Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e32801061e1
D. Green, S. Epstein
Purpose of reviewThe importance of parathyroid hormone in maintaining bone health has long been appreciated. Recent advances in the understanding of the cellular and molecular actions of this hormone have enhanced our treatment of parathyroid disorders and osteoporosis. Recent findingsParathyroid hormone has been shown to act at the cellular level through the activation of the RANK ligand system, which is a new target for drug development for osteoporosis. Our understanding of the natural history of primary hyperparathyroidism and the potential for medical management has recently come under greater scrutiny. An increased recognition of vitamin D inadequacy is changing our understanding of secondary hyperparathyroidism. Newer calcimimetic drugs are enhancing our therapy of both primary and secondary hyperparathyroidism. Synthetic parathyroid hormone has been shown to be both safe and effective in the treatment of osteoporosis. SummarySynthetic parathyroid hormone, the first anabolic agent for osteoporosis, has changed the therapeutic approach in severe osteoporosis. Although newer drugs have been used for primary hyperparathyroidism, surgery remains the definitive therapy. Increased understanding of the molecular biology of parathyroid hormone has allowed the development of new classes of therapeutic agents for osteoporosis.
{"title":"Parathyroids, bone and mineral metabolism","authors":"D. Green, S. Epstein","doi":"10.1097/MED.0b013e32801061e1","DOIUrl":"https://doi.org/10.1097/MED.0b013e32801061e1","url":null,"abstract":"Purpose of reviewThe importance of parathyroid hormone in maintaining bone health has long been appreciated. Recent advances in the understanding of the cellular and molecular actions of this hormone have enhanced our treatment of parathyroid disorders and osteoporosis. Recent findingsParathyroid hormone has been shown to act at the cellular level through the activation of the RANK ligand system, which is a new target for drug development for osteoporosis. Our understanding of the natural history of primary hyperparathyroidism and the potential for medical management has recently come under greater scrutiny. An increased recognition of vitamin D inadequacy is changing our understanding of secondary hyperparathyroidism. Newer calcimimetic drugs are enhancing our therapy of both primary and secondary hyperparathyroidism. Synthetic parathyroid hormone has been shown to be both safe and effective in the treatment of osteoporosis. SummarySynthetic parathyroid hormone, the first anabolic agent for osteoporosis, has changed the therapeutic approach in severe osteoporosis. Although newer drugs have been used for primary hyperparathyroidism, surgery remains the definitive therapy. Increased understanding of the molecular biology of parathyroid hormone has allowed the development of new classes of therapeutic agents for osteoporosis.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"503–508"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e32801061e1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61687237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e3280109b6c
Michael T Yin, Elizabeth Shane
PURPOSE OF REVIEW: Low bone-mineral density is a recently recognized metabolic complication of HIV infection and its treatment. While the clinical impact of low bone-mineral density remains uncertain, the prolongation of survival attributable to more effective antiretroviral therapy has contributed to an aging population of HIV-infected patients who may be prone to developing fragility fractures. RECENT FINDINGS: While most of the available data are on young men, recent publications have increased our understanding of the epidemiology of low bone-mineral density and bone loss in HIV-positive women. Most studies suggest that initiation of certain combinations of antiretroviral agents may be associated with moderate bone loss initially, but bone-mineral density usually stabilizes or improves with longer follow-up. Most studies suggest that, despite lower bone-mineral density, fragility fractures are relatively uncommon in HIV-positive patients, perhaps because of their relative youth. SUMMARY: The pathogenesis of low bone-mineral density in HIV-positive patients is complex and multifactorial, and its clinical impact remains unclear. Further research is needed to clarify the approach to optimal screening and treatment of osteoporosis in the setting of HIV infection.
