bluuebunny/crossref_metadata_2025_split huggingface dataset:
8620 Prevalence of Osteopenia of Prematurity and Risk Factors in Neonatal of Maternity Hospital
Authors: Lopes Bastos Dyrlanne Marcia , da Cunha Joao Gabriel Freire , da Cunha Ana Clara Freire 
Published: October 2024

Abstract
Disclosure: D.M. Bastos: None. J.G. Bastos: None. A.C. Bastos: None.
Introduction: The osteometabolic disease of prematurity (ODP), formerly known as osteopenia of prematurity, corresponds to a disorder of bone mineralization in the neonatal period in very low birth weight premature newborns. The estimated prevalence is about 30% when the birth weight is less than 1,500 grams and around 60% when it is less than 1,000 grams. There is no specific clinical picture, and it can present with mild manifestations, growth deficit, or even evolve with severe rickets and fractures. To qualify the care of premature newborns (NB) in our Service, we question what is the local prevalence of ODP and what are the clinical, biochemical, or imaging risk factors that are potentially related to a greater predisposition to this condition. Objective: Evaluate the prevalence of ODP and recognize potential risk factors in NBs in a neonatal ICU of a reference maternity hospital in Curitiba/ PR. Method: Retrospective longitudinal study, with analysis of medical records of patients born with a gestational age less than 34 weeks and birth weight less than 1,500 grams, born between January/2013 to August/2016. Discussion: Prematurity is the significant factor, followed by low birth weight, for osteopenia. Newborns (NB) with a birth weight below 1500g should receive 40mg/Kg of calcium and 50 mg/Kg of phosphorus. Supplementation of human milk should be started from 15 days of life or when oral intake reaches 100ml/Kg per day (1g/20 ml of milk). In this study, the classification of the growth curve and prevalence by sex were divergent with the literature. The most vulnerable are those with parenteral nutrition or prolonged fasting, as the adequate diet is the basis of prevention and treatment, similar data being found, as well as association with prolonged use of diuretic, presence of sepsis diagnosis and bronchopulmonary dysplasia. However, there is still a lack of specific and sensitive markers for early diagnosis and treatment. Conclusion: The prevalence of Osteopenia of Prematurity was lower than that found in the literature. The risk factors bronchopulmonary dysplasia and use of diuretics were statistically significant when evaluated in patients with osteopenia. However, no relationship was found between ODP and sepsis, as well as a relationship between ODP and Necrotizing Enterocolitis. Regarding the days kept fasting, use of TPN and Use of antibiotics, a longer duration of use was obtained when compared with the group that did not develop the disease.
Presentation: 6/3/2024
7388 Rare Case of Mediastinal Parathyroid Carcinoma
Authors: Esaki Yumiko , Moalem Jacob , Israel Anna-Karoline , Shafiq Ismat 
Published: October 2024

Abstract
Disclosure: Y. Esaki: None. J. Moalem: None. A. Israel: None. I. Shafiq: None.
Introduction: Parathyroid carcinoma accounts for 1% of primary hyperparathyroidism with an estimated prevalence of 0.005% of all cancers. Ectopic locations of parathyroid tumors have been found in 6-16% of cases, most commonly in the thyroid, the thymus, or behind the esophagus. Parathyroid carcinoma is rarely found in the mediastinum and only 30 cases have been reported in the literature. Clinical Case: A 68-year-old male without significant past medical history was evaluated by his primary care physician for constipation, polyuria and 20 lb weight loss over the past year. He presented to the hospital after blood work revealed serum calcium of 13.5 mg/dl (8.6-10.2 mg/dl). Initial hospital workup demonstrated serum calcium 12.9 mg/dl, phosphorus 2.6 mg/dl (2.7-4.5 mg/dl), 25-OH vitamin D 21 ng/ml (30-60 ng/ml), 1,25-(OH)2 vitamin D 143.0 pg/ml (19.9-79.3 pg/ml), PTH-related protein &lt; 2.0 pmol/L (0.0-2.3 pmol/L) and PTH 1,250.0 pg/ml (15.0-65.0 pg/ml). CT scan revealed a 3.5 cm x 2.6 cm heterogeneous right paratracheal soft tissue mass with areas of calcifications with mass effect on SVC. Thyroid ultrasound showed multinodular thyroid tissues with a left 1.1 cm heterogeneous solid nodule along the mid posterior aspect as well as a 0.5 cm hypoechoic lesion inferior to the left lobe. Sestamibi scan demonstrated a large area of increased uptake corresponding to the mass seen in the superior mediastinum on CT imaging. He underwent neck exploration and left hemithyroidectomy as well as median sternotomy with resection of the paratracheal mass. Intraoperative PTH decreased from the baseline of 1,177.0 pg/ml to 65.6pg/ml following the removal of the paratracheal mass. The final pathology of right anterior mediastinal mass was consistent with a 5 cm parathyroid carcinoma with angioinvasion, intermediate lymphatic invasion, invasion into adjacent structures, and Ki67 proliferative index focally &gt; 5%. His post-operative course was complicated by hypocalcemia, which improved with treatment with calcitriol and calcium supplementation. He declined the genetic testing. His calcium and parathyroid hormone have remained in the normal range after 1 year. Conclusion: This case illustrates a rare case of parathyroid carcinoma found in the mediastinum. It is important to recognize that parathyroid carcinoma can present in ectopic locations including the mediastinum, as this can affect the preoperative investigation and management. Fine needle biopsy (FNA) prior to the initial operation is not recommended as it is difficult to differentiate the parathyroid carcinoma from benign disease based on FNA, and it may cause tumor rupture and seeding. Also, in the mediastinal parathyroid carcinoma, localization of the lesions including the size and invasiveness is critical in order to allow for radical surgery.
