- N Engl J Med 2022; 387:368-370
An estimated one third or more of U.S. adults 60 years of age or older take vitamin D supplements, not including those who take multivitamins or other compounds containing vitamin D.1 Yet controversy continues about its overall benefits. In this issue of the Journal, LeBoff and...
- N Engl J Med 2022; 387:299-309
A study ancillary to a large trial showed that supplemental vitamin D3 did not lower the risk of fractures among generally healthy midlife and older adults not selected for vitamin D deficiency, low bone mass, or osteoporosis.
- N Engl J Med 2022; 386:2316-2326
A 29-year-old woman presented with recurrent bone fractures and hypophosphatemia. The patient had been well until 19 months before admission, when pain in the right foot developed. During the next 19 months, multiple fractures of the metatarsal bones of the right foot occurred. On admission, the blood phosphorus level was...
- N Engl J Med 2022; 386:1467-1469
This interactive feature about the use of bisphosphonates to treat osteoporosis offers a case vignette accompanied by two essays, one supporting continuation of bisphosphonate therapy beyond 5 years and the other supporting a “drug holiday.”
- N Engl J Med 2022; 386:1443-1451
Cancer-associated hypercalcemia often occurs late in the course of solid-tumor development and is associated with a poor prognosis. Treatment includes intravenous hydration followed by antiresorptive agents, typically intravenous bisphosphonates. Successful management ultimately depends on effective treatment of the underlying cancer.
- N Engl J Med 2022; 386:e22
A 31-year-old man presented with progressive digital clubbing and bony proliferation of his fingers and toes. Evaluation for secondary causes was negative, and primary hypertrophic osteoarthropathy was diagnosed.
- N Engl J Med 2021; 385:1604-1613
A 14-year-old girl presented with progressive swelling of the jaw. Six weeks before this admission, a nonpainful lump in the left lower jaw developed. The mass increased in size, and swelling of the left side of the face and neck developed. A biopsy specimen from the mass showed abundant giant...
- N Engl J Med 2021; 385:1510-1510
A 32-year-old man presented with lower back pain, joint stiffness, and tooth discoloration. Work-up showed osteosclerosis and elevated serum and urinary fluoride levels. Skeletal fluorosis was diagnosed.
- N Engl J Med 2020; 383:1387-1389
This letter describes the treatment of a patient with tumor-induced osteomalacia due to a phosphaturic mesenchymal tumor. The discovery of FN1–FGFR1 fusion genes in such tumors has led to the identification of fibroblast growth factor receptor 1 as a potential therapeutic target. Here, the use of...
- N Engl J Med 2020; 383:743-753
In this study involving women 50 years of age or older who were receiving bisphosphonates, the risk of atypical femur fracture was very low as compared with the number of hip and other fractures that were prevented. Risk of atypical fractures increased with longer duration of bisphosphonate use and rapidly...
- N Engl J Med 2020; 382:2249-2255
A 63-year-old woman presented with several months of pain in both ankles. She had had a fracture of the left tibial plateau 2 years earlier, followed by a fracture of the left medial femoral condyle. She reported no fevers, weight loss, or pain elsewhere.
- N Engl J Med 2020; 382:e15
A 48-year-old man with end-stage renal disease presented with shortness of breath. Computed tomography of the face revealed mandibular hypertrophy and a heterogeneous appearance of the bone, findings consistent with osteitis fibrosa cystica.
- N Engl J Med 2019; 381:581-582
The benefits of vitamin D on myriad health outcomes have been much debated.1,2 Although vitamin D sufficiency is crucial for skeletal health (Table 1), the relation between vitamin D and other health outcomes is less clear.3 One potential vitamin D–related disease of interest has been diabetes...
- N Engl J Med 2019; 381:520-530
Observational studies suggest an association between a low 25-hydroxyvitamin D level and the risk of type 2 diabetes; whether vitamin D supplements reduce the risk is unknown. In this trial in which high-risk persons received either vitamin D3 (4000 IU per day) or placebo, such supplementation did not...
- N Engl J Med 2019; 381:25-35
Vosoritide is a biologic analogue of C-type natriuretic peptide, a stimulator of endochondral ossification, which is disordered in achondroplasia. In this phase 2 dose-finding study and extension study involving children with achondroplasia, once-daily administration of vosoritide resulted in a sustained increase in the annualized growth velocity.
- N Engl J Med 2019; 380:1480-1482
A recent study suggests that irisin, a cytokine secreted by muscle during exercise, effects bone resorption and the differentiation of preadipocytes into thermogenic brown fat cells by displacing tethers between the cell and extracellular matrix molecules.
- N Engl J Med 2019; 380:1150-1157
A 58-year-old woman had congenital absence of vitamin D–binding protein, normocalcemia, mild disruption of bone metabolism, and severe autoimmune disease. A homozygous deletion of the group-specific component (GC) gene that encodes the protein was found, which provided new data about vitamin D metabolism.
- N Engl J Med 2018; 379:2547-2556
Fracture-risk screening is indicated with initiation of glucocorticoids. If the risk is high because of age, bone mineral density, or the fracture risk assessment tool score, pharmacologic treatment is recommended; bisphosphonates are recommended as first-line treatment.
- N Engl J Med 2018; 379:2407-2416
In this randomized trial, women 65 years of age or older who had osteopenia received four infusions of zoledronate or normal saline at 18-month intervals. Zoledronate was associated with a significantly lower risk of fragility fractures than placebo.
- N Engl J Med 2018; 379:2465-2466
Low bone mineral density (i.e., a T score below −2.5) is the current operational definition of osteoporosis. However, low bone mineral density is actually a risk factor for fracture, not a disease marker. Notwithstanding, nearly all osteoporosis treatment algorithms are based on bone mineral density, frequently combined with the clinical...