Endocrinology and Metabolism

Special Article

Mineral, bone & muscle
Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean Multidisciplinary Task Force: Jin-Woo Kim, Sung-Hye Kong, Jae-Young Kim, Mi Kyung Kwak, Jun-Young Kim, Ji-Hyeon Oh, Hyung-Youl Park, BeomTaek Kim, Young-Kyun Lee, Jeong Joon Han, Moon-Young Kim, Yong Jun Choi, Yong-Dae Kwon, Kwang-Sup Song, Beom-Jun Kim, Sun-Jong Kim, Seung-Hoon Baek, Dong Ock Lee, Han Seok Choi, Ha Young Kim, Tae-Geon Kwon; Endocrinol Metab. 2025;40(6):787-810. Published online December 12, 2025; DOI: https://doi.org/10.3803/EnM.2025.2712

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With a rapidly aging population and increasing use of antiresorptive agents, medication-related osteonecrosis of the jaw (MRONJ) represents a growing clinical challenge worldwide. To address the need for tailored clinical guidance, a multidisciplinary task force was convened. Five Korean academic societies—the Korean Society for Bone and Mineral Research, the Korean Association of Oral and Maxillofacial Surgeons, the Korean Society of Maxillofacial Plastic and Reconstructive Surgeons, the Korean Osteoporosis Society, and the Korean Endocrine Society—collaborated to develop this position statement. The consensus was formulated through comprehensive reviews of literature, combined with three rounds of formal surveys to consolidate expert opinion on controversial topics. This position paper provides evidence-based clinical guidelines for the prevention, diagnosis, and management of MRONJ tailored to the Korean healthcare environment. The diagnostic criteria affirm the standard definition but add a provision for diagnosis based on clinical or radiographic evidence of necrotic bone, even if the traditional 8-week timeframe has not been met. The committee advocates for retaining stage 0 in the staging system to emphasize early detection and preventive intervention. Key recommendations include prescriptive, drug-specific guidelines for prophylactic drug holidays (e.g., a 2-month pause for oral bisphosphonates; timing surgery 3 to 4 months after the last denosumab injection) to minimize MRONJ risk from dental procedures. This statement also provides a clear framework for therapeutic drug holidays in established MRONJ, carefully balancing the need for jaw healing against systemic fracture risk. For treatment, this statement advocates for early and active surgical intervention across all MRONJ stages, supported by evidence of superior long-term outcomes compared to conservative management. This position statement offers a unique, evidence-based Korean clinical practice guideline for managing MRONJ. It is intended to standardize care, reduce clinical confusion, and ultimately improve patient outcomes by providing a clear framework for decision-making.

Citations

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Asia-Pacific consensus statement on medication-related osteonecrosis of the jaw in patients with osteoporosis
Akira Taguchi, Daisuke Inoue, Jin-Woo Kim, Keskanya Subbalekha, Wai Sin Chan, Hee Dong Chae, Chung-Hwan Chen, Ching-Lung Cheung, Eddie Siu Lun Chow, Yoon-Sok Chung, Linsey Gani, Muhammad Kamil bin Hassan, Unnop Jaisamrarn, Chakorn Vorakulpipat, Nutchada S
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Targeted drug repurposing in medication-related osteonecrosis of the jaw: a review of teriparatide and pentoxifylline/α-tocopherol protocols
Weijia Huang, Jishizhan Chen, Quan Zhou, Azadeh Rezaei
Frontiers in Medicine.2026;[Epub] CrossRef
The Korean medication-related osteonecrosis of the jaw position paper—a milestone toward practical, evidence-based guidance
Won Lee
Journal of the Korean Association of Oral and Maxillofacial Surgeons.2026; 52(1): 1. CrossRef

Review Article

Mineral, Bone & Muscle
Effects of Endocrine-Disrupting Chemicals on Bone Health: So Young Park, Sung Hye Kong, Kyoung Jin Kim, Seong Hee Ahn, Namki Hong, Jeonghoon Ha, Sihoon Lee, Han Seok Choi, Ki-Hyun Baek, Jung-Eun Kim, Sang Wan Kim, on Behalf of Metabolic Bone Disease Study Group of Korean Endocrine Society; Endocrinol Metab. 2024;39(4):539-551. Published online July 17, 2024; DOI: https://doi.org/10.3803/EnM.2024.1963

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This comprehensive review critically examines the detrimental impacts of endocrine-disrupting chemicals (EDCs) on bone health, with a specific focus on substances such as bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, and dioxins. These EDCs, by interfering with the endocrine system’s normal functioning, pose a significant risk to bone metabolism, potentially leading to a heightened susceptibility to bone-related disorders and diseases. Notably, BPA has been shown to inhibit the differentiation of osteoblasts and promote the apoptosis of osteoblasts, which results in altered bone turnover status. PFASs, known for their environmental persistence and ability to bioaccumulate in the human body, have been linked to an increased osteoporosis risk. Similarly, phthalates, which are widely used in the production of plastics, have been associated with adverse bone health outcomes, showing an inverse relationship between phthalate exposure and bone mineral density. Dioxins present a more complex picture, with research findings suggesting both potential benefits and adverse effects on bone structure and density, depending on factors such as the timing and level of exposure. This review underscores the urgent need for further research to better understand the specific pathways through which EDCs affect bone health and to develop targeted strategies for mitigating their potentially harmful impacts.

