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Images in Clinical Medicine
Vertebra Plana with Spontaneous Healing
Figure 1.
- May 10, 2012
- Tsai P.-Y. and Tzeng W.-S.
- N Engl J Med 2012; 366:e30
- Free Full Text
A 3-year-old girl presented with a 3-week history of low back pain. Physical examination revealed mild tenderness over the upper lumbar spine.
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Perspective
Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?
In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the risk of both nonvertebral and vertebral…
- May 9, 2012
- Black D.M., Bauer D.C., Schwartz A.V., Cummings S.R., Rosen C.J.
- 10.1056/NEJMp1202623
- Free Full Text
In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the ...
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Perspective
Bisphosphonates for Osteoporosis — Where Do We Go from Here?
Osteoporosis, a disease characterized by reduced bone mass and increased skeletal fragility, affects 10 million Americans; another 34 million are at risk for it. Bisphosphonates are widely prescribed for osteoporosis; more than 150 million prescriptions were dispensed to outpatients between 2005…
- May 9, 2012
- Whitaker M., Guo J., Kehoe T., Benson G.
- 10.1056/NEJMp1202619
- Free Full Text
Osteoporosis, a disease characterized by reduced bone mass and increased skeletal fragility, affects 10 million Americans; another 34 million are at risk for it. Bisphosphonates are widely prescribed for osteoporosis; more than 150 million prescriptions ...
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Original Article
Enzyme-Replacement Therapy in Life-Threatening Hypophosphatasia
Hypophosphatasia is the inborn error of metabolism that is characterized by low serum alkaline-phosphatase activity from loss-of-function mutations, typically missense, within the gene for the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP). Natural substrates of TNSALP that accumulate…
- March 8, 2012
- Whyte M.P., Greenberg C.R., Salman N.J., et al.
- N Engl J Med 2012; 366:904-913
- Video
In this study of perinatal and infantile hypophosphatasia, patients received ENB-0040, a bone-targeted, recombinant, human tissue-nonspecific isozyme of alkaline phosphatase that is lacking in this disease. Rickets healed, and developmental milestones and pulmonary function improved.
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Images in Clinical Medicine
Hypertrophic Pulmonary Osteoarthropathy and Tripe Palms
Figure 1.
- January 26, 2012
- Saeed H. and Massarweh S.
- N Engl J Med 2012; 366:360
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A 56-year-old female smoker presented with cough, a weight loss of 27 kg, and diffuse bone pain. There was digital clubbing, and the palms had a raised, velvety texture. There was a fixed, tender lump (4 cm in diameter) on the right lower leg and one over the lower lumbar spine.
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Original Article
Bone-Density Testing Interval and Transition to Osteoporosis in Older Women
Current osteoporosis management guidelines– recommend routine bone mineral density (BMD) screening with the use of dual-energy x-ray absorptiometry (DXA) scans for women 65 years of age or older, but no guidelines specify an osteoporosis screening interval that is based on data from longitudinal…
- January 19, 2012
- Gourlay M.L., Fine J.P., Preisser J.S., et al.
- N Engl J Med 2012; 366:225-233
- CME
This study analyzed the transition from normal BMD or osteopenia to osteoporosis; in women 67 years of age or older, the time for 10% to develop osteoporosis was approximately 15 years for normal BMD or mild osteopenia at baseline, 5 years for moderate osteopenia, and 1 year for advanced osteopenia.
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Clinical Practice
Primary Hyperparathyroidism
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 62-year-old…
- December 22, 2011
- Marcocci C. and Cetani F.
- N Engl J Med 2011; 365:2389-2397
- CME
- Full Text Audio
This article reviews the differential diagnosis and management of primary hyperparathyroidism. For most patients, parathyroidectomy (usually by a minimally invasive approach) is recommended, but surveillance is an option for asymptomatic patients who meet certain criteria.
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Images in Clinical Medicine
Metastasis of Renal-Cell Carcinoma
Figure 1.
- November 3, 2011
- Pugliese F. and Pagliuca V.
- N Engl J Med 2011; 365:e38
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Four years after a right nephrectomy for renal-cell carcinoma, an 89-year-old man was referred for evaluation of a pulsating mass on the fourth digit of the right hand. The mass had increased in size during the preceding 3 months after minor trauma to the finger.
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Case Records of the Massachusetts General Hospital
Case 33-2011 — A 56-Year-Old Man with Hypophosphatemia
Presentation of Case. Dr. Eric Hesse (Harvard School of Dental Medicine): A 56-year-old man was seen in the outpatient endocrinology and oral-surgery clinics of this hospital because of recurrent hypophosphatemia. The patient had been well until 19 years earlier, when rib pain developed and a left…
- October 27, 2011
- Bergwitz C., Collins M.T., Kamath R.S., Rosenberg A.E.
- N Engl J Med 2011; 365:1625-1635
- CME
A 56-year-old man presented with recurrent bone pain, stress fractures, and hypophosphatemia. A tumor of the jaw had been resected in the past, with resolution of symptoms. Studies of the jaw revealed no recurrent tumor. Diagnostic tests were performed.
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Correspondence
Atypical Femoral Fractures and Bone Turnover
To the Editor: Epidemiologic studies and case series and reports suggest that there is a relation between the long-term use of bisphosphonates and the development of atypical femoral fractures. Although the cause of such fractures is unknown, the fact that bisphosphonates decrease bone resorption…
- September 29, 2011
- N Engl J Med 2011; 365:1261-1262
- Free Full Text
A bone biopsy performed in a woman treated with bisphosphonates who had bilateral atypical femoral fractures did not reveal decreased bone turnover, suggesting the possibility that fractures associated with bisphosphonate use are not due to oversuppression of bone turnover.