{"title":"Low bone-mineral density in patients with HIV: pathogenesis and clinical significance.","authors":"Michael T Yin, Elizabeth Shane","doi":"10.1097/MED.0b013e3280109b6c","DOIUrl":"10.1097/MED.0b013e3280109b6c","url":null,"abstract":"<p><p>PURPOSE OF REVIEW: Low bone-mineral density is a recently recognized metabolic complication of HIV infection and its treatment. While the clinical impact of low bone-mineral density remains uncertain, the prolongation of survival attributable to more effective antiretroviral therapy has contributed to an aging population of HIV-infected patients who may be prone to developing fragility fractures. RECENT FINDINGS: While most of the available data are on young men, recent publications have increased our understanding of the epidemiology of low bone-mineral density and bone loss in HIV-positive women. Most studies suggest that initiation of certain combinations of antiretroviral agents may be associated with moderate bone loss initially, but bone-mineral density usually stabilizes or improves with longer follow-up. Most studies suggest that, despite lower bone-mineral density, fragility fractures are relatively uncommon in HIV-positive patients, perhaps because of their relative youth. SUMMARY: The pathogenesis of low bone-mineral density in HIV-positive patients is complex and multifactorial, and its clinical impact remains unclear. Further research is needed to clarify the approach to optimal screening and treatment of osteoporosis in the setting of HIV infection.</p>","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 6","pages":"497-502"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868191/pdf/nihms157118.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28984517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010d23b
J. Rogers
Purpose of reviewThis review covers the past year's papers germane to the Barker hypothesis. While much of the literature has centered on maternal and developmental nutrition, new findings have emerged on the ability of toxic exposures during development to impact fetal/developmental programming. Recent findingsMost papers lend strong support to the idea that the intrauterine and early postnatal periods are sensitive to endogenous and exogenous influences on metabolic programming. These studies rely on birth weight or other size metrics as a surrogate for nutrition during development. Not only low-protein but also high-fat or high-carbohydrate diets are linked to adverse metabolic profiles in animal studies. Nutritional intervention studies in animals show that antioxidant or essential fatty acid supplements may combat development of the metabolic syndrome. Developmental exposures to the endocrine disrupting chemical vinclozolin cause male germ cell abnormalities in offspring that are transmitted to subsequent generations through an epigenetic mechanism. SummaryThese studies solidify the scientific basis of the Barker hypothesis and extend its tenets to developmental toxicology. Long-term, latent effects of developmental toxicant exposure have rarely been considered to date, and work is needed to understand how such effects may occur.
{"title":"The Barker hypothesis: implications for future directions in toxicology research","authors":"J. Rogers","doi":"10.1097/MED.0b013e328010d23b","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010d23b","url":null,"abstract":"Purpose of reviewThis review covers the past year's papers germane to the Barker hypothesis. While much of the literature has centered on maternal and developmental nutrition, new findings have emerged on the ability of toxic exposures during development to impact fetal/developmental programming. Recent findingsMost papers lend strong support to the idea that the intrauterine and early postnatal periods are sensitive to endogenous and exogenous influences on metabolic programming. These studies rely on birth weight or other size metrics as a surrogate for nutrition during development. Not only low-protein but also high-fat or high-carbohydrate diets are linked to adverse metabolic profiles in animal studies. Nutritional intervention studies in animals show that antioxidant or essential fatty acid supplements may combat development of the metabolic syndrome. Developmental exposures to the endocrine disrupting chemical vinclozolin cause male germ cell abnormalities in offspring that are transmitted to subsequent generations through an epigenetic mechanism. SummaryThese studies solidify the scientific basis of the Barker hypothesis and extend its tenets to developmental toxicology. Long-term, latent effects of developmental toxicant exposure have rarely been considered to date, and work is needed to understand how such effects may occur.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"536–540"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010d23b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61687483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010ab20
D. Schneider
Purpose of reviewVitamin D is an important determinant of bone health and neuromuscular function. This article discusses recent research findings about the association of vitamin D and skeletal health with respect to parathyroid hormone, bone mineral density, physical performance, falls, and fracture. Recent findingsThe critical threshold to maximize adequate calcium absorption and suppress excess parathyroid hormone secretion is a 25-hydroxyvitamin D level of 30 ng/ml or 75 nmol/l. In a study of postmenopausal women on osteoporosis therapy, 45% of women taking 400 IU or more of vitamin D daily had serum 25-hydroxyvitamin D levels lower than 30 ng/ml compared with 63% taking less than 400 IU of vitamin D supplementation daily. In community-dwelling adults, a significant positive association was shown between 25-hydroxyvitamin D levels and total hip bone mineral density and lower extremity function. A meta-analysis of hip fractures demonstrated a 26% lowering of risk with doses of greater than 700 IU of vitamin D supplementation. Subsequent clinical trials showed similar reductions but were not statistically significant. SummaryThe inexpensive and simple practice of maintaining adequate vitamin D can contribute to decreasing fracture risk through skeletal and neuromuscular effects. Prevention strategies for fracture risk reduction should include vitamin D supplementation, particularly in the elderly.