Presentation: 6/3/2024
7987 Ravenous Bone
Authors: Oo Yadana , Srisawitri Liana , Patel Purva , Zaw Thein Min 
Published: October 2024

Abstract
Disclosure: Y. Oo: None. L. Srisawitri: None. P. Patel: None. M. Thein: None.
Introduction Hungry bone syndrome ( HBS ) is the rapid drop in serum total calcium concentration of less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy. It is more frequent in hemodialysis patients with secondary hyperparathyroidism (SHPT). The severe hypocalcemia after the parathyroidectomy is believed to be due to the increased usage of calcium by the starving bones. The key management is to replenish the severe calcium deficit aggressively. Clinical Case A 44-year-old Hispanic male patient with ESRD on hemodialysis was admitted for elective parathyroidectomy for SHPT from ESRD. The hospital course was complicated with profound hypocalcemia after the surgery. The pertinent lab results before surgery were total calcium level of 7.2 mg/dl ( normal 8.4 - 10.2 ), ionized calcium level of 4.9 ( normal 4.48 - 4.92 ), and PTH level of 2184 pg/ml (normal 15 - 65). After the parathyroidectomy, the ionized calcium level became 3.4 mg/dl and the PTH level trended down to 56 pg/ml. On the post-op day ( POD ) 1, the patient was started on calcitriol 1 mcg BID and calcium carbonate 600 mg QID and also got the hemodialysis with a high calcium bath. Even with the replacement, the calcium level kept worsening and calcium gluconate infusion was started on POD 4. On POD 5, calcium gluconate infusion was on hold as the ionized calcium was improved. On POD 7, calcitriol was increased to 2 mcg BID as ionized calcium was 3.2 mg/dl and restarted on calcium gluconate infusion. On POD 8, ionized calcium was 3.5 mg/dl, and calcium gluconate infusion was titrated down. On POD 9, as the total calcium level was 8.8 mg/dl, the calcium gluconate infusion was discontinued and he was discharged with calcium carbonate 1200 mg TID and calcitriol 2 mcg TID. Unfortunately, 13 days from the discharge date, he was readmitted with the volume overload, and on this second admission, the total calcium was 7 mg/dl and ionized calcium was 3.2 mg/dl. The calcitriol dose was increased to 2 mcg TID and the same dose of calcium carbonate which was 1200 mg TID. He got hemodialysis with a high calcium bath. After being treated for the volume overload, he was discharged with calcitriol 2 mcg TID and calcium carbonate 1200 mg TID and followed up with the endocrinology team in 2 weeks. Conclusion Even with the aggressive and constant replacement of calcium, the HBS cases are challenging in terms of achieving and maintaining a normal calcium level after surgery. We, the clinicians, need a better understanding of how to avoid the development of HBS or at least minimize the severity of hypocalcemia in the postoperative course and the ultimate management regimen to maintain the normal calcium level in both inpatient and outpatient settings.
Presentation: 6/1/2024
9397 Shatter Proofing Bones: Revamping Osteoporosis Screening
Authors: Subramani Rashmi , Gupta Tanya , Anwar Maheen , Pamula John 
Published: October 2024

Abstract
Disclosure: R. Subramani: None. T. Gupta: None. M. Anwar: None. J. Pamula: None.