Citations

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Bile acids insufficiency links perfluorooctane sulfonate-induced oxidative stress-mediated fatty liver with osteoarthritis
Jialing Yu, Sihan Huang, Jianbin Zhang, Zijian Su, Yiming Chang, Keke Liu, Lu Yang, Huiying Guo, Jinshao Ye, Xujing Liang, Xiaojia Chen, An Hong, Yibo Zhang
Journal of Hazardous Materials.2026; 501: 140750. CrossRef
Unraveling the Mechanisms of Osteoporosis Triggered by Methylparaben and Monomethyl Phthalate through Integrated Mendelian Randomization, In Silico Simulations, and Experimental Validation
Hailong Liu, Xin Xu, Longzhuo Du, Wencan Zhang, Yongyuan Guo, Fujian Zhang, Houyi Sun, Haipeng Si, Peilai Liu
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Yun-Cheng Mei, Tesfaye Abebe Geleta, Ashkan Miri, Prashanth Venkatesan, Yu-Chiang Chao, Yutong Chen, Pei-Hsin Chou, Ren Qian Tee, Yang-hsin Shih
Journal of Environmental Chemical Engineering.2026; 14(1): 121018. CrossRef
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Methyl-4-hydroxybenzoate induces osteoporosis via the AKT1/LC3B/Beclin1 autophagy signaling pathway: Integrating network toxicology and experimental validation
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Ecotoxicology and Environmental Safety.2026; 312: 119913. CrossRef
Endocrine Society of India’s National White Paper on Endocrine Disrupting Chemicals – A Call for Action
Gagan Priya, Narendra Kotwal, Sri V. Madhu, Shinjan Patra, Kaushik Pandit, Beatrice Anne, Mohan T. Shenoy, Jayshree Swain, Sambit Das, Lakshmi N. Kopalle, Lakshmi Nagendra, Saptarshi Bhattacharya, Shehla S. Shaikh, Sunetra Mondal, Ganesh K. Bhat, Ameya Jo
Indian Journal of Endocrinology and Metabolism.2026; 30(1): 4. CrossRef
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Elucidating the mechanism of phthalates induced osteoporosis through network toxicology and molecular docking
Xiao Zhang, Xi Zhu, Wenbo Gu, Xusheng Li, Tenyao Niu, Pengcheng Mao, Haifeng Yuan
Ecotoxicology and Environmental Safety.2025; 291: 117820. CrossRef
Exposure to polycyclic aromatic hydrocarbons and bone mineral density in children and adolescents: results from the 2011–2016 National Health and Nutrition Examination Survey
Peng Zhang, Shuailei Li, Hao Zeng, Yongqiang Sun
Frontiers in Public Health.2025;[Epub] CrossRef
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Achilleas Karakoltzidis, Spyros P. Karakitsios, Catherine Gabriel, Dimosthenis Α. Sarigiannis
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Associations of urinary organophosphate ester metabolites with bone mineral density in U.S. children and adolescents aged 8–19 years: a cross-sectional study based on NHANES 2011–2018
Hongliang Jin, Xinyun Zhou, Xinyue Wang, Yan Zhang
European Journal of Pediatrics.2025;[Epub] CrossRef
Non-linear associations between exposure to a mixture of per- and polyfluoroalkyl substances and thyroid hormone levels in Korean adults
Seung Min Chung, Ji-Hyeon Cha, Young-Heun Jung, Ju-Hyun Kim, Jun Sung Moon, Kyu Chang Won
Environment International.2025; 201: 109585. CrossRef
Citizen Science in Action: Preliminary Observations on Bat Box Use in the Perth and Peel Regions, Western Australia
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Journal of The Royal Society of Western Australia.2025;[Epub] CrossRef
Comment on “Standardized gynecologic consultation and bone surveillance in patients with breast cancer receiving hormone therapy”2
Rachana Mehta, Ranjana Sah
Supportive Care in Cancer.2025;[Epub] CrossRef

Letter

Mineral, Bone & Muscle
Potential of Calcilytics as a Novel Treatment for Post-Surgical Hypoparathyroidism: Han Seok Choi; Endocrinol Metab. 2024;39(3):534-536. Published online May 27, 2024; DOI: https://doi.org/10.3803/EnM.2024.2035

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Repurposing osteoporosis medications for other diseases: a narrative review by the European Calcified Tissue Society (ECTS)
Polyzois Makras, Maria P. Yavropoulou, Athanasios D. Anastasilakis, Natasha M. Appelman-Dijkstra, John J. Carey, Anda Mihaela Naciu, Julien Paccou, Tim Rolvien, Elizabeth M. Winter, Socrates E. Papapoulos, Willem F. Lems
Bone.2026; 204: 117769. CrossRef

Review Articles

Mineral, Bone & Muscle
Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations: Kyoung Jin Kim, Jeonghoon Ha, Sang Wan Kim, Jung-Eun Kim, Sihoon Lee, Han Seok Choi, Namki Hong, Sung Hye Kong, Seong Hee Ahn, So Young Park, Ki-Hyun Baek, on Behalf of Metabolic Bone Disease Study Group of Korean Endocrine Society; Endocrinol Metab. 2024;39(2):267-282. Published online April 25, 2024; DOI: https://doi.org/10.3803/EnM.2024.1939

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This review article investigates solid organ transplantation-induced osteoporosis, a critical yet often overlooked issue, emphasizing its significance in post-transplant care. The initial sections provide a comprehensive understanding of the prevalence and multifactorial pathogenesis of transplantation osteoporosis, including factors such as deteriorating post-transplantation health, hormonal changes, and the impact of immunosuppressive medications. Furthermore, the review is dedicated to organ-specific considerations in transplantation osteoporosis, with separate analyses for kidney, liver, heart, and lung transplantations. Each section elucidates the unique challenges and management strategies pertinent to transplantation osteoporosis in relation to each organ type, highlighting the necessity of an organ-specific approach to fully understand the diverse manifestations and implications of transplantation osteoporosis. This review underscores the importance of this topic in transplant medicine, aiming to enhance awareness and knowledge among clinicians and researchers. By comprehensively examining transplantation osteoporosis, this study contributes to the development of improved management and care strategies, ultimately leading to improved patient outcomes in this vulnerable group. This detailed review serves as an essential resource for those involved in the complex multidisciplinary care of transplant recipients.

