Endocrinology and Metabolism

Original Articles

Mineral, bone & muscle Big Data Articles (National Health Insurance Service Database)
Comprehensive Evaluation of Treatment Patterns in Postmenopausal Patients with Osteoporosis without Fractures: Insights from Tertiary Care Institutions and Nationwide OMOP-CDM Data: Kyoung Jin Kim, Dachung Boo, Jimi Choi, Hyemin Yoon, Chai Young Jung, Seong Hee Ahn, Namki Hong, Beom-Jun Kim, Ji Seon Oh, Seng Chan You; Endocrinol Metab. 2025;40(5):737-747. Published online May 28, 2025; DOI: https://doi.org/10.3803/EnM.2024.2252

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Background
Osteoporosis is a global health concern. Despite emerging treatment options for this condition, limited data are available on hospital practices in South Korea. This study addresses the need for a hospital network database that reflects changes in routine clinical practice for osteoporosis in a timely manner.
Methods
We analyzed prescription patterns for anti-osteoporosis medications (AOMs) in postmenopausal women aged ≥50 years diagnosed with osteoporosis between 2012 and 2021 using data from Osteoporosis Analysis and Surveillance Initiative using Standardized data (OASIS) (four tertiary hospitals in South Korea) and a nationwide database from the Health Insurance Review and Assessment (HIRA) Service. AOMs were categorized into antiresorptive and anabolic agents, with a focus on secular changes in the use of oral bisphosphonates, denosumab, selective estrogen receptor modulators (SERMs), and anabolic agents.
Results
In the OASIS cohort, oral bisphosphonates were the most prescribed first-line AOM (49.0%), followed by denosumab (15.7%) and SERMs (18.0%). Denosumab use increased from 2% in 2016 to 40% in 2020, while oral bisphosphonate use declined from 69% in 2012 to 22% in 2021. The use of anabolic agents, including romosozumab and teriparatide, doubled to 6% after 2019. In the HIRA cohort, parenteral bisphosphonates were most common (54.3%), with significant denosumab use (17.3%).
Conclusion
Pronounced shifts in AOM prescription patterns were observed in South Korea, marked by a notable increase in denosumab prescriptions and a decline in bisphosphonate use. These trends highlight the impact of policy changes and clinical guidelines on osteoporosis treatment and may inform future management strategies.

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Comparison of the Efficacy of Denosumab and Alendronate in Improving Bone Mineral Density in Osteoporosis Patients and High-Risk Populations: A Systematic Review and Meta-Analysis
Kejia Zhu, Hang Li, Hui Zhang, Zongke Zhou, Bin Shen, Yong Nie
Clinical Drug Investigation.2026; 46(3): 243. CrossRef
Trends and prescribing patterns of antiosteoporosis medicines in Chinese patients: a real-world retrospective study
Shuo Zhang, Yuqing Fan, Mengyao Xue, Linfeng Jiang, Chen Mu, Nan Peng, Dongning Yao
Aging Clinical and Experimental Research.2026;[Epub] CrossRef

Mineral, bone & muscle
Effects of Sequential Anti-Resorptive Agents on Bone Mineral Density Following Denosumab Withdrawal: A Multicenter Real-World Study in Korea (MAXCARE Study): Jeonghoon Ha, Kyong Yeun Jung, Kyoung Jin Kim, Seong Hee Ahn, Hyo-Jeong Kim, Yoon-Sok Chung, on Behalf of MAXCARE Research Group; Endocrinol Metab. 2025;40(5):748-758. Published online February 11, 2025; DOI: https://doi.org/10.3803/EnM.2024.2227

