Journal of the Endocrine Society最新文献

{"title":"Characterizing Lipoprotein(a) in Children With New-Onset Diabetes and Implications for Cardiovascular Risk Assessment.","authors":"Andrew Kanouse, Rubab Sohail, Parissa Salemi","doi":"10.1210/jendso/bvaf142","DOIUrl":"10.1210/jendso/bvaf142","url":null,"abstract":"<p><strong>Context: </strong>Children with diabetes mellitus (DM) have an increased risk for cardiovascular disease (CVD), a risk potentially exacerbated by elevated lipoprotein(a) (Lp(a)). While other cholesterol parameters are screened in this population, Lp(a) is often overlooked despite being an independent CVD risk factor. Lp(a) levels are historically believed to not change over an individual's life and are genetically determined, but newer literature suggests variation.</p><p><strong>Objective: </strong>This study investigated Lp(a) levels and their relationship with glycated hemoglobin A_1c (HbA_1c) in children with incident diabetes mellitus (DM).</p><p><strong>Methods: </strong>Children and adolescents aged 5 to 18 years with incident DM had baseline Lp(a) and lipid profiles. Repeat Lp(a) and HbA_1c were obtained 3 months later. Descriptive statistics (frequencies, proportions, means, medians) and nonparametric tests (Spearman correlation, Wilcoxon rank-sum/Kruskal-Wallis) were used. Statistical significance was set at <i>P</i> less than .05.</p><p><strong>Results: </strong>Seventy-six children were included for evaluation: 76% with type 1% and 23% type 2 DM. Baseline median (Q1-Q3) Lp(a) was 43.3 nmol/L (13-73.7 nmol/L), 17 of which were elevated (≥75 nmol/L). Of the 22 participants with follow-up, 8 were abnormal: A total of 4 whose baseline Lp(a) were abnormal remained so and 4 with normal levels became abnormal. A positive correlation was found between 3-month Lp(a) values and HbA_1c (<i>P</i> = .004).</p><p><strong>Conclusion: </strong>Children with DM have abnormal Lp(a) levels at a prevalence of approximately 20%, so this should be considered in CVD risk stratification. Further, observed Lp(a) fluctuations suggest value in serial Lp(a) assessments due to nongenetic influences. Without Lp(a) quantification, CVD risk characterization in children with DM may be inaccurate and should be considered for a comprehensive assessment.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 10","pages":"bvaf142"},"PeriodicalIF":3.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186136","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}

{"title":"The Association of Bone-related Biomarkers With Incident Hip Fracture: A Nested Case-control Study.","authors":"Sara J Cromer, Elaine W Yu, Elisabetta Patorno, Gary C Curhan, Julie M Paik","doi":"10.1210/jendso/bvaf148","DOIUrl":"https://doi.org/10.1210/jendso/bvaf148","url":null,"abstract":"<p><strong>Context: </strong>Current osteoporosis risk stratification relies on clinical factors and bone mineral density alone.</p><p><strong>Objective: </strong>To determine if osteocalcin, c-terminal cross-linking telopeptide of type 1 collagen, sclerostin, and bicarbonate (\"bone-related biomarkers\") are associated with future fracture risk or improve risk stratification.</p><p><strong>Design: </strong>Nested, matched case-control.</p><p><strong>Setting: </strong>Longitudinal cohorts of health care workers.</p><p><strong>Patients: </strong>Individuals with and without hip fracture in the Nurses' Health Study I and the Health Professionals Follow-up Study.</p><p><strong>Main outcome measure: </strong>Hip fracture.</p><p><strong>Results: </strong>Among 642 women in Nurses' Health Study I (mean age, 70.3 years; 29% with osteoporosis), we found no consistent associations between bone-related biomarkers and incident hip fracture, and addition of biomarkers to clinical models predicting incident hip fracture did not improve model fit. Among 586 men in Health Professionals Follow-up Study (mean age, 63.8 years; <1% with osteoporosis), higher levels of osteocalcin (odds ratio, 0.37 [95% CI, 0.13-1.04] for quintile 5 vs quintile 1; <i>P</i> for trend = .02) and sclerostin (odds ratio, 0.22 [95% CI, 0.09-0.54] for quintile 5 vs quintile 1; <i>P</i> for trend < .001) were associated with lower risk of hip fracture; however, addition of sclerostin to clinical models predicting incident hip fracture provided limited additional predictive value.</p><p><strong>Conclusion: </strong>Osteocalcin, c-terminal cross-linking telopeptide of type 1 collagen, sclerostin, and bicarbonate were not associated with incident hip fracture among older, predominantly White women. Osteocalcin and sclerostin were associated with hip fracture among men but did not meaningfully improve the predictive accuracy of models based on clinical risk factors alone.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 10","pages":"bvaf148"},"PeriodicalIF":3.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232876","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}