{"title":"Vitamin D and skeletal health","authors":"D. Schneider","doi":"10.1097/MED.0b013e328010ab20","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010ab20","url":null,"abstract":"Purpose of reviewVitamin D is an important determinant of bone health and neuromuscular function. This article discusses recent research findings about the association of vitamin D and skeletal health with respect to parathyroid hormone, bone mineral density, physical performance, falls, and fracture. Recent findingsThe critical threshold to maximize adequate calcium absorption and suppress excess parathyroid hormone secretion is a 25-hydroxyvitamin D level of 30 ng/ml or 75 nmol/l. In a study of postmenopausal women on osteoporosis therapy, 45% of women taking 400 IU or more of vitamin D daily had serum 25-hydroxyvitamin D levels lower than 30 ng/ml compared with 63% taking less than 400 IU of vitamin D supplementation daily. In community-dwelling adults, a significant positive association was shown between 25-hydroxyvitamin D levels and total hip bone mineral density and lower extremity function. A meta-analysis of hip fractures demonstrated a 26% lowering of risk with doses of greater than 700 IU of vitamin D supplementation. Subsequent clinical trials showed similar reductions but were not statistically significant. SummaryThe inexpensive and simple practice of maintaining adequate vitamin D can contribute to decreasing fracture risk through skeletal and neuromuscular effects. Prevention strategies for fracture risk reduction should include vitamin D supplementation, particularly in the elderly.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"483–490"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010ab20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61686783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010ca30
S. MacLaughlin, B. Mühlhäusler, S. Gentili, I. McMillen
Purpose of reviewWhilst the ‘early origins of adult disease’ hypothesis has focused primarily on the impact of early undernutrition, an increased fat and energy intake has recently become a dominant characteristic of the human diet. This review presents a summary of recent developments in understanding of how maternal overnutrition and undernutrition during critical windows of development program adult metabolic and cardiovascular disease. Recent findingsRecent evidence suggests that exposure to maternal overnutrition results in changes in the development of the energy balance regulating system that may be ‘maladaptive’ for life and result in an intergenerational cycle of obesity. Whilst activation of the fetal hypothalamo–pituitary–adrenal axis in response to a poor nutritional environment confers an early fitness advantage, it also incurs delayed health costs. Recent findings highlight that such tradeoffs may be anticipated from conception as changes in the periconceptional nutritional environment program the developmental trajectory of the hypothalamo–pituitary–adrenal axis. SummaryA better understanding of the long-term impact of overnutrition in early life and of changes in the nutritional environment of the embryo will provide insights into the timing and type of maternal dietary interventions required to improve metabolic health in adult life.
{"title":"When in gestation do nutritional alterations exert their effects? A focus on the early origins of adult disease","authors":"S. MacLaughlin, B. Mühlhäusler, S. Gentili, I. McMillen","doi":"10.1097/MED.0b013e328010ca30","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010ca30","url":null,"abstract":"Purpose of reviewWhilst the ‘early origins of adult disease’ hypothesis has focused primarily on the impact of early undernutrition, an increased fat and energy intake has recently become a dominant characteristic of the human diet. This review presents a summary of recent developments in understanding of how maternal overnutrition and undernutrition during critical windows of development program adult metabolic and cardiovascular disease. Recent findingsRecent evidence suggests that exposure to maternal overnutrition results in changes in the development of the energy balance regulating system that may be ‘maladaptive’ for life and result in an intergenerational cycle of obesity. Whilst activation of the fetal hypothalamo–pituitary–adrenal axis in response to a poor nutritional environment confers an early fitness advantage, it also incurs delayed health costs. Recent findings highlight that such tradeoffs may be anticipated from conception as changes in the periconceptional nutritional environment program the developmental trajectory of the hypothalamo–pituitary–adrenal axis. SummaryA better understanding of the long-term impact of overnutrition in early life and of changes in the nutritional environment of the embryo will provide insights into the timing and type of maternal dietary interventions required to improve metabolic health in adult life.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"516–522"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010ca30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61686798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010ca43
S. D. de Rooij, R. Painter, T. Roseboom
Purpose of reviewEvidence from experimental and epidemiologic studies suggests that early nutrition may play an important role in the pathogenesis of type 2 diabetes. It is hypothesized that the fetus adapts its structure and physiology in response to an adverse environment in utero, which predisposes to chronic disease in later life. We review results from the Dutch famine birth cohort study, in which the effects of prenatal exposure to famine on health in later life are investigated. We focus on the consequences for glucose and insulin metabolism. Recent findingsPeople exposed to famine during gestation show impaired glucose tolerance at ages 50 and 58 years. The aetiology of this association seems to lie, at least partly, in programming of the pancreatic beta cell, resulting in an impaired insulin response that is already present in the normoglycaemic state. We found no evidence indicating that the hypothalamic–pituitary–adrenal axis plays an intermediate role in the association between prenatal undernutrition and glucose intolerance. SummaryAlthough the exact pathophysiology of the association between exposure to famine in utero and glucose intolerance is not clear, our findings stress the importance of maternal nutrition during gestation for the offspring's glucose metabolism in later life.