Citations

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Considerations for Endpoints in Lung Transplant Clinical Trials: An ISHLT Consensus Statement
John R. Greenland, Michael Perch, Kieran Halloran, Deborah J. Levine, Eric D. Morrell, Anna Reed, Ciara M. Shaver, Jonathan P. Singer, Stuart C. Sweet, Robin Vos, Shambhu Aryal, Nicholas Avdimiretz, Fay Burrows, Daniel Calabrese, Fiorella Calabrese, Silvi
The Journal of Heart and Lung Transplantation.2026; 45(2): e104. CrossRef
The immunobiology and therapeutic potential of regulatory T cells in autoimmune diseases and allergic diseases
Wen-Wen Xie, Jian-Bin Huang, Yi-Chi Zhou, Jing-Yi Yuan, Jia-Xue Feng, Xiao-Hang Shi, Li Tian, Xian-Hai Zeng, Shu-Qi Qiu, Mei-Zhen Zhao, Bao-Hui Cheng, Hao-Tao Zeng
Frontiers in Immunology.2026;[Epub] CrossRef
Osteoporosis After Menopause and After Drug Therapy: The Molecular Mechanism of Bone Loss and Its Treatment
Kelly I-Rong Lee, Jie-Hong Chen, Kuo-Hu Chen
International Journal of Molecular Sciences.2026; 27(2): 641. CrossRef
Bone Health in Young Lung Transplant Recipients: A Retrospective Study
Aviva Lerman, Osnat Shtraichman, Yaron Rudman, Mordechai R. Kramer, Idit Dotan, Gloria Tsvetov, Talia Diker Cohen
Respiration.2026; : 1. CrossRef
Endocrine disorders linked to chronic kidney disease: Mechanisms and clinical implications
Marcio J Concepción-Zavaleta, Jenyfer M Fuentes-Mendoza, Elida P López-Ramírez, Jesús A Martínez-García, Luis A Concepción-Urteaga, José Paz-Ibarra
World Journal of Nephrology.2026;[Epub] CrossRef
Romosozumab as Treatment for Severe Osteoporosis in Heart and Lung Transplant Recipients
Lisa M. Raven, Jacqueline R. Center, Christopher A. Muir
Endocrines.2025; 6(1): 2. CrossRef
Side Effects of Immunosuppressant Drugs After Liver Transplant
Filippo Gabrielli, Elisa Bernasconi, Arianna Toscano, Alessandra Avossa, Alessia Cavicchioli, Pietro Andreone, Stefano Gitto
Pharmaceuticals.2025; 18(3): 342. CrossRef
Exploiting regulatory T cells (Tregs): Cutting-edge therapy for autoimmune diseases
Marwa Hassan, Mohamed Elzallat, Dina Mostafa Mohammed, Mahmoud Balata, Walaa H. El-Maadawy
International Immunopharmacology.2025; 155: 114624. CrossRef
Results of the implementation of a multidisciplinary care protocol for preventing fragility fractures following liver transplantation
A. Monegal, J. L. Carrasco, P. Peris, B. Frade-Sosa, A. Azuaga, H. Florez, A. Dura, N. Guañabens, J. Colmenero
Osteoporosis International.2025; 36(7): 1213. CrossRef
Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach
Soumya Kurnool, Nandi Shah, Preethika Ekanayake
Therapeutic Advances in Endocrinology and Metabolism.2025;[Epub] CrossRef
Global and regional prevalence of osteoporosis in kidney transplant recipients: a systematic review and meta-analysis
Mobin Ghazaiean, Tahoora Mousavi, Mahmood Moosazadeh
Clinical and Experimental Medicine.2025;[Epub] CrossRef
Endocrine effects of long-term calcineurin inhibitor use in solid organ transplant recipients
Talia Diker Cohen, Idit Dotan, Bronya Calvarysky, Eyal Robenshtok
European Journal of Endocrinology.2025; 193(3): R1. CrossRef
Bone disease in kidney transplant: don’t forget about osteomalacia: a case report and literature review
Francesco Aguanno, Alessia Passaseo, Simona Barbuto, Daniele Vetrano, Guido Zavatta, Guido Marzocchi, Sandro Giannini, Giorgia Comai, Gaetano La Manna, Giuseppe Cianciolo
International Urology and Nephrology.2025; 58(4): 1381. CrossRef

Diabetes, Obesity and Metabolism Big Data Articles (National Health Insurance Service Database)
Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database: Sun Wook Cho, Jung Hee Kim, Han Seok Choi, Hwa Young Ahn, Mee Kyoung Kim, Eun Jung Rhee; Endocrinol Metab. 2023;38(1):10-24. Published online February 9, 2023; DOI: https://doi.org/10.3803/EnM.2023.102

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The Korean National Health Information Database (NHID) contains big data combining information obtained from the National Health Insurance Service and health examinations. Data are provided in the form of a cohort, and the NHID can be used to conduct longitudinal studies and research on rare diseases. Moreover, data on the cause and date of death are provided by Statistics Korea. Research and publications based on the NHID have increased explosively in the field of endocrine disorders. However, because the data were not collected for research purposes, studies using the NHID have limitations, particularly the need for the operational definition of diseases. In this review, we describe the characteristics of the Korean NHID, operational definitions of endocrine diseases used for research, and an overview of recent studies in endocrinology using the Korean NHID.