{"title":"MEN1-Related Neuroendocrine Tumors Show c-MET Overexpression.","authors":"Raisa Ghosh, Dilara Akbulut, William F Simonds, Lee S Weinstein, Samira M Sadowski, Jenny E Blau, Martha Quezado, Sunita K Agarwal, Smita Jha","doi":"10.1210/jendso/bvaf147","DOIUrl":"10.1210/jendso/bvaf147","url":null,"abstract":"<p><strong>Context: </strong>Approximately 50% to 70% of patients with multiple endocrine neoplasia type 1 (MEN1) die of duodenopancreatic neuroendocrine tumors (NETs). While c-MET inhibitors in combination with antivascular endothelial growth factor therapy have been shown to result in longer progression-free survival in patients with sporadic NETs, data regarding their efficacy in patients with MEN1-related NETs are lacking.</p><p><strong>Objective: </strong>We sought to characterize c-MET expression in MEN1-related NETs and evaluate its association with clinicopathologic characteristics.</p><p><strong>Methods: </strong>Forty-three tumors from 22 genetically confirmed patients with MEN1-related metastatic NETs were identified. Of these, 15 of 22 (68%) patients had distant metastases while the remaining 7 of 22 had locoregional metastases.</p><p><strong>Results: </strong>c-MET expression was assessed in these tumors via immunohistochemistry. A total of 19 of 43 (44%) were primary tumors (duodenum, pancreas, stomach) while the remaining were metastases. c-MET expression was scored as strongly positive in 3 of 43 (H-score >50), weakly positive in 6 of 43 (H-score: 10-50), and negative in 34 of 43 (H-score <10) tumors. All 3 tumors with strong positive c-MET expression were from patients with a distinctly aggressive clinical course. The 6 tumors with weakly positive c-MET expression were from patients with stable disease, including 4 with distant metastases. Of the 13 patients with all tumors negative for c-MET expression, all but 1 had stable disease. Age at initial NET diagnosis; tumor site, type or grade; number of sites of distant metastases; total number of surgeries for NETs; or the stability of overall tumor burden did not predict c-MET expression.</p><p><strong>Conclusion: </strong>Our findings suggest a role for c-MET inhibition in personalizing therapy for patients with MEN1-related NETs.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 10","pages":"bvaf147"},"PeriodicalIF":3.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186180","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}

{"title":"Dietary Habits and Osteoporotic Fracture Risk: Retrospective Cohort Study Using Large-Scale Claims Data.","authors":"Hiroki Nakajima, Yuichi Nishioka, Yuko Tamaki, Fumika Kamitani, Yukako Kurematsu, Sadanori Okada, Tomoya Myojin, Tatsuya Noda, Tomoaki Imamura, Yutaka Takahashi","doi":"10.1210/jendso/bvaf127","DOIUrl":"10.1210/jendso/bvaf127","url":null,"abstract":"<p><strong>Context: </strong>Lifestyle habits, such as exercise, alcohol consumption, and smoking, are known to be closely associated with the risk of osteoporotic fracture. However, little is known regarding the association between osteoporotic fracture and dietary habits such as skipping breakfast and having a late dinner.</p><p><strong>Objective: </strong>This study aimed to examine the association between lifestyle habits, including diet, and the risk of osteoporotic fracture.</p><p><strong>Methods: </strong>Individuals aged 20 years or older were enrolled using the results of lifestyle questionnaires in health checkup data and the DeSC database, a Japanese claims database. Outcome was defined as the diagnosis of osteoporotic fracture (hip, distal forearm, vertebral, and humeral fractures). A Cox proportional-hazards model was used to calculate the association between osteoporotic fracture risk and lifestyle, adjusting for conventional risk factors. In the lifestyle questionnaires, those who answered \"yes\" to each question were compared to those who answered \"no.\"</p><p><strong>Results: </strong>Altogether, 927 130 participants were included, with a median follow-up duration of 2.6 years. The adjusted hazard ratios (95% CI) for lifestyle factors of smoking, daily alcohol consumption, exercise habits, fast gait speed, enough sleep, skipping breakfast, and late dinner were 1.11 (1.06-1.17), 0.91 (0.88-0.95), 0.99 (0.97-1.02), 0.84 (0.82-0.86), 0.95 (0.93-0.98), 1.18 (1.12-1.23), and 1.08 (1.04-1.12), respectively.</p><p><strong>Conclusion: </strong>Our study is the first to demonstrate that skipping breakfast and having a late dinner are independently associated with a higher risk of osteoporotic fracture, using a large health checkup cohort.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf127"},"PeriodicalIF":3.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958926","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}