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Background
Denosumab is a potent anti-resorptive agent widely used for osteoporosis. However, its discontinuation results in a ‘rebound phenomenon’ of rapid bone loss, necessitating transition to alternative anti-resorptive therapies. Despite this, there is limited evidence to guide the selection of the most effective agent, particularly among bisphosphonates. This study aimed to evaluate the efficacy of different anti-resorptive therapies following denosumab discontinuation in a real-world clinical setting.
Methods
This retrospective study included 360 patients (low-dose alendronate/calcitriol combination [MXM, n=118], alendronate [ALD, n=53], risedronate [RIS, n=20], ibandronate [IBN, n=30], zoledronic acid [ZOL, n=106], selective estrogen receptor modulator [SERM, n=33]) who received at least 12 months of post-denosumab anti-resorptive therapy. Bone mineral density (BMD) changes from baseline and fracture patterns were assessed over the treatment period.
Results
Baseline characteristics, including age and body mass index, were comparable across groups, with an average of 4.2 denosumab administrations per patient. The SERM group experienced the greatest BMD decline across all sites. Significant BMD reductions in the lumbar spine and femoral neck and in the femoral neck alone were observed in the IBN and RIS groups, respectively. While BMD decline was also observed in the MXM, ALD, and ZOL groups, these changes were not statistically significant.
Conclusion
MXM, ALD, and ZOL mitigated BMD loss following denosumab discontinuation. Conversely, RIS, IBN, and SERM did not adequately prevent BMD decline. These findings underscore the importance of selecting the most appropriate sequential antiresorptive therapy in clinical practice to minimize BMD loss and reduce the risk of adverse outcomes.

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当院におけるデノスマブ使用継続による中期的な骨密度変化の検討
暖基中野, 克樹江﨑, 雄太土居, 慶一小澤
Orthopedics & Traumatology.2026; 75(1): 147. CrossRef
Pharmacological Management of Osteoporosis in Geriatric Populations: A Comprehensive Literature Review
E. N. Dudinskaya, N. V. Brailova, O. N. Tkacheva
Russian Journal of Geriatric Medicine.2025; (2): 115. CrossRef

Mineral, Bone & Muscle
Elevated Circulating Sclerostin Levels in Frail Older Adults: Implications beyond Bone Health: Ji Yeon Baek, Seong Hee Ahn, Il-Young Jang, Hee-Won Jung, Eunhye Ji, So Jeong Park, Yunju Jo, Eunju Lee, Dongryeol Ryu, Seongbin Hong, Beom-Jun Kim; Endocrinol Metab. 2025;40(1):73-81. Published online October 24, 2024; DOI: https://doi.org/10.3803/EnM.2024.2100

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Background
Sclerostin, initially recognized for its pivotal role in bone metabolism, has gained attention for its multifaceted impact on overall human health. However, its influence on frailty—a condition that best reflects biological age—has not been thoroughly investigated.
Methods
We collected blood samples from 244 older adults who underwent comprehensive geriatric assessments. Sclerostin levels were quantified using an enzyme-linked immunosorbent assay. Frailty was assessed using two validated approaches: the phenotypic model by Fried and the deficit accumulation frailty index (FI) by Rockwood.
Results
After controlling for sex, age, and body mass index, we found that serum sclerostin levels were significantly elevated in frail individuals compared to their robust counterparts (P<0.001). There was a positive correlation between serum sclerostin concentrations and the FI (P<0.001). Each standard deviation increase in serum sclerostin was associated with an odds ratio of 1.87 for frailty (P=0.003). Moreover, participants in the highest quartile of sclerostin levels had a significantly higher FI and a 9.91-fold increased odds of frailty compared to those in the lowest quartile (P=0.003 and P=0.039, respectively).
Conclusion
These findings, which for the first time explore the association between circulating sclerostin levels and frailty, have significant clinical implications, positioning sclerostin as one of potential blood-based biomarkers for frailty that captures the comprehensive physical, mental, and social aspects of the elderly, extending beyond its traditional role in bone metabolism.

Citations

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Irisin, Sclerostin, and Inflammatory Axis: Implication in Bone‐Muscle Wasting Diseases
Mohamad Maged, Sameh Heikal, Salma Ibrahim, Sameh E. Hassanein
Cell Biochemistry and Function.2026;[Epub] CrossRef

Review Articles

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.