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Mee Kyoung Kim, Kyungdo Han, Hyuk-Sang Kwon, Soon Jib Yoo
Endocrinology and Metabolism.2023; 38(4): 426. CrossRef
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Hwa Young Ahn, Sun Wook Cho, Mi Young Lee, Young Joo Park, Bon Seok Koo, Hang-Seok Chang, Ka Hee Yi
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Hyeree Park, Sun Wook Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim, Aesun Shin, Won-Sang Cho
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Original Article

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
Hip Fracture Risk According to Diabetic Kidney Disease Phenotype in a Korean Population: Seung Eun Lee, Juhwan Yoo, Kyoung-Ah Kim, Kyungdo Han, Han Seok Choi; Endocrinol Metab. 2022;37(1):148-158. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2021.1315

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Background
Diabetic kidney disease (DKD) is associated with an elevated risk of fractures. However, little is known about the association between proteinuric or non-proteinuric DKD and the risk of hip fracture. Thus, we investigated the incidence of hip fractures among Korean adults with type 2 diabetes mellitus (T2DM) stratified by DKD phenotype.
Methods
In this retrospective cohort study using the Korean National Health Insurance Service database, patients with T2DM who received at least one general health checkup between 2009 and 2012 were followed until the date of hip fracture, death, or December 31, 2018. We classified the DKD phenotype by proteinuria and estimated glomerular filtration rate (eGFR), as follows: no DKD (PU⁻GFR⁻), proteinuric DKD with normal eGFR (PU⁺GFR⁻), non-proteinuric DKD with reduced eGFR (PU⁻GFR⁺), and proteinuric DKD with reduced eGFR (PU⁺GFR⁺)
Results
The cumulative incidence of hip fractures was highest in the PU⁺GFR⁺ group, followed by the PU⁻GFR⁺ group and the PU⁺GFR⁻ group. After adjustment for confounding factors, the hazard ratio (HR) for hip fracture was still highest in the PU⁺GFR⁺ group. However, the PU⁺GFR⁻ group had a higher HR for hip fracture than the PU⁻GFR⁺ group (PU⁺GFR⁺ : HR, 1.69; 95% confidence interval [CI], 1.57 to 1.81; PU⁺GFR⁻ : HR, 1.37; 95% CI, 1.30 to 1.46; PU⁻GFR⁺ : HR, 1.20; 95% CI, 1.16 to 1.24 using the PU⁻GFR⁻ group as the reference category).
Conclusion
The present study demonstrated that DKD was significantly associated with a higher risk of hip fracture, with proteinuria as a major determinant.

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Nandong Hu, Yiping Zhang, Zicheng Wei, Rui Yu, Yingying Zhang, Xiao Chen
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 1915. CrossRef
Risk of fracture with sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes: an updated meta-analysis of randomized controlled trials
Mahdieh Khoshzaban Banisi
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Bone Mineral Density and the Risk of Fracture According to eGFR in Postmenopausal Women
Minsang Kim, Kyungdo Han, Jin Kyung Kwon, Jae-ik Oh, Jinsun Lee, Jung Hun Koh, Min Woo Kang, Jeong Min Cho, Semin Cho, Seong Geun Kim, Sehyun Jung, Hyuk Huh, Soojin Lee, Eunjeong Kang, Yaerim Kim, Kwon Wook Joo, Dong Ki Kim, Sehoon Park
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Proteinuria screening and risk of bone fracture: a retrospective cohort study using a nationwide population-based database
Akira Okada, Akira Honda, Hideaki Watanabe, Yusuke Sasabuchi, Shotaro Aso, Kayo Ikeda Kurakawa, Masaomi Nangaku, Toshimasa Yamauchi, Hideo Yasunaga, Hirotaka Chikuda, Takashi Kadowaki, Satoko Yamaguchi
Clinical Kidney Journal.2024;[Epub] CrossRef
Fracture risks associated with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients across eGFR and albuminuria categories: A population-based study in Hong Kong
David Tak Wai Lui, Tingting Wu, Eric Ho Man Tang, Ivan Chi Ho Au, Chi Ho Lee, Yu Cho Woo, Kathryn Choon Beng Tan, Carlos King Ho Wong
Diabetes Research and Clinical Practice.2023; 197: 110576. CrossRef
Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2023)
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Wiener klinische Wochenschrift.2023; 135(S1): 207. CrossRef
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Seung Eun Lee, Juhwan Yoo, Bong-Seong Kim, Kyoung-Ah Kim, Kyungdo Han, Han Seok Choi
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Two-Year Changes in Diabetic Kidney Disease Phenotype and the Risk of Heart Failure: A Nationwide Population-Based Study in Korea
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Editorial

Mineral, Bone & Muscle
Why Do We Need Proactive Management for Fracture Prevention in Long-Term Glucocorticoid Users?: Han Seok Choi; Endocrinol Metab. 2020;35(3):549-551. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.308

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Original Articles

Miscellaneous
Influence of Vitamin D Deficiency on Progression of Experimental Otitis Media in Rats: Hee-Bok Kim, So Hyun Lim, Chang Gun Cho, Han Seok Choi; Endocrinol Metab. 2018;33(2):296-304. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.296

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Background

Vitamin D plays an important role in the immune response against infection. The purpose of the present study was to investigate the influence of vitamin D deficiency on the progression of otitis media (OM) using an experimental rat model.

