United States

ENDO 2022

Management of Hereditary Medullary Thyroid Cancer

**Program**
ENDO’s comprehensive program provides attendees the opportunity to learn about the latest developments in hormone science and medicine from renowned investigators, expert clinicians, and educators from all over the world. 

This year’s education program features:
more than 100 in-person and virtual sessions with another 70+ in-person only sessions;
six plenary sessions including plenaries on Envisioning Future Therapies for Type 1 Diabetes and Addressing Challenges in Fertility and Reproduction;
over 20 Meet the Professor sessions presented both in-person and live-streamed virtually and another 20+ presented live in Atlanta;
four Basic Science Pathways, including Diabetes and Metabolism; Neuroendocrinology; Nuclear Receptors and Signaling; and Reproductive Endocrinology; and
more than 30 oral sessions and a robust virtual poster hall for accepted scientific abstracts.

**What Programming Is Included in My Virtual Meeting Registration?**
As you build your schedule during the conference, you can select the sessions that are tagged with 'Livestreamed', so you can view virtually. These sessions are being livestreamed, so they are available in real time to our virtual audience. In addition, our in-person and livestreamed sessions will be recorded, so you can access them on demand after 72 hours. We will have over 200 hours available on demand for Standard and Premium pass registrants.

Product theaters and the Communications and Career Center will also include hybrid content delivery.

**Plenaries**
Spanning the spectrum of science, clinical care, and social implications, an outstanding slate of world-renowned speakers will showcase the most cutting-edge advances on research and medicine.

**Symposia**
Our ENDO 2022 lineup of sessions offers a unique opportunity to dive into topics from nearly every major therapeutic area of endocrinology and hormone science. Listen, learn, and be inspired by world-class faculty who are at the forefront of scientific discovery and high-quality health care.

**Basic Science Pathways**

These special “meeting-within-a-meeting” tracks integrate focused discussions, poster sessions, and networking opportunities to provide you with the latest research in:
Diabetes and Metabolism
Neuroendocrinology
Nuclear Receptors and Signaling
Reproductive Endocrinology

**Meet the Professor & Meet the Scientist**
Discover insights from experts on treating a variety of endocrine conditions and emerging science in the field of endocrinology, and learn the latest in patient care and scientific research.

ENDO’s comprehensive program provides attendees the opportunity to learn about the latest developments in hormone science and medicine from renowned investigators, expert clinicians, and educators from all over the world. 

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Meet the Scientist: My Path to a Career in Academic Research Studying Signal-Regulated Gene Expression