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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
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Methyl-4-hydroxybenzoate induces osteoporosis via the AKT1/LC3B/Beclin1 autophagy signaling pathway: Integrating network toxicology and experimental validation
Furui Fu, Wenhao Wang, Yunqi Li, Senjie Shi, Jin Huang, Tianpeng Liu, Yi Shen, Mengting Yuan, Chuanglong Xu, Hongyu Wang, Haitao Zhang, Xiang Gao, Dezhi Tang
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The effects of acetamiprid exposure on osteoporosis: inducing imbalanced bone remodeling by disrupting the equilibrium of adipogenic/osteoblast/osteoclast differentiation
Yanan Song, Yucheng Yan, Feng Liu, Yunyun Du, Yichao Li, Yiman Li, Haoxuan Gao, Bing Wu, Yundi Hu, Xiaoyu Li, Huifang Yang, Ji Zhao
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Shuo Duan, Shuaishuai Wang, Zhiyang Liu, Shuaiwei Li, Yisi Wang, Minglei Zhang
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PFOA effects on osteoblast differentiation: Involvement of oxidative stress and endocannabinoid receptors
Fiorenza Sella, Christian Giommi, Damiano Carbonari, Marta Lombó, Oliana Carnevali
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Heather M. Guetterman, Jessie P. Buckley, Kasandra Sanidad, Emily Jamo, Rita S. Strakovsky
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Xiao Zhang, Xi Zhu, Wenbo Gu, Xusheng Li, Tenyao Niu, Pengcheng Mao, Haifeng Yuan
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Peng Zhang, Shuailei Li, Hao Zeng, Yongqiang Sun
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Branislav Kolena, Natália Prochácková, Henrieta Hlisníková, Miroslava Nagyová, Ida Petrovičová
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Hongliang Jin, Xinyun Zhou, Xinyue Wang, Yan Zhang
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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.

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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
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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
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Talia Diker Cohen, Idit Dotan, Bronya Calvarysky, Eyal Robenshtok
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Bone disease in kidney transplant: don’t forget about osteomalacia: a case report and literature review
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Original Articles

Mineral, Bone & Muscle
Familial Correlation and Heritability of Hand Grip Strength in Korean Adults (Korea National Health and Nutrition Examination Survey 2014 to 2019): Seong Hee Ahn, Eun Byeol Park, Seongha Seo, Yongin Cho, Da Hea Seo, So Hun Kim, Young Ju Suh, Seongbin Hong; Endocrinol Metab. 2023;38(6):709-719. Published online November 7, 2023; DOI: https://doi.org/10.3803/EnM.2023.1740

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Background
The onset and progression of sarcopenia are highly variable among individuals owing to genetic and environmental factors. However, there are a limited number of studies measuring the heritability of muscle strength in large numbers of parent-adult offspring pairs. We aimed to investigate the familial correlation and heritability of hand grip strength (HGS) among Korean adults.
Methods
This family-based cohort study on data from the Korea National Health and Nutrition Examination Survey (2014 to 2019) included 5,004 Koreans aged ≥19 years from 1,527 families. HGS was measured using a digital grip strength dynamometer. Familial correlations of HGS were calculated in different pairs of relatives. Variance component methods were used to estimate heritability.
Results
The heritability estimate of HGS among Korean adults was 0.154 (standard error, 0.066). Correlation coefficient estimates for HGS between parent-offspring, sibling, and spouse pairs were significant at 0.07, 0.10, and 0.23 (P<0.001, P=0.041, and P<0.001, respectively). The total variance in the HGS phenotype was explained by additive genetic (15.4%), shared environmental (11.0%), and unique environmental (73.6%) influences. The odds of weak HGS significantly increased in the offspring of parents with weak HGS (odds ratio [OR], 1.69–3.10; P=0.027–0.038), especially in daughters (OR, 2.04–4.64; P=0.029–0.034).
Conclusion
HGS exhibits a familial correlation and significant heritable tendency in Korean adults. Therefore, Asian adults, especially women, who have parents with weak HGS, need to pay special attention to their muscle health with the help of healthy environmental stimuli.