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Images in Clinical Medicine
Radiographic Zebra Lines from Cyclical Pamidronate Therapy
Figure 1.
- July 21, 2011
- Sarraf K.M.
- N Engl J Med 2011; 365:e5
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A 6-year-old boy with type IV osteogenesis imperfecta presented to the ER with pain in the right leg after a fall. Plain radiographs revealed an undisplaced, transverse fracture of the right tibia. The images also revealed the presence of radiographic zebra lines.
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Clinical Practice
Glucocorticoid-Induced Bone Disease
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 55-year-old…
- July 7, 2011
- Weinstein R.S.
- N Engl J Med 2011; 365:62-70
- CME
- Full Text Audio
This article reviews the risks of osteoporosis and osteonecrosis associated with glucocorticoid use, which are present even in the absence of low bone mineral density, and discusses strategies to reduce the risk of fractures and the data to support the strategies.
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Original Article
Bisphosphonate Use and Atypical Fractures of the Femoral Shaft
Bisphosphonates reduce the overall risk of fracture among patients with osteoporosis, with a long-lasting beneficial effect. However, since bisphosphonates reduce bone remodeling, they might "freeze" the skeleton, allowing accumulation of microcracks over time, leading to fatigue fractures (also…
- May 5, 2011
- Schilcher J., Michaëlsson K., Aspenberg P.
- N Engl J Med 2011; 364:1728-1737
- Free Full Text
- CME
Radiographs of Swedish women with atypical subtrochanteric fractures were compared with radiographs of women with ordinary subtrochanteric or shaft fractures. The increase in absolute risk was 5 cases per 10,000 patient-years of bisphosphonate use.
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Clinical Practice
Vertebral Fractures
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 72-year-old…
- April 28, 2011
- Ensrud K.E. and Schousboe J.T.
- N Engl J Med 2011; 364:1634-1642
- CME
- Full Text Audio
This article reviews the implications of documentation of vertebral fracture for subsequent fracture risk and its role as an adjunct to bone-density assessment. Strategies for the management of vertebral fractures are also discussed.
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Images in Clinical Medicine
Myositis Ossificans
Figure 1.
- February 24, 2011
- Martin D.A. and Senanayake S.
- N Engl J Med 2011; 364:758
- Free Full Text
A 40-year-old Korean woman who had been immobilized in bed for several weeks while recovering from tuberculous meningitis reported having pain in the right hip. Her right leg was externally rotated and flexed. She reported discomfort on any passive ...
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Correspondence
Osteochondromas after Total-Body Irradiation
To the Editor: A 9-year-old boy received the diagnosis of acute biphenotypic leukemia. Once remission was induced, treatment proceeded to bone marrow transplantation with donation from the child's HLA-identical sister. The patient received total-body irradiation consisting of four fractions of 300…
- February 17, 2011
- N Engl J Med 2011; 364:687-688
- Free Full Text
To the Editor: A 9-year-old boy received the diagnosis of acute biphenotypic leukemia. Once remission was induced, treatment proceeded to bone marrow transplantation with donation from the child's HLA-identical sister. The patient received total-body ...
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Clinical Practice
Vitamin D Insufficiency
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A healthy 61…
- January 20, 2011
- Rosen C.J.
- N Engl J Med 2011; 364:248-254
- CME
- Full Text Audio
The author reviews data supporting the recommendation to maintain a serum concentration of vitamin D above 20 ng per milliliter and notes the lack of evidence to support a higher target level. He reviews the limitations of data linking vitamin D insufficiency to chronic disease risk.
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Original Article
Teriparatide and Osseous Regeneration in the Oral Cavity
Periodontitis affects more than one in five American adults, is a major cause of tooth loss, and is associated with systemic disorders such as diabetes mellitus, preterm low birth weight, and cardiovascular disease.– Therefore, the development of predictable procedures to regenerate oral bone…
- December 16, 2010
- Bashutski J.D., Eber R.M., Kinney J.S., et al.
- N Engl J Med 2010; 363:2396-2405
- Free Full Text
Patients with chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide or placebo. The primary outcome was radiographic linear resolution of alveolar bone defects. Teriparatide was associated with improved outcomes.
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Clinical Therapeutics
Bisphosphonates for Osteoporosis
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- November 18, 2010
- Favus M.J.
- N Engl J Med 2010; 363:2027-2035
A 67-year-old woman is referred by her primary care physician for treatment of osteoporosis and progressive bone loss. Oral bisphosphonate therapy is recommended. Bisphosphonates suppress bone resorption by interfering with osteoclast activity. Several of these agents have been shown to prevent fractures and increase bone mineral density in patients with osteoporosis. Long-term bisphosphonate therapy has been associated with osteonecrosis of the jaw and atypical femur fractures.
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Sounding Board
Placebo-Controlled Trials in Osteoporosis — Proceeding with Caution
This article presents one viewpoint on the issues surrounding placebo-controlled trials in osteoporosis. The other Sounding Board article in this issue presents an opposing view. In a related interactive feature, the authors of each article give their Point of View about the other article.…
- September 30, 2010
- Rosen C.J. and Khosla S.
- N Engl J Med 2010; 363:1365-1367
- Free Full Text
The authors suggest that placebo-controlled trials in osteoporosis can, with appropriate safeguards, benefit some patients with osteoporosis and can be informative, provided that appropriate guidelines are used to exclude high-risk patients.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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