of economic issues, a concomitant increased age of patients, and, interestingly, also a progressive increase in the percentage of surgical treatment among patients admitted for PHPT.
    European Journal of Endocrinology 07/2014; 171(4). DOI:10.1530/EJE-14-0493 · 3.69 Impact Factor
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    ABSTRACT: Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.
    Arquivos Brasileiros de Endocrinologia & Metabologia 07/2014; 58(5):553-561. DOI:10.1590/0004-2730000003381 · 0.68 Impact Factor
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    ABSTRACT: Several factors are involved in determining bone quality including bone density, bone turnover, the extent of trabecular bone connectivity, cortical porosity and geometry. Metabolically active and in a continuous process of remodeling, approximately 20% of bone tissue is renewed annually. Bone turn over markers (BTM) are frequently used in clinical trials and to provide valid information about the effectiveness of osteoporosis treatment, reflecting the state of bone metabolism and its response to treatment, although they are not useful alone to estimate bone loss. In this review the behavior of BTM from different clinical trials or different osteoporotic drugs will be addressed.
    Arquivos Brasileiros de Endocrinologia & Metabologia 07/2014; 58(5):504-513. DOI:10.1590/0004-2730000003384 · 0.68 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 07/2014; 17(3). DOI:10.1016/j.jocd.2013.11.006 · 1.60 Impact Factor
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    ABSTRACT: Context: In hypoparathyroidism, quality of life (QOL) is compromised as compared to normal subjects. We previously reported our results showing an association with recombinant human PTH(1-84) therapy in hypoparathyroidism and improvement in QOL measures through 1 year. Objective: We tested the hypothesis that PTH(1-84) therapy in hypoparathyroidism through 5 years would be associated with continued improvement in QOL measures. Design: Sixty-nine hypoparathyroid subjects received open-label PTH(1-84). Before and during therapy, subjects completed the RAND 36-Item Short Form (SF-36) 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 -1.4 to -0.9; p<0.001 for all). With PTH therapy, intention-to-treat analysis showed significant improvement in the overall score at 2 months that persisted through 5 years (386 ± 19 to 482 ± 25; p<0.0001). The mental component summary score improved at 2 months and was sustained through 5 years (199 ± 11 to 246 ± 14; p=0.001), as did all 4 individual mental health domains and T-scores (vitality, social functioning, role emotional, mental health). The physical component summary score improved at 2 months and was sustained through 5 years (187 ± 10 to 237 ± 13; p<0.0001), as did 3 physical health domains and T-scores (physical functioning, role physical, general health). Conclusions: PTH(1-84) therapy is not only associated with improvement in biochemical and skeletal indices, previously well-documented, but also in mental and physical health as determined by the SF-36 metric.
    Journal of Clinical Endocrinology &amp Metabolism 06/2014; 99(10):jc20142267. DOI:10.1210/jc.2014-2267 · 6.31 Impact Factor
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    ABSTRACT: Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone.
    Endocrine 05/2014; 47(2). DOI:10.1007/s12020-014-0280-4 · 3.53 Impact Factor

Publication Stats

12k Citations
2,260.73 Total Impact Points


  • 1978–2015
    • Columbia University
      • • College of Physicians and Surgeons
      • • Department of Medicine
      • • Division of Endocrinology
      New York, New York, United States
  • 1978–2014
    • CUNY Graduate Center
      New York City, New York, United States
  • 2013
    • Universidade Católica de Brasília
      Brasília, Federal District, Brazil
  • 2009
      Newark, New Jersey, United States
  • 1984–2009
    • New York Medical College
      • Department of Medicine
      New York City, NY, United States
  • 2008
    • New Mexico Clinical Research and Osteoporosis Center
      Albuquerque, New Mexico, United States
  • 2007
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2006
    • University of Vermont
      Burlington, Vermont, United States
  • 2005
    • Università degli Studi di Siena
      • Department of Medicine, Surgery and Neuroscience
      Siena, Tuscany, Italy
  • 2003–2005
    • University of California, San Francisco
      • Department of Epidemiology and Biostatistics
      San Francisco, CA, United States
    • Duke University
      • Department of Surgery
      Durham, North Carolina, United States
  • 2004
    • Gracie Square Hospital, New York, NY
      New York, New York, United States
  • 2002
    • Kaiser Permanente
      Oakland, California, United States
  • 1984–1997
    • Albert Einstein College of Medicine
      • • Department of Pathology
      • • Department of Medicine
      New York City, NY, United States
  • 1995
    • Temple University
      Philadelphia, Pennsylvania, United States
  • 1990
    • Helen Hayes Hospital
      West Haverstraw, New York, United States
  • 1987
    • National Institutes of Health
      베서스다, Maryland, United States