Background: Osteoporosis is a common disease characterized by low bone mass, structural deterioration of bone tissue, and increased risk of fractures. The World Health Organization (WHO) has defined osteoporosis based on bone density measurements. According to their definition, osteoporosis is diagnosed when the bone density at the hip or spine is at least 2.5 standard deviations (SDs) below the mean bone density of a reference population of young, healthy women (T score ≤ -2.5). According to NHANES data from 2017-2018, the overall prevalence of osteoporosis among adults over 50 was found to be 12.6%. It was observed that the prevalence of osteoporosis was higher among women (19.6%) compared to men (4.4%). According to US Preventative Services Task Force (USPSTF), the guidelines for screening are as follows: BMD Testing (DEXA) for all women aged 65 and older, postmenopausal women younger than 65 with clinical risk factors for fracture including advancing age, previous fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, secondary osteoporosis. BMD Testing for Men is not recommended. The most used bone measurement test to screen for osteoporosis is central DXA which measures BMD at the hip and lumbar spine. Goal: To improve the osteoporosis screening using DXA scan in the outpatient internal medicine resident patient panel by 5% Study Design:Subjects were identified by an EPIC report and will include retrospective chart review of records from July 2022 and prospective screening until April 2024 for the outpatient IM clinic list of patients including both resident panel. Methods: Pre-intervention data analysis of current rates; Educating residents about appropriate screening; Utilization of osteoporosis screening as care-gap in EPIC ;Calling patients who are due for screening from IM residents patient panels; Post-interventional data analysis Results: The total number of patients on the residents panel was 196. Before interventions, screening rate for osteoporosis were 71.2% among residents' patients. After intervention, screening rates increased to 75.5%. There was a 4.3 % improvement in screening rate. Conclusion: Resident education, addressing Osteoporosis care gaps in EPIC and patient outreach are effective interventions to improve screening rates. Discussion: Osteoporosis screening remains an area of needed improvement in IM clinic. EPIC system should not only take age for prompting osteoporosis screening but also other factors such as family history, pre-mature fractures, steroid use, etc. Adding osteoporosis screening into the metric system are few steps to be considered for future directions.
Presentation: 6/3/2024
5043 Skeletal Microstructure in Men with Celiac Disease
Authors: Rubenstein Ayelet , Kondapalli Ananya , Agarwal Sanchita , Bucovsky Mariana , Colon Ivelisse , Kil Nayoung , Lewis Suzanne , Lebwohl Benjamin , Green Peter , Walker Marcella 
Published: October 2024

Abstract
Disclosure: A. Rubenstein: None. A. Kondapalli: None. S. Agarwal: None. M. Bucovsky: None. I. Colon: None. N. Kil: None. S. Lewis: None. B. Lebwohl: None. P. Green: None. M. Walker: Advisory Board Member; Self; Alexion Pharmaceuticals, Inc..
The pathophysiology of osteoporosis related to celiac disease (CD) remains incompletely understood. High resolution peripheral quantitative computed tomography (HRpQCT) has revealed microarchitectural deficits in women with CD, but no data exist in men. We prospectively studied bone health using DXA and HRpQCT in 17 men with duodenal biopsy-confirmed CD (mean age 43±16 years; 82% white, 6% Asian, 12% other) and 5 male controls (mean age 40±12 years; 80% white, 20% Asian). Compared to controls, men with CD had lower self-rated health scores (p&lt;0.05), but age, BMI, alcohol use, physical activity, acid blocker use, and vitamin D intake did not differ. Among patients with CD, 23.5% had other autoimmune diseases (type 1 diabetes, hypothyroidism, vitiligo, systemic sclerosis). At CD diagnosis, mean age was 34.3 ± 14.8. CD patients had a mean CD and gluten-free diet duration of 8 years. 29% of patients (n=5/17) were enrolled within 13 months of CD diagnosis. Mean tissue transglutaminase IgA, serum calcium, PTH, Vitamin D, and alkaline phosphatase were normal, but vitamin D levels were &lt; 30 ng/mL in 36% (n=5/14) and PTH was elevated in 11% (n=1/9). T- (-0.5±1.5 vs. 0.8±0.8, p=0.03) and Z-scores (-0.1±1.4 vs. 1.1±0.9, p=0.05) by DXA were normal at all sites but tended to be lower at the 1/3-radius only in CD compared to controls. By HRpQCT, there were no differences. Compared to a larger control group including HRpQCT data from an additional 14 normative database controls (n=19), CD had lower radial cortical (-4.7%, p=0.02) and tibial trabecular (-13.3%, p=0.04) vBMD and a trend toward lower cortical volumetric BMD (vBMD; -3.5%, p=0.06) at the tibia. Within the CD group, longer CD duration was associated with worse tibial cortical vBMD at (r=-0.55, p=0.02). Higher PTH (n=9) correlated with lower lumbar spine areal BMD (r=-0.75, p=0.02), tibial trabecular thickness (Tb.Th; r=-0.77, p=0.02) as well as radial cortical vBMD (r=-0.81, p&lt;0.01), trabecular Tb.Th (r=-0.78, p=0.01), and cortical thickness (r=-0.75, p=0.02). Those with greater dietary vitamin D intake had higher total vBMD (r=0.50, p=0.04) and trabecular thickness at the tibia (r=0.51, p=0.04). Similarly, higher 25-hydroxy vitamin D levels were associated with higher total hip aBMD (r=0.58, p=0.03). In summary, CD in men is associated with lower areal BMD at the 1/3-radius by DXA and lower vBMD at the radius and tibia by HRpQCT. Low vitamin D levels and secondary hyperparathyroidism may contribute. Further work is needed to understand the extent and pathophysiology of skeletal disease in men with CD.