{"title":"Dehydroepiandrosterone Sulfate in Diagnosing Mild Autonomous Cortisol Secretion and Adrenal Insufficiency.","authors":"Jasmine Saini, Bahaa Salama, Kai Yu, Shireen R Chacko, Ashley J Han, Camila Villavicencio Torres, Mohammad Hassan Murad, Irina Bancos","doi":"10.1210/jendso/bvaf136","DOIUrl":"10.1210/jendso/bvaf136","url":null,"abstract":"<p><strong>Context: </strong>Data on diagnostic accuracy of dehydroepiandrosterone sulfate (DHEA-S) for mild autonomous cortisol secretion (MACS) and adrenal insufficiency (AI) are discrepant.</p><p><strong>Objective: </strong>We conducted a systematic review and meta-analysis of published studies assessing the accuracy of DHEA-S in diagnosing MACS or AI.</p><p><strong>Methods: </strong>From inception to January 8, 2024, we searched databases for original studies of at least 20 participants with MACS or AI. MACS was defined as postdexamethasone cortisol greater than 1.8 mcg/dL or postsurgical hypocortisolism. AI was defined by abnormal dynamic testing. QUADAS-2 was used to assess the risk of bias. Bivariate random effects meta-analysis was used to generate pooled diagnostic accuracy estimates.</p><p><strong>Results: </strong>Seven studies on DHEA-S accuracy in diagnosing MACS (574 patients with MACS, 830 referent individuals), and 2 studies on DHEA-S accuracy in diagnosing AI (52 patients with AI, 59 referent individuals) were included. A meta-analysis of studies using DHEA-S cutoff between 60 and 70 mcg/dL to diagnose MACS demonstrated a sensitivity of 82% (95% CI, 64%-93%) and a specificity of 82% (95% CI, 74%-88%). In the 2 studies evaluating DHEA-S in diagnosing AI, the reference standard was a 1-mcg cosyntropin stimulation test. The sensitivity of DHEA-S for diagnosing AI ranged from 70.3% to 86.7%, and the specificity was 87.1%. Most studies were at a moderate risk of bias.</p><p><strong>Conclusion: </strong>Based on limited heterogeneous evidence, measurement of DHEA-S provides additional value in diagnosing MACS, as well as AI.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf136"},"PeriodicalIF":3.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000875","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}

{"title":"Independent Effects of Vitamin D on Leukocyte Telomere Length and Activity: An RCT in Asian Indian Women With Prediabetes.","authors":"Surya Prakash Bhatt, Shivam Pandey, Anoop Misra","doi":"10.1210/jendso/bvaf124","DOIUrl":"10.1210/jendso/bvaf124","url":null,"abstract":"<p><strong>Introduction: </strong>Prediabetes is increasing in India and progresses rapidly to type 2 diabetes. The impact of vitamin D3 supplementation on telomerase activity and leukocyte telomere length (LTL) among people with prediabetes has been poorly researched.</p><p><strong>Research design and methods: </strong>In this 18-month prospective trial, we enrolled 121 women with prediabetes and randomized them into intervention (vitamin D3 supplementation, n = 61) and placebo (n = 60) groups. LTL and telomerase activity were measured.</p><p><strong>Results: </strong>In the current study, LTL and telomerase activity were assessed at visit 1 (week 0), visit 2 (week 52), and visit 3 (week 78). LTL increased significantly in the intervention group by week 52 (<i>P</i> = .004) and became more pronounced at week 78 (<i>P</i> = .001), representing a 14.5% increase from baseline. Similarly, telomerase activity showed progressive enhancement with vitamin D treatment, achieving significance by week 52 (<i>P</i> = .001) and continuing through week 78 (<i>P</i> < .0001), reflecting a 16.2% increase from baseline. Within-group analysis confirmed significant improvements over time in the vitamin D group (<i>P</i> = .002) but not in placebo (<i>P</i> = .18) group. After adjusting for potential confounders including body mass index, subscapular skinfold thickness, fasting blood glucose, and PTH, serum 25-hydroxyvitamin D levels maintained a significant independent association with both LTL (OR = 2.053; 95% CI, 1.410-2.243; <i>P</i> = .001) and telomerase activity (OR = 2.032; 95% CI, 1.410-2.254; <i>P</i> = .001) in the intervention group.</p><p><strong>Conclusion: </strong>Vitamin D supplementation, over 78 weeks, is independently associated with increased LTL and telomerase activity in Asian Indian women with prediabetes.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf124"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958912","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}