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Association of Handgrip Strength with Diabetes, Hypertension, and Comorbidities in a Korean Population: A Large-Scale Cross-Sectional Study
Bum Ju Lee
Journal of Clinical Medicine.2025; 14(8): 2801. CrossRef
Malnutrition and Handgrip Strength are Correlated in Community Dwelling Elderly
Mehmet Göl, Ayse Elkoca, İbrahim Halil Türkbeyler, Melek Tarakçıoğlu, Alican Çelik, Kazım Ersin Altınsoy
STED / Sürekli Tıp Eğitimi Dergisi.2024;[Epub] CrossRef

Mineral, Bone & Muscle
Decreased Serum Level of Sclerostin in Older Adults with Sarcopenia: Seong Hee Ahn, Hee-Won Jung, Eunju Lee, Ji Yeon Baek, Il-Young Jang, So Jeong Park, Jin Young Lee, Eunah Choi, Yun Sun Lee, Seongbin Hong, Beom-Jun Kim; Endocrinol Metab. 2022;37(3):487-496. Published online May 27, 2022; DOI: https://doi.org/10.3803/EnM.2022.1428

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Background
Although muscles and bones interact with each other through various secretory factors, the role of sclerostin, an osteocyte-secreted factor, on muscle metabolism has not been well studied. We investigated the levels of serum sclerostin in Korean older adults with sarcopenia.
Methods
Blood samples were collected from 129 participants who underwent evaluation of muscle mass and function in an outpatient geriatric clinic of a teaching hospital. Sarcopenia and related parameters were determined using cutoff values for the Asian population. Serum sclerostin levels were measured using an enzyme-linked immunosorbent assay.
Results
The mean age of the participants was 69.6 years, and 20 participants (15.5%) were classified as having sarcopenia. After adjusting for age, sex, and body mass index, serum sclerostin levels were significantly lower in participants with sarcopenia, low muscle mass, or weak muscle strength (P=0.003 to 0.045). Serum sclerostin levels were positively associated with skeletal muscle index and grip strength after adjusting for confounders (P=0.001 and P=0.003), whereas sarcopenic phenotype score showed a negative association (P=0.006). These increases in muscle mass and strength were also dose dependent as serum sclerostin levels increased (P for trends=0.003 and P for trends=0.015). Higher serum sclerostin levels were associated with lower odds ratio (ORs) for sarcopenia, low muscle mass, and weak muscle strength after adjusting for confounders (OR, 0.27 to 0.50; P<0.001 to 0.025).
Conclusion
Higher serum sclerostin levels were associated with a lower risk of sarcopenia, low muscle mass, and weak muscle strength in Korean older adults.

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Food & Function.2026;[Epub] CrossRef
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Ben Kirk, Giovanni Lombardi, Gustavo Duque
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Elevated Circulating Sclerostin Levels in Frail Older Adults: Implications beyond Bone Health
Ji Yeon Baek, Seong Hee Ahn, Il-Young Jang, Hee-Won Jung, Eunhye Ji, So Jeong Park, Yunju Jo, Eunju Lee, Dongryeol Ryu, Seongbin Hong, Beom-Jun Kim
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Special Article

Miscellaneous
Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology: Jung Hee Kim, Hyun Wook Chae, Sang Ouk Chin, Cheol Ryong Ku, Kyeong Hye Park, Dong Jun Lim, Kwang Joon Kim, Jung Soo Lim, Gyuri Kim, Yun Mi Choi, Seong Hee Ahn, Min Ji Jeon, Yul Hwangbo, Ju Hee Lee, Bu Kyung Kim, Yong Jun Choi, Kyung Ae Lee, Seong-Su Moon, Hwa Young Ahn, Hoon Sung Choi, Sang Mo Hong, Dong Yeob Shin, Ji A Seo, Se Hwa Kim, Seungjoon Oh, Sung Hoon Yu, Byung Joon Kim, Choong Ho Shin, Sung-Woon Kim, Chong Hwa Kim, Eun Jig Lee; Endocrinol Metab. 2020;35(2):272-287. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.272