Presentation: 6/3/2024
6683 The Interrelationship of Baseline Vitamin K and Vitamin D Status on Incident Fractures: Results from the VITamin D and OmegA-3 TriaL (VITAL)
Authors: Chou S H , Booth S L , Ratnarajah D , Cook N , Kotler G , Fu X , Buring J , Manson J E , LeBoff M S 
Published: October 2024

Abstract
Disclosure: S.H. Chou: None. S.L. Booth: None. D. Ratnarajah: None. N. Cook: None. G. Kotler: None. X. Fu: None. J. Buring: None. J.E. Manson: None. M.S. LeBoff: None.
Vitamin D and vitamin K have interdependent roles in bone metabolism. We recently reported that, in the VITamin D and OmegA-3 TriaL (VITAL), daily supplemental vitamin D (2000 IU/d) vs. placebo did not reduce fracture risk in 25,871 U.S. men (aged ≥50) and women (aged ≥55).[1] While vitamin D stimulates transcription and translation of osteocalcin (OC) and matrix Gla protein (MGP), vitamin K is needed to carboxylate and activate these proteins. Older adults tend to have low vitamin K intakes, and low vitamin K status may attenuate effects of vitamin D on bone. In this VITAL ancillary study, we tested in a case-cohort sample of 1,162 participants with fractures and an age-sex-matched subcohort size of 2,652, whether baseline low vitamin K status, alone or in combination with lower 25(OH) vitamin D level, predicts incident total, non-vertebral, and hip fractures. The mean (±SD) age of participants was 68.3±7.2 years, 61.5% were female, and 81.7% was Non-Hispanic White. Fractures were reported on annual questionnaires and adjudicated through medical record review. To assess vitamin K function, percent undercarboxylated OC (%ucOC) and dephosphorylated undercarboxylated MGP ([dp]ucMGP) were measured in fasting baseline blood samples, with %ucOC calculated from measures of ucOC and total OC. Higher levels of %ucOC and (dp)ucMGP indicate lower vitamin K status. Serum 25(OH)D was measured by LC-MS/MS and vitamin K biomarkers by sandwich ELISAs (IDS-iSYS Multi-Discipline Automated System). Participants with incident fracture had higher baseline vitamin K status, as assessed by (dp)ucMGP levels, but this was not corroborated by %ucOC. Compared to participants with low baseline vitamin K status and baseline 25(OH) vitamin D levels below the median (30.0 ng/mL), participants with higher baseline vitamin K and D status had a similar incidence of total and non-vertebral fractures. For the 91 hip fracture cases, baseline status of vitamin K and D did not predict hip fracture incidence. In this ancillary study, low vitamin K status by (dp)ucMGP and %ucOC, alone or in combination with baseline 25(OH) vitamin D levels below the median, was not associated with increased fracture incidence. Ongoing analyses are assessing whether phylloquinone levels as another vitamin K biomarker predict incident fracture risk. Furthermore, we have also previously shown that the effects of supplemental vitamin D on total and hip fractures were not modified by baseline vitamin K status in VITAL, the largest randomized controlled trial of supplemental vitamin D vs. placebo on fractures. From our findings in VITAL, higher vitamin K status does not protect against fractures. 1. LeBoff MS, et al. NEJM. 2022.
Presentation: 6/1/2024
12321 The Neurotransmitter Glutamate Promotes The Endocrine Functions Of Bone
Authors: Delgado I Canal , Romeo-Guitart D , Oury F , Karsenty G 
Published: October 2024

Abstract
Disclosure: I. Canal Delgado: None. G. Karsenty: None.
