Restorative Justice Practices as a Foundation for Medical Education Innovation.

Background: Restorative justice (RJ) is an ethical lens that places emphasis on a community's connection and proliferative impact of actions, promoting communication and establishing methods for accountability. RJ practices can be applied on a spectrum, including proactive community-building practices, community discussions in response to an event, and restorative conferences addressing specific incidences of harm. This article describes an intervention that utilized RJ community-building practices within a medical education environment and evaluates its acceptability and feasibility.

Ultra-low dose hip CT-based automated measurement of volumetric bone mineral density at proximal femoral subregions.

Background: Forty to fifty percent of women and 13%-22% of men experience an osteoporosis-related fragility fracture in their lifetimes. After the age of 50 years, the risk of hip fracture doubles in every 10 years. x-Ray based DXA is currently clinically used to diagnose osteoporosis and predict fracture risk.

Displaced Proximal Tibia Fracture After Proximal Tibial Autograft Harvest: A Case Report.

Background: A 60-year-old female underwent proximal tibial autograft harvest for a Cotton osteotomy. Her postoperative course was complicated by psychogenic non-epileptic seizure (PNES) episodes leading to unintentional weightbearing. Knee radiographs at 6 weeks post-procedure demonstrated a displaced proximal tibia fracture through the autograft harvest site.

National Survey of the Bone Densitometry Evaluation Process Within an Integrated Healthcare System.

Background: To assess the current state of bone mineral density evaluation services via dual energy x-ray absorptiometry (DXA) provided to Veterans with fracture risk through the development and administration of a nationwide survey of facilities in the Veterans Health Administration.

Methodology: The Bone Densitometry Survey was developed by convening a Work Group of individuals with expertise in bone densitometry and engaging the Work Group in an iterative drafting and revision process. Once completed, the survey was beta tested, administered through REDCap, and sent via e-mail to points of contact at 178 VHA facilities.

Association between RAAS Antagonism and COVID-19-related Mortality in Patients with Overweight/Obesity-related Hypertension: A Retrospective Cohort Study.

Background: Angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) increase the expression of ACE2, which is a receptor for entry of SARS-CoV-2 into cells. Though evidence suggests that ARB/ACEI are safe among the general population with COVID-19, their safety in patients with overweight/obesity-related hypertension deserves further evaluation.

Objective: We assessed the association between ARB/ACEI use and COVID-19 severity in patients with overweight/obesity-related hypertension.

An Assessment of Diversity, Inclusion, and Health Equity Training in Endocrinology Fellowship Programs in the United States.

Context: The Accreditation Council for Graduate Medical Education has instituted common program requirements related to diversity, equity, and inclusion (DEI) for postgraduate trainees in the United States; however, the extent to which DEI training is being incorporated across endocrinology fellowship programs is unknown.

Objectives: To describe the sociodemographic representation and DEI training experiences within endocrinology fellowship programs.

Design, Setting, And Participants: National cross-sectional survey study of fellows and fellowship program leaders in the United States whose fellowships were members of the Association of Program Directors in Endocrinology and Metabolism.

Denosumab Use in Adults With Fibrous Dysplasia: Case Reports and Review of the Literature.

Objective: In fibrous dysplasia (FD) of the bone, a gain-of-function mutation in the G-nucleotide binding protein alpha subunit results in constitutively active cyclic adenosine monophosphate. Downstream effects include formation of disorganized cortex and bone marrow fibrosis. Patients with FD experience bone pain and are at risk of fracture.

Effect of Denosumab on Bone Health in Adult Patients with Duchenne/Becker Muscular Dystrophy: A Report of 2 Cases.

Case: Duchenne/Becker muscular dystrophy (DMD/BeMD) is caused by a loss of dystrophin leading to muscular weakness. Glucocorticoids are used to delay loss of muscle strength but frequently result in osteoporosis and fractures. Bisphosphonates are the drug of choice, and there are limited data on the efficacy of denosumab.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument.

Background: Medical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students' perceptions of their clinical skill growth.

Methods: A self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year.

Development and evaluation of novel tool to assess communication skills in adult triadic interviews.

Objective: Develop and evaluate the reliability and validity of a novel assessment tool for triadic communication.

Methods: We developed the tool using published opinions of patients and companions regarding effective communication, and used it in a four-station Objective Standardized Clinical Examination (OSCE) with 140 medical students, including one triadic interview station. We conducted multitrait-multimethod (MTMM) and generalizability (G) analyses to assess its performance.

Immediate preoperative hyperglycemia correlates with complications in non-cardiac surgical cases.

Study Objective: Assess for a relationship between immediate preoperative glucose concentrations and postoperative complications.

Design: Retrospective cohort study.

Setting: Single large, tertiary care academic medical center.

Quantitative CT-Based Methods for Bone Microstructural Measures and Their Relationships With Vertebral Fractures in a Pilot Study on Smokers.