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Abstract PDF PubReader ePub

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

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Original Article

Clinical Study
The Association of Higher Plasma Macrophage Migration Inhibitory Factor Levels with Lower Bone Mineral Density and Higher Bone Turnover Rate in Postmenopausal Women: Hyeonmok Kim, Seong Hee Ahn, Chaeho Shin, Seung Hun Lee, Beom-Jun Kim, Jung-Min Koh; Endocrinol Metab. 2016;31(3):454-461. Published online July 26, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.454

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Abstract PDF Supplementary Material PubReader

Background

Despite evidence from animal and clinical studies showing the detrimental effects of macrophage migration inhibitory factor (MIF) on bone metabolism, there are no clinical studies relating circulating MIF levels to osteoporosis-related phenotypes. This cross-sectional study investigated the association of plasma MIF with bone mineral density (BMD), bone turnover markers (BTMs), and prevalence of osteoporosis in postmenopausal Korean women.

Methods

A total of 246 women not taking any medications or diagnosed with any diseases that could affect bone metabolism were enrolled. BMD values at the lumbar spine, femoral neck, and total femur, and blood levels of MIF and BTMs were measured in all subjects. Osteoporosis was defined by World Health Organization criteria.

Results

Before and after adjustment for confounding variables, higher MIF levels were significantly associated with lower BMD values at all measured sites and higher levels of all BTMs. All BMD values and BTMs significantly changed in a dose-dependent fashion across increasing MIF quartile. When participants were divided into two groups according to osteoporosis status, postmenopausal women with osteoporosis demonstrated 24.2% higher plasma MIF levels than those without osteoporosis (P=0.041). The odds ratio per each standard deviation increment of MIF levels for prevalent osteoporosis was 1.32 (95% confidence interval, 1.01 to 1.73).

Conclusion

This study provides the first epidemiological evidence that higher plasma MIF may be associated with higher risk of osteoporosis resulting from lower bone mass and higher bone turnover rate, and thus it could be a potential biomarker of poor bone health outcomes in postmenopausal women.

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Case Report

Long-Term Survival of a Patient with Pulmonary Artery Intimal Sarcoma after Sequential Metastasectomies of the Thyroid and Adrenal Glands: Yun Mi Choi, Eun Kyung Jang, Seong Hee Ahn, Min Ji Jeon, Ji Min Han, Seong Chul Kim, Duck Jong Han, Gyungyup Gong, Tae Yong Kim, Young Kee Shong, Won Bae Kim; Endocrinol Metab. 2013;28(1):46-49. Published online March 25, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.1.46

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Abstract PDF PubReader

Cancer metastases to the thyroid or adrenal gland are uncommon. Furthermore, cases showing long-term survival after surgical resection of those metastatic tumors are rare. We report a case of pulmonary artery intimal sarcoma with metastases to the thyroid and adrenal glands sequentially that was successfully treated with sequential metastasectomies. A 62-year-old woman presented with a 4-week history of dyspnea on exertion and facial edema in November 1999. Echocardiography and chest computed tomography (CT) revealed an embolism-like mass in the pulmonary trunk. Pulmonary artery endarterectomy with pulmonary valve replacement was performed, and histopathology revealed pulmonary artery intimal sarcoma. A thyroid nodule was found by chest CT in November 2001 (2 years after initial surgery). During follow-up, this lesion showed no change, but we decided to obtain fine needle aspiration cytology (FNAC) in August 2004 (4.7 years after initial surgery). FNAC revealed atypical spindle cells suggestive of metastatic intimal sarcoma. She underwent total thyroidectomy. During follow-up, a right adrenal gland mass was detected by chest CT in March 2006 (6.3 years after initial surgery), and adrenalectomy was done, which also revealed metastatic sarcoma. She has been followed up without any evidence of recurrent disease until May 2012 (12.5 years after initial surgery).

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