{"title":"Epigenetic Changes Associated With Obesity-related Metabolic Comorbidities.","authors":"Ionel Sandovici, Tiago Morais, Miguel Constância, Mariana P Monteiro","doi":"10.1210/jendso/bvaf129","DOIUrl":"10.1210/jendso/bvaf129","url":null,"abstract":"<p><p>Obesity arises from a complex interaction of genetic, hormonal, dietary, and behavioral factors that drive chronic energy imbalance, excessive fat accumulation, systemic inflammation, and insulin resistance, thus increasing the risk of metabolic diseases. Recent evidence suggests a significant role for epigenetic mechanisms, such as changes in patterns of DNA methylation, histone modifications, and chromatin accessibility, in the aetiology, progression, and intergenerational transmission of obesity risk. In this review, we first explore the link between cellular metabolism and epigenetics in the context of an obesogenic environment and highlight the mechanisms leading to cell-type and sex-specific epigenetic changes. We then highlight recent human studies that uncovered epigenetic alterations in key metabolic organs that distinguish metabolically healthy obesity from obesity complicated with insulin resistance, metabolic syndrome, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease. Mechanistic studies performed in the mouse support an important role for epigenetic mechanisms in driving the metabolic comorbidities of obesity. Given the difficulty of accessing tissues directly implicated in metabolic homeostasis, peripheral blood epigenetic biomarkers offer insights into the pathogenesis of these metabolic comorbidities of obesity and may predict their future development. The dynamic and reversible nature of obesity-associated epigenetic changes underscores their therapeutic potential. Future research should address challenges such as tissue specificity, interactions with genetic variants, and the functional impact of epigenetic alterations. Expanding studies on intergenerational inheritance, RNA modifications, and the development of epigenetic therapies hold promise for mitigating the impact of obesity-related metabolic comorbidities and informing precision interventions in clinical practice.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf129"},"PeriodicalIF":3.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958978","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}

{"title":"Usefulness of Preradioactive Iodine Scans in Thyroid Cancer.","authors":"Gayatri Jaiswal, Michael Grimes, Patricia Bononi, Nishit Vaghasia, Saira Khan, Kersthine Andre, Ashni Dharia, Jamil Alkhaddo","doi":"10.1210/jendso/bvaf128","DOIUrl":"10.1210/jendso/bvaf128","url":null,"abstract":"<p><strong>Context: </strong>There is an evolving role for radioactive iodine (RAI) in thyroid cancer treatment. Radioactive iodine treatment usually involves a pre-RAI whole-body iodine scan and a posttherapy scan. The clinical utility of pre-RAI therapy scans has been increasingly questioned.</p><p><strong>Aim: </strong>To evaluate the clinical utility of pre-RAI whole-body iodine scans.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of differentiated thyroid cancer patients treated with RAI. Using records blinded for pre-RAI scans, 3 endocrinologists developed empiric RAI treatment plans for each patient based on surgical pathology. This was repeated using the unblinded records, and the treatment plans made with and without pre-RAI scan results were compared.</p><p><strong>Results: </strong>A total of 164 patients met the inclusion criteria: 89 patients (54.3%) were low risk, 61 (37.2%) intermediate risk, and 14 (8.5%) high risk for thyroid cancer recurrence. After blinded review, RAI treatment was recommended for 122 patients (74.3%); 46 were determined to be appropriate for a low-dose RAI, 75 a medium dose, and 1 a high dose. When unblinded, different recommendations were made for only 7 patients (5.7%), with 6 being recommended for a higher RAI dose. In addition, the prescan RAI results prompted recommendations for additional testing, such as neck ultrasounds or computed tomography or postoperative thyroglobulin levels. Pre-RAI scans affected patient care plans in only 7 (5.7%) of the 164 patients in the study.</p><p><strong>Conclusion: </strong>In most patients with thyroid cancer who may need RAI, pre-RAI scans may not affect management, and empiric RAI doses may be a more cost-effective and convenient option.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf128"},"PeriodicalIF":3.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958773","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}

