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News Briefs: August 2008
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Thursday, August 28, 2008 Contacts:
1. HIV Patients at Greater Risk for Bone Fractures HIV-infected patients have a higher prevalence of fractures than non HIV-infected patients, across both genders and critical fracture sites according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM). "Prior studies have indicated reduced bone density in HIV-infected patients, but little was known whether fracture risk increased in this population," said Dr. Steven Grinspoon, M.D., of Massachusetts General Hospital in Boston and lead author of the study. "These data are the first to suggest that there is a clinically significant increase in bone fractures among HIV-infected patients, using data from a large healthcare system." In this study, researchers analyzed data from the Partners HealthCare System, which includes two primary hospitals, Brigham and Women's Hospital and Massachusetts General Hospital. They studied fracture diagnoses from 1996 to 2008 in 8,525 HIV-infected patients and more than 2 million non HIV-infected patients. Dr. Grinspoon and his colleagues found that overall fracture prevalence increased more than 60 percent in HIV-infected patients versus non HIV-infected patients. The data in this study showed HIV-infected patients had a significantly higher prevalence of vertebral, hip, wrist, and combined fractures compare to non HIV-infected patients. Within both sexes, fracture prevalence was higher in HIV-infected patients for the majority of sites assessed, across age categories. Dr. Grinspoon said the study found the relative difference in fracture prevalence between HIV-infected patients and non HIV-infected patients increases with age for both sexes. Therefore, as the HIV-infected population ages, reduced bone mineral density and increased fracture risk may become an even greater problem. "HIV patients with risk for low bone density should be assessed and potentially treated to prevent fractures," said Dr. Grinspoon. "Further research is needed into the mechanisms of bone loss in this population." Other researchers working on the study include Todd Brown of Johns Hopkins University in Baltimore, Md. and Virginia Triant and Hang Lee of Massachusetts General Hospital in Boston. The article "Fracture Prevalence Among HIV-Infected versus Non HIV-Infected Patients in a Large U.S. Healthcare System," will appear in the September issue of JCEM, a publication of The Endocrine Society. 2. Endocrine Society Releases New Clinical Practice Guideline on the Diagnosis and Treatment of Primary Aldosteronism The Endocrine Society has released a new clinical practice guideline for the detection, diagnosis, and treatment of patients with primary aldosteronism. The guidelines appear in the September issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society. Primary aldosteronism (PA) refers to conditions in which production of aldosterone, a steroid hormone produced in the adrenal gland, is inappropriately high. Such inappropriate production of aldosteronism causes cardiovascular damage, hypertension, sodium retention, and potassium excretion that, if prolonged and severe, may lead to significant potassium deficiency. PA is commonly caused by benign tumors of the adrenal gland, over-activity of steroid producing cells in the adrenal cortex, or in rare cases by hereditary conditions or adrenal cancer. "Studies show primary aldosteronism may be more prevalent than previously thought, affecting more than ten percent of hypertensive patients," said Dr. John Funder of Prince Henry's Institute of Medical Research in Clayton, Australia and chair of the task force that developed these guidelines. "The new guideline uses the best available research to help physicians diagnose primary aldosteronism and employ specific treatments that can alleviate the impact of this condition." The guideline recommends that case detection of PA be sought in higher risk groups of hypertensive patients and those with potassium deficiency by determining the ratio of aldosterone to renin, an enzyme that regulates blood pressure. If this ratio is elevated, diagnosis should then be confirmed or excluded by commonly-used confirmatory tests. If PA is confirmed, the guideline recommends that patients undergo adrenal computed tomography (CT) to exclude adrenocorticol carcinoma, followed by radiographic lateralization to determine whether PA is due to unilateral or bilateral oversecretion. Lateralization is important because if only one of the two adrenal glands is responsible for oversecretion PA is best treated by laparoscopic surgery to remove the overproducing adrenal gland. For the bilateral form, medical therapy is the treatment of choice. When medical therapy is needed, the guideline recommends patients be treated with mineralocorticoid receptor antagonists, drugs which inhibit the action of aldosterone. The new guideline was developed by a task force chaired by Dr. Funder. Other members of the task force included Robert M. Carey of the University of Virginia Health System in Charlottesville, Va.; Carlos Fardella of Facultad de Medicina Pontificia Universidad Catolica de Chile in Santiago, Chile; Celso Gomez-Sanchez of Montgomery VA Medical Center in Jackson, Miss.; Franco Mantero of the University of Padova in Padua, Italy; Michael Stowasser of the University of Queensland in Brisbane, Australia; and William Young, Jr. and Victor Montori of the Mayo Clinic in Rochester, Minn. 3. New Patient Fact Sheet Now Available from The Hormone Foundation: Diabetes and Low Blood Sugar (Hypoglycemia) This bilingual fact sheet answers patient questions about what is hypoglycemia, the relationship between hypoglycemia and diabetes, signs and symptoms of hypoglycemia, prevention, and treatment. The fact sheet is available in both English and Spanish. To download free copies of the new fact sheet visit: http://www.hormone.org/Resources/upload/diabetes-and-low-blood-sugar-bilingual-08-25-08.pdf The Hormone Foundation, the public education affiliate of The Endocrine Society, is a leading source of hormone-related health information for the public, physicians, allied health professionals and the media.
# # # Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org. |