Methods

Four-week-old male Sprague-Dawley rats (n=72) were divided into two groups based on their diet: a control diet group (n=36) and a vitamin D-deficient diet group (n=36). After 8 weeks of diet, experimental OM was induced by inoculation of non-typeable Haemophilus influenzae in the middle ear cavity. The rats were evaluated with otomicroscopy to determine the inflammation in the middle ear mucosa on days 1, 2, 4, 7, and 14 post-inoculation. Bullae from sacrificed rats were collected and analyzed histologically.

Results

The middle ear mucosa from rats with vitamin D deficiency showed a significantly higher thickness than that of controls during the course of OM. The maximum mucosal thickness was 56.0±9.1 µm in the vitamin D deficiency group, and 43.9±9.8 µm in the control group, although there was no significant difference in the tympanic membrane score between the two groups evaluated with otomicroscopy. An immunohistochemical study showed increased expression of interleukin 6 (IL-6) and tumor necrosis factor α in rats manifesting vitamin D deficiency and decreased expression of IL-10 compared with controls.

Conclusion

Our results showed that vitamin D deficiency may exacerbate the pathophysiological changes of OM via altered cytokine production. Therefore, maintaining vitamin D status in the optimal range may be beneficial for proper management of OM.

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The Role of Diet in Tympanostomy Tube Otorrhea
Kavita Dedhia, Alyssa Tindall, Jillian Karpink, Ashley Williams, Terri Giordano, Virginia Stallings
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Association between vitamin D deficiency and otitis media with effusion in children: a systematic review and meta-analysis
Ratna Dwi Restuti, Eka Dian Safitri, Respati Wulansari Ranakusuma, Ayu Astria Sriyana, Harim Priyono, Rangga Rayendra Saleh, Dora A Marpaung, Gilbert Lazarus
Paediatrica Indonesiana.2024; 64(5): 419. CrossRef
The role of vitamin D in subjective tinnitus—A case-control study
Magdalena Nowaczewska, Stanisław Osiński, Maria Marzec, Michał Wiciński, Katarzyna Bilicka, Wojciech Kaźmierczak, Rafael da Costa Monsanto
PLOS ONE.2021; 16(8): e0255482. CrossRef
Vitamin D and Otitis Media
Rebecca E. Walker, Jim Bartley, Carlos A. Camargo, Edwin A. Mitchell
Current Allergy and Asthma Reports.2019;[Epub] CrossRef

Clinical Study
Effects of Single Vitamin D₃ Injection (200,000 Units) on Serum Fibroblast Growth Factor 23 and Sclerostin Levels in Subjects with Vitamin D Deficiency: Dongdong Zhang, Da Hea Seo, Han Seok Choi, Hye-Sun Park, Yoon-Sok Chung, Sung-Kil Lim; Endocrinol Metab. 2017;32(4):451-459. Published online December 14, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.4.451

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Background

Vitamin D deficiency remains common in all age groups and affects skeletal and non-skeletal health. Fibroblast growth factor 23 is a bone-derived hormone that regulates phosphate and 1,25-dihydroxyvitamin D homeostasis as a counter regulatory factor. 1,25-Dihydroxyvitamin D stimulates fibroblast growth factor 23 synthesis in bone, while fibroblast growth factor 23 suppresses 1,25-dihydroxyvitamin D production in the kidney. The aim of this study was to evaluate the effects of vitamin D₃ intramuscular injection therapy on serum fibroblast growth factor 23 concentrations, and several other parameters associated with bone metabolism such as sclerostin, dickkopf-1, and parathyroid hormone.

Methods

A total of 34 subjects with vitamin D deficiency (defined by serum 25-hydroxyvitamin D levels below 20 ng/mL) were randomly assigned to either the vitamin D injection group (200,000 units) or placebo treatment group. Serum calcium, phosphate, urine calcium/creatinine, serum 25-hydroxyvitamin D, fibroblast growth factor 23, sclerostin, parathyroid hormone, and dickkopf-1 levels were serially measured after treatment.

Results

Comparing the vitamin D injection group with the placebo group, no significant changes were observed in serum fibroblast growth factor 23, parathyroid hormone, or dickkopf-1 levels. Serum sclerostin concentrations transiently increased at week 4 in the vitamin D group. However, these elevated levels declined later and there were no statistically significant differences as compared with baseline levels.

Conclusion

Serum fibroblast factor 23, sclerostin, parathyroid hormone, and dickkopf-1 levels were not affected significantly by single intramuscular injection of vitamin D₃.