The osteoblast-derived hormone osteocalcin must be decarboxylated to become active. This can be achieved by neurite-derived glutamate, which once in osteoblasts, inhibits the enzyme responsible of osteocalcin carboxylation. Glutamate enters osteoblasts through the EAAT1/Glast transporter, a gene highly expressed in glial cells but whose functions in peripheral organs has not been systematically investigated. To precisely define the functions of glutamate in osteoblasts, we generated mice lacking Glast only in osteoblasts (Glastosb-/-). We first observed that deleting Glast from osteoblasts decreased circulating levels of the uncarboxylated and active form of osteocalcin. Phenotypic analysis showed that Glastosb-/- mice experience a much weaker acute stress response following exposure to a physical stressor, are hyperglycemic and hypoinsulinemic compared to wild-type (WT) littermates. These abnormalities are the ones seen in mice lacking osteocalcin and were corrected by exogenous osteocalcin. We next used this mutant mouse strain as a tool to ask whether any of the symptoms observed in GLAST-deficient patients might be due, in part, to the absence of glutamate signaling in osteoblasts. We focused on cognition because this central function is impaired in GLAST-deficient subjects, and it is regulated by osteocalcin. We observed that Glastosb-/- mice had a severe cognitive impairment. To define more precisely the contribution of bone to the cognitive defect caused by the absence of GLAST, we relied on both pharmacological and genetic experiments. First, we treated WT mice with a Glast inhibitor that does not cross the blood-brain barrier (BBB) and therefore, does not affect any brain structure, or with another Glast inhibitor that crosses the BBB. In the conditions of this experiment, only the Glast inhibitor that does not cross the BBB impaired cognition in WT mice, further suggesting that glutamate signaling regulates behavior in part by regulating the release of active osteocalcin from bone. To strengthen these results, we are currently comparing cognition functions in mutant mice lacking Glast in glial cells or neurons. Together, our observations illustrate the important functions played by of glutamate in osteoblasts and suggest that some behavioral phenotype caused by the absence of GLAST in humans may originate, at least in part, from the disruption of glutamate signaling in the skeleton.
Presentation: 6/2/2024
8775 The Silent Orchestrator: Tumor Induced Osteomalacia as a Rare Culprit Behind Hypophosphatemia
Authors: Montesinos-Cartagena M , Rivera-Rosa J , Perez-Draper C S , Colon-Castellano J 
Published: October 2024

Abstract
Disclosure: M. Montesinos-Cartagena: None. J. Rivera-Rosa: None. C.S. Perez-Draper: None. J. Colon-Castellano: None.
Tumor induced osteomalacia (TIO) is a rare disorder characterized by the abnormal metabolism of phosphate and active vitamin D due to overproduction of fibroblast growth factor 23 (FGF23). FGF23 is a hormone that regulates phosphate homeostasis by reducing both phosphate renal reabsorption and production of active vitamin D. Here, we present the case of a 92-year-old male with past medical history pertinent for prostate adenocarcinoma with metastasis to bone on palliative therapy with leuprorelin, enzalutamide, and zoledronic acid who was admitted due to persistent watery diarrheas. Biochemical parameters showed mild hypocalcemia of 8.1 mg/dL (Normal Range (NR), 9-11), hypophosphatemia of 0.8 mg/dl (NR, 2.5- 4.5), albumin of 3.7 g/dl (NR, 3.5-5.5), alkaline phosphatase of 122 IU/l (NR,40-150), preserved renal function with creatinine of 0.79 mg/dl (NR, 0.7-1.2), elevated intact parathyroid hormone (PTH) of 134 pg/ml (NR, 9-52) and active vitamin D deficiency of 11 ng/ml (NR, 30-100 ng/ml). Urine electrolytes remarkable for hyperphosphaturia of 266.8mmol/L. Due to the decreased levels of active vitamin D in this patient with hypophosphatemia, FGF23 levels were measured and came back elevated on 3457 RU/mL (NR, &lt;180RU/mL). Thus, diagnosis of tumor induced osteomalacia was made. The patient was initiated on calcitriol, calcium carbonate and electrolyte replacement was provided. Treatment with burosumab was considered, however due to multiple comorbidities and advanced cancer stage, goals of care were discussed with the patient and his family who opted for hospice care. Our case shows the importance of considering TIO as a possible underlying cause of hypophosphatemia. Moreover, measurement of FGF23 levels is key for diagnosis of TIO, especially in patients with multiple factors contributing to low serum phosphate levels. Adequate diagnosis is essential to determine prognosis and subsequent treatment.
Presentation: 6/1/2024