{"title":"The effects of prenatal exposure to undernutrition on glucose and insulin metabolism in later life","authors":"S. D. de Rooij, R. Painter, T. Roseboom","doi":"10.1097/MED.0b013e328010ca43","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010ca43","url":null,"abstract":"Purpose of reviewEvidence from experimental and epidemiologic studies suggests that early nutrition may play an important role in the pathogenesis of type 2 diabetes. It is hypothesized that the fetus adapts its structure and physiology in response to an adverse environment in utero, which predisposes to chronic disease in later life. We review results from the Dutch famine birth cohort study, in which the effects of prenatal exposure to famine on health in later life are investigated. We focus on the consequences for glucose and insulin metabolism. Recent findingsPeople exposed to famine during gestation show impaired glucose tolerance at ages 50 and 58 years. The aetiology of this association seems to lie, at least partly, in programming of the pancreatic beta cell, resulting in an impaired insulin response that is already present in the normoglycaemic state. We found no evidence indicating that the hypothalamic–pituitary–adrenal axis plays an intermediate role in the association between prenatal undernutrition and glucose intolerance. SummaryAlthough the exact pathophysiology of the association between exposure to famine in utero and glucose intolerance is not clear, our findings stress the importance of maternal nutrition during gestation for the offspring's glucose metabolism in later life.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"530–535"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010ca43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61686809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e32801061f2
E. Lewiecki
Purpose of reviewThe technology and clinical applications of vertebral fracture assessment by dual-energy X-ray absorptiometry are assessed. Recent findingsVertebral fracture is the most common type of fragility fracture, yet most vertebral fractures are not clinically apparent. It is now recognized that they are associated with increased risk of future fracture, increased morbidity, and increased mortality. Vertebral fracture assessment is a method for imaging the spine by dual-energy X-ray absorptiometry to diagnose vertebral fractures. Vertebral fracture assessment exposes the patient to less radiation than conventional spine radiographs, with lower cost and greater convenience. Knowledge of vertebral fractures may change diagnostic classification, estimation of future fracture risk, and clinical management. Patients with prevalent vertebral fractures may benefit from pharmacological therapy that might not be given based only on bone mineral density and other clinical risk factors for fracture. Vertebral fracture assessment requires a compatible dual-energy X-ray absorptiometry system with vertebral fracture assessment software installed. Technologists performing vertebral fracture assessment must be trained in proper patient positioning and image analysis. The interpretation of vertebral fracture assessment is a skill that is acquired through training and experience. SummaryVertebral fracture assessment is a technology for diagnosing vertebral fractures that enhances estimation of fracture risk and helps to identify patients who are likely to benefit from pharmacological therapy.