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Effect of vitamin D supplementation on circulating fibroblast growth factor-23 concentration in adults with prediabetes
Lisa Ceglia, Anastassios G. Pittas, Bess Dawson-Hughes
Aging Clinical and Experimental Research.2023; 35(3): 525. CrossRef
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Athena Myrou, Theodoros Aslanidis, Keli Makedou, Athanasios Mitsianis, Aikaterini Thisiadou, Paraskevi Karalazou, Georgios Chatzopoulos, Anastasios Papadopoulos, Antonios Kalis, Dimitrios Giagkoulis, Fotios Lezgidis, Christos Savopoulos
Cureus.2023;[Epub] CrossRef
The effect of vitamin D supplementation on serum levels of fibroblast growth factor- 23: A systematic review and meta-analysis of randomized controlled trials
Fatemeh Meshkini, Sepideh Soltani, Cain C.T. Clark, Vivian Tam, David Meyre, Omid Toupchian, Sahar Saraf-Bank, Shima Abdollahi
The Journal of Steroid Biochemistry and Molecular Biology.2022; 215: 106012. CrossRef
Serum sclerostin levels in osteoporotic fracture patients
Erwin A. Gorter, Casper R. Reinders, Pieta Krijnen, Natasha M. Appelman-Dijkstra, Inger B. Schipper
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Clinical Utility of Preoperative Vitamin D3 Injection for Preventing Transient Hypocalcemia after Total Thyroidectomy
Kwangsoon Kim, Cho Rok Lee, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Claudio Casella
International Journal of Endocrinology.2021; 2021: 1. CrossRef
The effect of vitamin D supplementation on fibroblast growth factor‐23 in patients with chronic kidney disease: A systematic review and meta‐analysis
Elmira Karimi, Sama Bitarafan, Seyed Mohammad Mousavi, Nikan Zargarzadeh, Pari Mokhtari, Jessie Hawkins, Alipasha Meysamie, Fariba Koohdani
Phytotherapy Research.2021; 35(10): 5339. CrossRef
Pharmacodynamics of Oral Cholecalciferol in Healthy Individuals with Vitamin D Deficiency: A Randomized Open-Label Study
Angelo Fassio, Davide Gatti, Maurizio Rossini, Camilla Benini, Elena Fracassi, Eugenia Bertoldo, Ombretta Viapiana, Stefano Milleri, Matteo Gatti, Giovanni Adami
Nutrients.2021; 13(7): 2293. CrossRef
Vitamin D Deficiency at Mid-Pregnancy Is Associated with a Higher Risk of Postpartum Glucose Intolerance in Women with Gestational Diabetes Mellitus
Kyung-Soo Kim, Seok Won Park, Yong-Wook Cho, Soo-Kyung Kim
Endocrinology and Metabolism.2020; 35(1): 97. CrossRef
Effects of vitamin D supplementation on bone turnover markers and other bone-related substances in subjects with vitamin D deficiency
Rolf Jorde, Astrid Kamilla Stunes, Julia Kubiak, Ragnar Joakimsen, Guri Grimnes, Per Medbøe Thorsby, Unni Syversen
Bone.2019; 124: 7. CrossRef
Vitamin D Enhances the Efficacy of Topical Artificial Tears in Patients With Dry Eye Disease
Jin Sun Hwang, Yoon Pyo Lee, Young Joo Shin
Cornea.2019; 38(3): 304. CrossRef

Clinical Study
Obesity and Hyperglycemia in Korean Men with Klinefelter Syndrome: The Korean Endocrine Society Registry: Seung Jin Han, Kyung-Soo Kim, Wonjin Kim, Jung Hee Kim, Yong-ho Lee, Ji Sun Nam, Ji A Seo, Bu Kyung Kim, Jihyun Lee, Jin Ook Chung, Min-Hee Kim, Tae-Seo Sohn, Han Seok Choi, Seong Bin Hong, Yoon-Sok Chung; Endocrinol Metab. 2016;31(4):598-603. Published online December 20, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.4.598

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Background

The aim of this study was to investigate the prevalence of obesity in Korean men with Klinefelter syndrome (KS) and the associated risk factors for obesity and hyperglycemia.

Methods

Data were collected retrospectively from medical records from 11 university hospitals in Korea between 1994 and 2014. Subjects aged ≥18 years with newly diagnosed KS were enrolled. The following parameters were recorded at baseline before treatment: chief complaint, height, weight, fasting glucose level, lipid panel, blood pressure, testosterone, luteinizing hormone, follicle-stimulating hormone, karyotyping patterns, and history of hypertension, diabetes, and dyslipidemia.

Results

Data were analyzed from 376 of 544 initially enrolled patients. The rate of the 47 XXY chromosomal pattern was 94.1%. The prevalence of obesity (body mass index ≥25 kg/m²) in Korean men with KS was 42.6%. The testosterone level was an independent risk factor for obesity and hyperglycemia.

Conclusion

Obesity is common in Korean men with KS. Hypogonadism in patients with KS was associated with obesity and hyperglycemia.