Osteoporosis causes fragile bone, and bone microstructural quality is a critical determinant of bone strength and fracture risk. This study pursues technical validation of novel CT-based methods for assessment of peripheral bone microstructure together with a human pilot study examining relationships between bone microstructure and vertebral fractures in smokers. To examine the accuracy and reproducibility of the methods, repeat ultra-high-resolution (UHR) CT and micro-CT scans of cadaveric ankle specimens were acquired.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation.

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies.

Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D.

Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement.

Zoledronic Acid after Treatment with Denosumab is Associated with Bone Loss within 1 Year.

Background: Bone mineral density (BMD) declines when zoledronic acid (ZA) is administered. This case series describes the patterns of change in BMD when 1 or 2 doses of ZA are administered after denosumab.

Methods: Twelve patients who received at least 2 doses of denosumab followed by at least 1 dose of ZA and who had a dual energy X-ray absorptiometry (DXA) scan at the end of denosumab and 1 year after the first dose of ZA were included.

Anorexia Nervosa and Osteoporosis.

Patients with anorexia nervosa (AN) often experience low bone mineral density (BMD) and increased fracture risk, with low body weight and decreased gonadal function being the strongest predictors of the observed bone mineral deficit and fractures. Other metabolic disturbances have also been linked to bone loss in this group of patients, including growth hormone resistance, low insulin-like growth factor-1 (IGF-1) concentrations, low leptin concentrations, and hypercortisolemia. However, these correlations lack definitive evidence of causality.

Bone Health and Osteoporosis Prevention and Treatment.

Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have devastating consequences on morbidity and mortality. In this article, we review the pathogenesis and diagnostic approach to postmenopausal osteoporosis. We review available nonpharmacologic and pharmacologic therapies and we discuss their clinical efficacy and complications, with a detailed discussion of atypical femur fractures and osteonecrosis of the jaw.

Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment.

Anorexia nervosa (AN) affects 2.9 million people, many of whom experience bone loss and increased fracture risk. In this article, we review data on the underlying pathophysiology of AN-related osteoporosis and possible approaches to disease management.

A Practical Approach to Integrating Communication Skills and Early Clinical Experience into the Preclinical Medical School Curriculum.

Background: Effective integration of early clinical experiences (ECE) with preclinical curricula is challenging, given the limited knowledge-base of students and the unpredictability of clinical environments. Integration of ECE with communication skills (CS) training presents an attractive opportunity since CSs apply to all types of clinical encounters and are independent of students' medical knowledge. We present an ECE program that integrates formal CS training with the realities of clinical practice.

Use of bone age for evaluating bone density in patients with Duchenne muscular dystrophy: A preliminary report.

Introduction: Patients with Duchenne muscular dystrophy (DMD) exhibit low bone mineral density and increased fracture risk. Because glucocorticoid therapy results in delayed puberty and short stature, it is important to account for delayed skeletal development when interpreting patients' bone mineral density.

Methods: Twelve glucocorticoid-treated patients with DMD were evaluated by dual x-ray absorptiometry scans and wrist x-rays to estimate bone density and bone age, respectively.

Effects of TZD Use and Discontinuation on Fracture Rates in ACCORD Bone Study.

Context: In trials, thiazolidinediones (TZDs) increase fracture risk in women, but the effects of discontinuation are unknown.

Objective: The objective was to investigate the effects of TZD use and discontinuation on fractures in women and men.

Design: This was a longitudinal observational cohort study using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial bone ancillary study.

Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents.

The increasing use of antipsychotics (APs) to treat pediatric psychiatric conditions has led to concerns over the long-term tolerability of these drugs. While the risk of cardiometabolic abnormalities has received most of the attention, preclinical and clinical studies provide preliminary evidence that APs can adversely impact bone metabolism. This would be most concerning in children and adolescents as suboptimal bone accrual during development may lead to increased fracture risk later in life.

Bone density and alendronate effects in Duchenne muscular dystrophy patients.

Introduction: Patients with DMD have low bone mineral density (BMD) and are at high risk for fractures. We examined changes in BMD and the effects of alendronate in DMD patients treated at our institution in the last decade.

Methods: Retrospective cohort study of 39 DMD patients.

Teriparatide treatment of osteoporosis in a patient with anorexia nervosa.

Osteoporosis commonly occurs in patients with anorexia nervosa (AN) and is often irreversible even after weight restoration. We describe a 52-year-old woman with AN and severe osteoporosis, discovered after she sustained multiple fractures from a fall. She had low weight for most of her life, but was only formally diagnosed with AN 6 years prior to her presentation.

Hyperprolactinemia and infertility.

Prolactin-secreting pituitary tumors are a common cause of amenorrhea and infertility in premenopausal women. The goals of therapy are to normalize prolactin, restore gonadal function and fertility, and reduce tumor size, and dopamine agonists are the preferred therapy. Clinically significant tumor enlargement during pregnancy is uncommon and dependent on tumor size and prepregnancy treatment.