{"title":"Vertebral fracture assessment","authors":"E. Lewiecki","doi":"10.1097/MED.0b013e32801061f2","DOIUrl":"https://doi.org/10.1097/MED.0b013e32801061f2","url":null,"abstract":"Purpose of reviewThe technology and clinical applications of vertebral fracture assessment by dual-energy X-ray absorptiometry are assessed. Recent findingsVertebral fracture is the most common type of fragility fracture, yet most vertebral fractures are not clinically apparent. It is now recognized that they are associated with increased risk of future fracture, increased morbidity, and increased mortality. Vertebral fracture assessment is a method for imaging the spine by dual-energy X-ray absorptiometry to diagnose vertebral fractures. Vertebral fracture assessment exposes the patient to less radiation than conventional spine radiographs, with lower cost and greater convenience. Knowledge of vertebral fractures may change diagnostic classification, estimation of future fracture risk, and clinical management. Patients with prevalent vertebral fractures may benefit from pharmacological therapy that might not be given based only on bone mineral density and other clinical risk factors for fracture. Vertebral fracture assessment requires a compatible dual-energy X-ray absorptiometry system with vertebral fracture assessment software installed. Technologists performing vertebral fracture assessment must be trained in proper patient positioning and image analysis. The interpretation of vertebral fracture assessment is a skill that is acquired through training and experience. SummaryVertebral fracture assessment is a technology for diagnosing vertebral fractures that enhances estimation of fracture risk and helps to identify patients who are likely to benefit from pharmacological therapy.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"509–515"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e32801061f2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61687247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010ef6f
P. Rackoff, S. Honig
Purpose of reviewThe female athlete triad – anorexia, athletics, and amenorrhea – is a clinical problem found among young women who are engaged in intense physical activity. This review describes the psychological factors involved in the triad and the endocrine and skeletal consequences of the disorder. This subject is particularly timely and important as eating disorders are increasing in frequency among young women athletes. Recent findingsConcern about body weight and its effect on athletic performance can lead to chronic undernutrition. Complications of low body weight include hormonal disturbances, bone loss and fracture. The potential endocrine abnormalities seen in this group of women include anovulatory cycles, chronic elevation in glucocorticoids and lower serum leptin concentrations. Lower insulin-like growth factor-1 and resistance to growth hormone have also been described. Treatment of consequent bone loss with hormones, and most recently, with bisphosphonates, provides conflicting, but also encouraging data. SummaryThe pressures to improve peak athletic performance often underlie the abnormal behavior and eating disorders characteristic of the female athlete triad, with subsequent life-long consequences. Physicians should be made aware of such pressures, and their psychological and physical consequences. Prevention is the best medicine; but more research in ways to effectively and safely treat bone loss in young women is needed.
{"title":"Anorexia nervosa, athletics, and amenorrhea: the female athlete triad","authors":"P. Rackoff, S. Honig","doi":"10.1097/MED.0b013e328010ef6f","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010ef6f","url":null,"abstract":"Purpose of reviewThe female athlete triad – anorexia, athletics, and amenorrhea – is a clinical problem found among young women who are engaged in intense physical activity. This review describes the psychological factors involved in the triad and the endocrine and skeletal consequences of the disorder. This subject is particularly timely and important as eating disorders are increasing in frequency among young women athletes. Recent findingsConcern about body weight and its effect on athletic performance can lead to chronic undernutrition. Complications of low body weight include hormonal disturbances, bone loss and fracture. The potential endocrine abnormalities seen in this group of women include anovulatory cycles, chronic elevation in glucocorticoids and lower serum leptin concentrations. Lower insulin-like growth factor-1 and resistance to growth hormone have also been described. Treatment of consequent bone loss with hormones, and most recently, with bisphosphonates, provides conflicting, but also encouraging data. SummaryThe pressures to improve peak athletic performance often underlie the abnormal behavior and eating disorders characteristic of the female athlete triad, with subsequent life-long consequences. Physicians should be made aware of such pressures, and their psychological and physical consequences. Prevention is the best medicine; but more research in ways to effectively and safely treat bone loss in young women is needed.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"491–496"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010ef6f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61687493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-12-01DOI: 10.1097/MED.0b013e328010ca54
F. Bloomfield, J. Harding
Purpose of reviewAnimal experiments demonstrating associations between birth weight and postnatal phenotypes that may increase the risk of cardiovascular disease, such as hypertension, obesity, anxiety, and increased glucocorticoid activity, support the human epidemiologic findings of an association between reduced size at birth and adult cardiovascular disease. Here we review the evidence for exposure of the fetus to excess glucocorticoid as the key underlying mechanism. Recent findingsAdministration of synthetic glucocorticoids to, and undernutrition of, pregnant animals both results in reduced birth weight and the relevant postnatal phenotypes. However, in the latter paradigm direct evidence of fetal exposure to excess endogenous glucocorticoids of often lacking. Thirty-year-old offspring of pregnant women given glucocorticoids for threatened preterm labour have minimal evidence of increased cardiovascular risk factors. SummaryExposure of the fetus to inappropriate amounts of glucocorticoids can result in a postnatal phenotype that may predispose to cardiovascular disease, although the fact that surrogate endpoints are often studied in animal experiments must be borne in mind. However, assumptions that effects of other interventions, such as maternal undernutrition, are mediated via exposure of the fetus to excess glucocorticoids are often not supported by direct evidence. The value of available human data should not be overlooked.