{"title":"Identifying Geographic Cold Spots of PCOS Diagnosis in Texas: A Spatial Analysis of Underdiagnosis and Rural Disparities.","authors":"Ryan Ramphul, Geethika Yalavarthy, Jooyeon Lee","doi":"10.1210/jendso/bvaf123","DOIUrl":"10.1210/jendso/bvaf123","url":null,"abstract":"<p><strong>Context: </strong>Polycystic ovary syndrome (PCOS) is a common yet underdiagnosed endocrine disorder with substantial reproductive and metabolic consequences. Although disparities in PCOS care have been documented, few studies have employed spatial methods to identify areas of potential underdiagnosis.</p><p><strong>Objective: </strong>This study uses geospatial analysis to detect cold spots of PCOS clinical encounters across Texas and investigates neighborhood characteristics associated with these areas.</p><p><strong>Methods: </strong>We analyzed inpatient and outpatient encounter data from the Texas Public Use Data File (PUDF) between 2018 and 2024 to identify PCOS-related visits (International Classification of Diseases, revision 10: E28.2). ZIP code tabulation area (ZCTA)-level PCOS encounter prevalence was calculated per 1000 females and stabilized using empirical Bayes smoothing to account for rate instability. The Anselin local Moran's I statistic was used to detect spatial clusters. ZCTAs with statistically significant low-prevalence clusters (cold spots) were identified. Logistic regression assessed associations between cold spot status and neighborhood-level variables, including rural-urban commuting area codes, socioeconomic indicators, and health-related factors.</p><p><strong>Results: </strong>Cold spots were concentrated in rural and periurban areas, suggesting potential underdiagnosis in communities with limited health-care access. This highlights the need for targeted public health interventions, including expanded provider training and diagnostic outreach in rural settings.</p><p><strong>Conclusion: </strong>Significant spatial disparities in PCOS diagnosis suggest differential health-care access, diagnostic practices, or population health behaviors across the state. Targeted health interventions in rural communities may improve PCOS recognition and care. Further research is needed to explore the role of infrastructure and provider practices in causing these geographic disparities.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf123"},"PeriodicalIF":3.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958948","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}

{"title":"Pregnancy and Lactation Associated Bone Fragility.","authors":"Christopher S Kovacs","doi":"10.1210/jendso/bvaf126","DOIUrl":"10.1210/jendso/bvaf126","url":null,"abstract":"<p><p>The skeleton is a storehouse of mineral that can be borrowed from in times of need, such as for reproduction. Skeletal resorption is normally modest during pregnancy but can be excessive when dietary calcium intake or absorption are insufficient for maternal and fetal needs. In contrast, substantial skeletal resorption is hormonally programmed to occur during lactation, with a loss of 5% to 10% of bone density from the spine over the first 6 months, independent of dietary calcium intake. The maternal skeleton is the main source of calcium in milk. Normally bone resorption during reproduction is without clinical consequences because the skeleton is restored to its prior mineral content and strength after weaning, such that parity and lactation are not risk factors for osteoporosis. However, bone strength is transiently reduced particularly during lactation, and can rarely lead to fragility fractures, especially if the skeleton was not normal before pregnancy. Women can present with fragility fractures during pregnancy but more often during lactation, sometimes with a frightening cascade of 5 to 10 vertebral compression fractures. This mini-review covers the epidemiology, pathophysiology, diagnostic approaches, and treatment considerations for this condition. Pharmacotherapy is often given in a desperate effort to do something, using agents that are not indicated in premenopausal women. The skeleton appears to recover, even in women who have fractured, such that it remains uncertain as to whether pharmacotherapy is necessary. Randomized trials are needed to determine when and in whom pharmacotherapy is needed, and which agent(s) might be preferable.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf126"},"PeriodicalIF":3.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958412","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}