From osteoporosis to hypophosphataemic maladies, CEU attendees will become very well versed in endocrine disorders of the bone and skeleton. A few of the speakers gave a glimpse into what their sessions will offer in discussing how to care for patients with common as well as rare bone and mineral conditions.

Each year, hundreds of clinicians register to attend the Endocrine Society’s Clinical Endocrinology Update (CEU) to learn about recent advances in the field of endocrinology. For clinicians with interests in bone health and the treatment of bone disease, the 2018 CEU/Endocrine Board Review is a can’t-miss opportunity to learn from the most trusted leaders in the specialty. The program encompasses a wide range of sessions that will focus on some of the most pressing concerns for treating today’s common, and rare, bone disorders.

Endocrine News asked several of the invited speakers to share some of the highlights that attendees of the CEU can anticipate.

The Year in Osteoporosis: What the Clinician Needs to Know

Clinicians who provide care to patients with osteoporosis or who have concerns about the disease will gain major benefits from attending the session, “The Year in Osteoporosis: What the Clinician Needs to Know,” to be moderated by two renowned experts in the field.

“I’ll be discussing the concept of treat-to-target with a review of strategies to monitor osteoporosis treatment,” says E.  Michael Lewiecki, MD, director of the New Mexico Clinical Research & Osteoporosis Center. “This will cover assessment of treatment response, achieving an acceptable level of fracture risk, and defining good response and poor response.”

Lewiecki will be joined by Carolyn Becker, MD, associate professor at Harvard Medical School and clinician in the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women’s Hospital. Becker says clinicians need to know some of the nuances of interpreting the Fracture Risk Assessment (FRAX) and dual X-ray absorptiometry (DXA) results, particularly in certain patient populations.

“They also need to think about fracture risk reduction from two perspectives: reducing falls and improving bone strength,” Becker adds. “Finally, they need to know how to approach long-term osteoporosis management, including ‘drug holidays’ and appropriate drug sequences or combinations.”

Attendees of the session will also hear the experts’ views on the future for treating the condition. Both agree that there are challenges.

“I’ll be discussing the concept of treat-to-target with a review of strategies to monitor osteoporosis treatment. This will cover assessment of treatment response, achieving an acceptable level of fracture risk, and defining good response and poor response.” – E.  Michael Lewiecki, MD, director, New Mexico Clinical Research & Osteoporosis Center, Albuquerque

“The future of osteoporosis therapy is bright if we can make osteoporosis screening more available, expand the reach of FLS for secondary fracture prevention, and do better at educating healthcare professionals with strategies such as a Bone Health TeleECHO,” Lewiecki says. He is the Director of the Bone Health TeleECHO (Extension for Community Healthcare Outcomes) Clinic, an ongoing interactive learning with teleconferencing discussions of real but de-identified patient cases.

Osteoporosis: Answers to Patient’s Questions

 The main point attendees of my session will walk away with is a bigger understanding of how to address patients’ biggest concerns about treating osteoporosis, whether it is about non-traditional approaches (supplements), or it is side effects of medications, says Ann Kearns, MD, PhD, associate professor in the Mayo Clinic’s Division of Endocrinology, Diabetes, Metabolism, Nutrition. Kearns will tackle the topic “Osteoporosis: Answers to Patient’s Questions.”

“The two most frequent questions I hear from patients are: ‘I heard that medication is dangerous (referring to bisphosphonates),’ and ‘I prefer to take a natural approach,’ usually meaning diet, supplements, and exercise,” Kearns explains.

In addition to presenting her audience with the latest information to answer these patient questions, and more, Kearns is also excited to highlight some of the initiatives to address osteoporosis after a fracture — secondary fracture prevention. Just as with treatment of other chronic diseases/conditions, osteoporosis treatments have a low level of adherence and that limits fracture risk reduction, she adds.

Update on the Management of Renal Bone Disease

Chronic kidney disease (CKD) is very common in the U.S., with an estimated prevalence of 14% — representing more than 26 million people, according to CEU presenter Robert Wermers, MD, Mayo Clinic professor and vice chair of Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine.

“CKD mineral-bone disorder (MBD) refers to a complex spectrum of abnormalities in mineralization of bone (M), bone turnover (T), and bone volume (V) that is commonly present in CKD stages 3–5,” Wermers explains. “Over 660,000 individuals in the U.S. have end-stage renal disease, and of these, 71% are on dialysis and 29% have had a kidney transplant. Those with end-stage have the most complex forms of CKD MBD.”

At his lecture “Update on the Management of Renal Bone Disease,” Wermers plans to evaluate the complexity of bone and mineral disease in CKD including turnover, mineralization, and volume concerns.

“We will especially focus on the complexities in stages 4–5 CKD where more severe forms of CKD MBD are seen,” he adds. “I hope that we can develop some reasonable clinical approaches to these patients in regard to treatment, realizing the paucity of data in this area.”

“The two most frequent questions I hear from patients are: ‘I heard that medication is dangerous (referring to bisphosphonates),’ and ‘I prefer to take a natural approach,’ usually meaning diet, supplements, and exercise.” – Ann Kearns, MD, PhD, associate professor, Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, Minn.

Wermers’ session will also review the new “The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).”  The guidelines are a major update in the field since the last ones were published in 2009, Wermers says.

Hypophosphatemic Disorders and their Management

In her scheduled session on “Hypophosphatemic Disorders and their Management,” Suzanne Jan de Beur, MD, will offer attendees a substantive look into the rare inherited bone disorder hypophosphatemia. Jan de Beur is an associate professor of medicine at The Johns Hopkins University School of Medicine and the director of endocrinology at Johns Hopkins Bayview Medical Center.

She plans to help clinicians become familiar with the physiological control of phosphate homeostasis and the central role of FGF23.

“I also want them to understand the differential diagnosis of hypophosphatemic disorders,” she adds.

The most common form of inherited hypophosphatemia is X-linked hypophosphatemia and its incidence is 1/20,000 live births in the U.S., according to Jan de Beur. The other inherited forms such as autosomal dominant hypophosphatemia rickets (ADHR), autosomal recessive hypophosphatemia rickets (ARHR), and hereditary hypophosphatemic rickets with hypercalcuria (HHRH) are much more rare.

—Fauntleroy Shaw is a freelance editor/writer based in Carmel, Ind. She is a regular contributor to Endocrine News.