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Male Hypogonadism: The Korean Society of Men's Health and Aging Position Statement
Sun Tae Ahn, Young-Sang Kim, Sung Hoon Yu, Yoon-Sok Chung
The World Journal of Men's Health.2025; 43(3): 492. CrossRef
New Horizons in Klinefelter Syndrome: Current Evidence, Gaps, and Research Priorities
Angela K Lucas-Herald, Lise Aksglaede, Ida Dyhr Caspersen, S Faisal Ahmed, Francesco Carlomagno, Andrea M Isidori
Endocrine Reviews.2025; 46(4): 447. CrossRef
A dual-center study of predictive factors for sperm retrieval through microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in men with non-mosaic Klinefelter syndrome
Jong Hyeun Baeck, Tae Jin Kim, Tae Heon Kim, Seung-Ryeol Lee, Dong Soo Park, Hwang Kwon, Ji Eun Shin, Dong Hyeon Lee, Young Dong Yu
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Julia Spiekermann, Kathrin Sinningen, Beatrice Hanusch, Michaela Kleber, Michael M. Schündeln, Cordula Kiewert, Heide Siggelkow, Jakob Höppner, Corinna Grasemann
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International Journal of Endocrinology.2022; 2022: 1. CrossRef
Metabolic and Nutritional Aspects in Paediatric Patients with Klinefelter Syndrome: A Narrative Review
Chiara Mameli, Giulia Fiore, Arianna Sangiorgio, Marta Agostinelli, Giulia Zichichi, Gianvincenzo Zuccotti, Elvira Verduci
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Klinefelter syndrome in an adolescent with severe obesity, insulin resistance, and hyperlipidemia, successfully treated with testosterone replacement therapy
Shota Fukuhara, Jun Mori, Hisakazu Nakajima
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Shixuan Liu, Tao Yuan, Shuoning Song, Shi Chen, Linjie Wang, Yong Fu, Yingyue Dong, Yan Tang, Weigang Zhao
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Anna G. W. Rosenberg, Minke R. A. Pater, Karlijn Pellikaan, Kirsten Davidse, Anja A. Kattentidt-Mouravieva, Rogier Kersseboom, Anja G. Bos-Roubos, Agnies van Eeghen, José M. C. Veen, Jiske J. van der Meulen, Nina van Aalst-van Wieringen, Franciska M. E. H
Journal of Clinical Medicine.2021; 10(22): 5457. CrossRef
Klinefelter Syndrome and Diabetes
Mark J. O’Connor, Emma A. Snyder, Frances J. Hayes
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Adriana Herrera Lizarazo, Michelle McLoughlin, Maria G. Vogiatzi
Current Opinion in Endocrinology, Diabetes & Obesity.2019; 26(1): 60. CrossRef
Sex differences in metabolism and cardiometabolic disorders
Karthickeyan Chella Krishnan, Margarete Mehrabian, Aldons J. Lusis
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Claus H Gravholt, Simon Chang, Mikkel Wallentin, Jens Fedder, Philip Moore, Anne Skakkebæk
Endocrine Reviews.2018; 39(4): 389. CrossRef
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Temeka Zore, Maria Palafox, Karen Reue
Molecular Metabolism.2018; 15: 35. CrossRef
Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives
Andrea Salzano, Roberta D’Assante, Liam M. Heaney, Federica Monaco, Giuseppe Rengo, Pietro Valente, Daniela Pasquali, Eduardo Bossone, Daniele Gianfrilli, Andrea Lenzi, Antonio Cittadini, Alberto M. Marra, Raffaele Napoli
Endocrine.2018; 61(2): 194. CrossRef
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Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
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Karen Reue
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Klinefelter Syndrome with Morbid Obesity Before Bariatric Surgery: A Case Report
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Clinical Study
Serum γ-Glutamyl Transferase Is Inversely Associated with Bone Mineral Density Independently of Alcohol Consumption: Han Seok Choi, Kwang Joon Kim, Yumie Rhee, Sung-Kil Lim; Endocrinol Metab. 2016;31(1):64-71. Published online March 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.1.64

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Background

γ-Glutamyl transferase (GGT) is a well-known marker of chronic alcohol consumption or hepatobiliary diseases. A number of studies have demonstrated that serum levels of GGT are independently associated with cardiovascular and metabolic disorders. The purpose of this study was to test if serum GGT levels are associated with bone mineral density (BMD) in Korean adults.

Methods

A total of 462 subjects (289 men and 173 women), who visited Severance Hospital for medical checkup, were included in this study. BMD was measured using dual energy X-ray absorptiometry. Cross-sectional association between serum GGT and BMD was evaluated.

Results

As serum GGT levels increased from the lowest tertile (tertile 1) to the highest tertile (tertile 3), BMD decreased after adjusting for confounders such as age, body mass index, amount of alcohol consumed, smoking, regular exercise, postmenopausal state (in women), hypertension, diabetes mellitus, and hypercholesterolemia. A multiple linear regression analysis showed a negative association between log-transformed serum GGT levels and BMD. In a multiple logistic regression analysis, tertile 3 of serum GGT level was associated with an increased risk for low bone mass compared to tertile 1 (odds ratio, 2.271; 95% confidence interval, 1.340 to 3.850; P=0.002).

Conclusion

Serum GGT level was inversely associated with BMD in Korean adults. Further study is necessary to fully elucidate the mechanism of the inverse relationship.

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Mineral, Bone & Muscle
Efficacy of a Once-Monthly Pill Containing Ibandronate and Cholecalciferol on the Levels of 25-Hydroxyvitamin D and Bone Markers in Postmenopausal Women with Osteoporosis: In-Jin Cho, Ho-Yeon Chung, Sung-Woon Kim, Jae-Won Lee, Tae-Won Lee, Hye-Soon Kim, Sin-Gon Kim, Han Seok Choi, Sung-Hee Choi, Chan Soo Shin, Ki-Won Oh, Yong-Ki Min, Jung-Min Koh, Yumie Rhee, Dong-Won Byun, Yoon-Sok Chung, Jeong Hyun Park, Dong Jin Chung, Minho Shong, Eun-Gyoung Hong, Chang Beom Lee, Ki Hyun Baek, Moo-Il Kang; Endocrinol Metab. 2015;30(3):272-279. Published online December 9, 2014; DOI: https://doi.org/10.3803/EnM.2015.30.3.272

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Background

The present study evaluated the efficacy of a combination of ibandronate and cholecalciferol on the restoration of the levels of 25-hydroxyvitamin D (25[OH]D) and various bone markers in postmenopausal women with osteoporosis.