{"title":"Evidence for fetal glucocorticoid excess as a cause of adult cardiovascular disease","authors":"F. Bloomfield, J. Harding","doi":"10.1097/MED.0b013e328010ca54","DOIUrl":"https://doi.org/10.1097/MED.0b013e328010ca54","url":null,"abstract":"Purpose of reviewAnimal experiments demonstrating associations between birth weight and postnatal phenotypes that may increase the risk of cardiovascular disease, such as hypertension, obesity, anxiety, and increased glucocorticoid activity, support the human epidemiologic findings of an association between reduced size at birth and adult cardiovascular disease. Here we review the evidence for exposure of the fetus to excess glucocorticoid as the key underlying mechanism. Recent findingsAdministration of synthetic glucocorticoids to, and undernutrition of, pregnant animals both results in reduced birth weight and the relevant postnatal phenotypes. However, in the latter paradigm direct evidence of fetal exposure to excess endogenous glucocorticoids of often lacking. Thirty-year-old offspring of pregnant women given glucocorticoids for threatened preterm labour have minimal evidence of increased cardiovascular risk factors. SummaryExposure of the fetus to inappropriate amounts of glucocorticoids can result in a postnatal phenotype that may predispose to cardiovascular disease, although the fact that surrogate endpoints are often studied in animal experiments must be borne in mind. However, assumptions that effects of other interventions, such as maternal undernutrition, are mediated via exposure of the fetus to excess glucocorticoids are often not supported by direct evidence. The value of available human data should not be overlooked.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"523–529"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/MED.0b013e328010ca54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61686877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-10-01DOI: 10.1097/01.med.0000244228.21776.94
S. Sherman
Purpose of reviewDisparities in cancer incidence and patient outcomes are now recognized as commonly due to socioeconomic parameters in addition to more traditional risk factors such as gender and toxic exposure. For thyroid carcinoma, studies published during the past 10 years have now focused on identifying these contributing factors to disparities. Recent findingsThe incidence of thyroid carcinoma is clearly increased due to radiation exposure, with recent emphasis on increased risk for persons exposed to radioactive fallout from above-ground nuclear testing performed in the 1950s. Among women, who have higher incidence rates of differentiated thyroid carcinoma, risk is higher if menarche did not occur between the ages of 12 and 14. Women who have emigrated from south-east Asia may have higher rates of thyroid cancer, whereas lower rates occur in African-Americans. Occupations associated with higher risks include those with increased exposure to known toxins such as radiation and dioxins, but also school teachers, for less obvious reasons. Cigarette smokers and regular exercisers have lower incidence rates. SummaryAlthough socioeconomic factors are increasingly recognized as important to understanding cancer disparities, only weak associations have been described for thyroid cancer incidence and outcomes.
{"title":"Cancer disparities and thyroid carcinoma","authors":"S. Sherman","doi":"10.1097/01.med.0000244228.21776.94","DOIUrl":"https://doi.org/10.1097/01.med.0000244228.21776.94","url":null,"abstract":"Purpose of reviewDisparities in cancer incidence and patient outcomes are now recognized as commonly due to socioeconomic parameters in addition to more traditional risk factors such as gender and toxic exposure. For thyroid carcinoma, studies published during the past 10 years have now focused on identifying these contributing factors to disparities. Recent findingsThe incidence of thyroid carcinoma is clearly increased due to radiation exposure, with recent emphasis on increased risk for persons exposed to radioactive fallout from above-ground nuclear testing performed in the 1950s. Among women, who have higher incidence rates of differentiated thyroid carcinoma, risk is higher if menarche did not occur between the ages of 12 and 14. Women who have emigrated from south-east Asia may have higher rates of thyroid cancer, whereas lower rates occur in African-Americans. Occupations associated with higher risks include those with increased exposure to known toxins such as radiation and dioxins, but also school teachers, for less obvious reasons. Cigarette smokers and regular exercisers have lower incidence rates. SummaryAlthough socioeconomic factors are increasingly recognized as important to understanding cancer disparities, only weak associations have been described for thyroid cancer incidence and outcomes.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"451–454"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000244228.21776.94","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61656320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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