Methods

This was a randomized, double-blind, active-controlled, prospective 16-week clinical trial conducted in 20 different hospitals. A total of 201 postmenopausal women with osteoporosis were assigned randomly to one of two groups: the IBN group, which received a once-monthly pill containing 150 mg ibandronate (n=99), or the IBN+ group, which received a once-monthly pill containing 150 mg ibandronate and 24,000 IU cholecalciferol (n=102). Serum levels of 25(OH)D, parathyroid hormone (PTH), and various bone markers were assessed at baseline and at the end of a 16-week treatment period.

Results

After 16 weeks of treatment, the mean serum levels of 25(OH)D significantly increased from 21.0 to 25.3 ng/mL in the IBN+ group but significantly decreased from 20.6 to 17.4 ng/mL in the IBN group. Additionally, both groups exhibited significant increases in mean serum levels of PTH but significant decreases in serum levels of bone-specific alkaline phosphatase and C-telopeptide of type 1 collagen (CTX) at 16 weeks; no significant differences were observed between the groups. However, in subjects with a vitamin D deficiency, IBN+ treatment resulted in a significant decrease in serum CTX levels compared with IBN treatment.

Conclusion

The present findings demonstrate that a once-monthly pill containing ibandronate and cholecalciferol may be useful for the amelioration of vitamin D deficiency in patients with postmenopausal osteoporosis. Moreover, this treatment combination effectively decreased serum levels of resorption markers, especially in subjects with a vitamin D deficiency, over the 16-week treatment period.

Citations

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Evaluation of compliance, persistence, safety profile and satisfaction to monthly single-pill treatment regimen of ibandronic acid 150 mg and cholecalciferol 22,400 IU among postmenopausal women with osteoporosis
Rita Neves, Tiago Torcato, Andreia Martins, Ana Laura Carreiras, Tânia Oliveira, Tânia Caseiro, Hugo Pedrosa, Filipe Brilhante, Augusto Filipe
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British Journal of Nutrition.2024; 131(9): 1473. CrossRef
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Mauro Geller, Mendel Suchmacher, Marcio Cohen, Spyros G. E. Mezitis, Flavia Wajnsztajn-Theil, Karin G. Cunha, Rafael Nigri
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Letter

Obesity and Metabolism
Letter: The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults (Endocrinol Metab 2013;28:33-40, Jung-Hee Yu et al.): Han Seok Choi; Endocrinol Metab. 2013;28(2):153-154. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.153

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Review Article

Mineral, Bone & Muscle
Vitamin D Status in Korea: Han Seok Choi; Endocrinol Metab. 2013;28(1):12-16. Published online March 25, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.1.12

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The majority of the vitamin D in our body is produced by cutaneous synthesis in response to sunlight. As more and more people live in cities and spend the bulk of their time indoors, it can be difficult to get sufficient sun exposure for adequate cutaneous production of vitamin D. Therefore, vitamin D insufficiency has become a very common health problem worldwide. The Korea National Health and Nutrition Examination Survey IV 2008 showed that the prevalence of vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D [25(OH)D] level below 50 nmol/L, was 47.3% in males and 64.5% in females. Only 13.2% of males and 6.7% of females had a serum 25(OH)D level of greater than 75 nmol/L. In Korea, vitamin D insufficiency was more prevalent in young adults than in elderly people, likely due to the indoor lifestyle of younger people. Compared with the United States and Canada, Korea has a lower mean 25(OH)D level and a higher prevalence of vitamin D insufficiency. To improve the vitamin D status of the Korean population, more aggressive policies on food fortification and vitamin D supplementation are needed.

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Case Report

1-34 PTH Could Reverse Impaired Bone Mineralization Induced By the Overdose of Bisphosphonate.: Kyeong Hye Park, Kwang Joon Kim, Han Seok Choi, Kyoung Min Kim, Eun Young Lee, Seonhui Han, Hyun Sil Kim, Daham Kim, Hannah Seok, Eun Yeong Choe, Yumie Rhee, Sung Kil Lim; Endocrinol Metab. 2012;27(3):247-250. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.247

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Abstract PDF: Bisphosphonates are the mainstay of osteoporosis treatment. Despite the fact that bisphosphonates have a relatively good safety record and are tolerated well by the majority of patients, serious adverse events have been associated with their use. A 41-year-old man had been diagnosed with osteoporosis and had taken etidronate 200 mg/day daily for 2 years due to the judgmental error. He was referred for the management of refractory bone pain and generalized muscle ache. Serum calcium, phosphate, 25-hydroxy-vitamin D (25(OH)D), and immunoreactive parathyroid hormone (iPTH) were within normal range. Plain X-ray showed multiple fractures. Whole body bone scan confirmed multiple sites of increased bone uptakes. Tetracycline-labeled bone biopsy showed typical findings of osteomalacia. He was diagnosed with iatrogenic, etidronate-induced osteomalacia. The patient received daily parathyroid hormone (PTH) injection for 18 months. PTH effectively reverses impaired bone mineralization caused by etidronate misuse. Currently, he is doing well without bone pain. Bone mineral density significantly increased, and the increased bone uptake was almost normalized after 18 months. This case seems to suggest that human PTH (1-34) therapy, possibly in association with calcium and vitamin D, is associated with important clinical improvements in patients with impaired bone mineralization due to the side effect of bisphosphonate.

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