BACKGROUND: The burden of proximal femur (hip) fractures is high in older adults and contributes to substantial mortality. Numerous studies also document racial/ethnic differences in hip fracture incidence, lower among US Asian compared to non-Hispanic White (NH-White) adults. These data have informed base population factors used for fracture risk calculation; for US Asian compared to NH-White populations, ratios of 0.50 and 0.64 have been used for women and men, respectively. In this study, we examined age-adjusted and age-specific incidences of hip fracture in a contemporary population of older US adults and compared findings in Asian and NH-White women and men. METHODS: Among adults age ≥50 years who were members of a large US healthcare system during 2010-2019, we identified Asian/Pacific Islander (Asian/PI) and NH-White adults based on self-reported race/ethnicity data. Incident hip fractures were identified during follow-up from 2010 to 2021 (censoring at hip fracture, death, or membership end) based on (1) initial principal/primary hospital diagnosis of femoral neck or pertrochanteric fracture or (2) secondary hospital diagnosis with hip fracture repair procedure(s). The incidence of hip fracture (per 100,000 person-years) by sex and age and overall age-standardized incidence (using the 2010 US Census) were reported with [95% confidence intervals]. To compare sex-specific fracture rates between Asian/PI and NH-White adults, Poisson models were fitted, adjusting for age (5-year age categories). RESULTS: Among 203,116 Asian/PI and 645,384 NH-White women, we identified 1,436 and 15,214 hip fractures, and among 174,594 Asian/PI and 573,693 NH-White men, we identified 582 and 7051 hip fractures during follow-up, respectively. The age-adjusted incidence of hip fracture was 136 [129-143] and 297 [292-302] per 100,000 person-years for Asian/PI and NH-White women and 54 [49-58] and 149 [145-153] per 100,000 person-years for Asian/PI and NH-White men, respectively. By 5-year age group, hip fracture incidence increased from 4, 40, to 1113 per 100,000 person-years for Asian/PI women and 7, 29, to 528 per 100,000 person-years for Asian/PI men ages 50-54, 65-69, to 85+ years, respectively. These estimates were lower than that observed in respective NH-White women (range 19, 140, to 2068 per 100,000 person-years) and NH-White men (range 22, 85, and 1381 per 100,000 person-years). The age-adjusted relative risk (risk ratio) of fracture comparing Asian/PI to NH-White women was 0.44 [0.41-0.46] and comparing Asian/PI to NH-White men was 0.35 [0.33-0.39]. CONCLUSION: Hip fracture incidence in Asian/PI women and men is 56% and 65% lower than that observed in NH-White women and men. These findings indicate that racial/ethnic differences in proximal femur fracture persist in contemporary aggregate populations of older US Asian/PI adults compared to NH-White adults. However, given the known and increasing heterogeneity of the US Asian/PI population, future studies should examine whether these risk ratios vary by Asian/PI ethnic subgroups.

Proximal Femur Fracture Incidence by Sex among Older US Asian/Pacific Islander Adults and non-Hispanic White Adults

Objective: Despite their normal to high bone mineral density, fracture risk was increased in patients with type 2 diabetes. Antidiabetic medications have been suspected to account for the excess risk partly. However, longitudinal comparative studies on the effects of various antidiabetic medications on fractures are limited. We aimed to evaluate the fracture risk of patients using various antidiabetic medications compared to those using metformin.
Methods: We included 6,694 patients aged ≥ 50 years from the common data model (CDM) database between 2008 and 2012, who used the same antidiabetic medications over a year. The patients were grouped as metformin, insulin, sulfonylurea, dipeptidyl-4-inhibitor (DPP4i)+metformin, insulin+metformin, sulfonylurea+insulin, sulfonylurea+metformin, DPP4i+sulfonylurea+insulin, and sulfonylurea+insulin+metformin. The risks of major osteoporotic fractures (MOF) and hip fractures in each group were analyzed using the Cox proportional hazards model compared with the metformin group as a reference.
Results: During a median follow-up duration of 6.1 years, the incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1000 person-year. The mean age was 65.8 years, and 47.7% were women. Compared to metformin users, insulin users showed an increased risk of MOF (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28-3.02) and hip fracture (HR 3.06, 95% CI 1.21-7.77) after multivariate adjustments, including age, sex, body mass index (BMI), HbA1c, history of fracture, secondary osteoporosis, rheumatoid arthritis, cardiovascular, cerebrovascular disease, dementia, chronic kidney disease, use of steroid, proton pump inhibitor, and warfarin. Besides, the risk became insignificant in patients using a combination of insulin and metformin in both MOF (HR 1.32, 95% CI 0.77-2.27) and hip fracture risks (HR 2.68, 95% CI 0.56-12.80) after covariates adjustments. In subgroup analysis, insulin users harbored a significantly higher risk for MOF than metformin users only in patients withHbA1c < 7%, or BMI < 25 kg/m².
Conclusion: From real-world data, we found that insulin users were at elevated risk of MOF and hip fracture compared to metformin users, which might be attenuated in users with a combination of insulin and metformin. The increased fracture risk in insulin users was exaggerated in non-obese and well-controlled diabetic patients, indicating the need for routine fracture risk assessment in these patients.

Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models

Objective: Hypogonadism is a known risk factor for decreased bone mineral density (BMD) and increased risk of fractures in men. The 2012 Endocrine Society Clinical Practice Guidelines recommend that men ≥ 50 years of age with a diagnosis of hypogonadism undergo BMD testing.¹ The objective of this study was to determine the frequency at which men aged ≥ 50 with a diagnosis of hypogonadism underwent BMD testing, and among those that underwent testing, the percentage of men diagnosed with osteopenia or osteoporosis and subsequently treated with an osteoporosis medication.
Methods: A retrospective chart review was conducted using the enterprise-wide electronic health record system at our institution. Inclusion requirements were an ICD-9 or -10 code for hypogonadism at any time between 7/1/2012 and 9/30/2020, and at least two subsequent visits with providers from primary care, endocrinology, or urology. Patients with a diagnosis of osteoporosis or who had undergone treatment with an osteoporosis medication, prior to the diagnosis of hypogonadism, were excluded. Patients were followed until the date of BMD assessment or censoring (9/30/2021). The testing results and documentation of treatment with an osteoporosis medication were recorded. Categorical variables and continuous variables were summarized using N (%) and median (IQR) or mean (SD), respectively.
Results: A total of 10,169 men with hypogonadism were identified. General characteristics included mean age of 63.4 years (±9.2), 85.2% white, 52.7% with history of smoking, 68.2% with hypertension, 36.9% with type 2 diabetes, and mean BMI of 31.3 kg/m2 (±6.0). Median follow-up time was 6.6 years (3.8, 8.5). Of 728 (7.2%) patients who underwent BMD testing, 352 (48.4%) had osteopenia and 87 (12.0%) had osteoporosis. A total of 5,633 (55.4%) men underwent treatment with testosterone replacement therapy. Of the 87 patients identified as having osteoporosis, 50 (57.5%) were treated with an osteoporosis medication.
Conclusion: Despite a recommendation from the 2012 Endocrine Society for men ≥ 50 years of age with hypogonadism to undergo BMD testing, the rate at which this testing is performed in real-world practice is quite low. The high rate (60.3%) at which low BMD was discovered in hypogonadal men who underwent testing, and further observation of a low rate of treatment with osteoporosis medication when indicated, is alarming and necessitates a call to action for more hypogonadal men to undergo testing and receive appropriate treatment. Further studies are needed to determine the reasons why so few men with hypogonadism undergo BMD assessment and what systems can be put in place to overcome this clinical conundrum.
Reference:
1. Watts NB, et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 6, 1 June 2012, Pages 1802–1822, https://doi.org/10.1210/jc.2011-304

Lack of Bone Mineral Density Testing in Men with Hypogonadism: A Clinical Conundrum

Background: Type 2 diabetes mellitus (DM) is associated with an increased risk of fracture despite a paradoxically higher average bone mineral density. Additional markers of fracture risk among older adults with DM are needed to identify at-risk individuals.
Method: The MURDOCK study is an ongoing, longitudinal cohort study, initiated in 2007, of residents in Cabarrus and surrounding counties, based in Kannapolis, North Carolina. At study enrollment, participants completed medical and health questionnaires, and provided biospecimen samples for the biorepository. In this nested case-control analysis, incident fractures since study enrollment among MURDOCK participants were identified by self-reported survey and by query of the electronic medical records (EMR). Fracture cases were matched 2: 1 by age, gender, race/ethnicity, and BMI to participants without incident fracture. Stored biorepository serum samples were analyzed for both conventional metabolites (non-esterified fatty acids (NEFA), triglycerides, lactate, and ketones) and targeted metabolomics (amino acids and acylcarnitines), using the Beckman DxC 600 clinical analyzer and flow injection electrospray ionization tandem mass spectrometry, respectively. Principal components analysis (PCA) was used to identify relevant profiles for metabolomics data. The association between incident fracture and metabolic profile was assessed using conditional logistic regression, stratified by matched group and controlled for multiple confounders including tobacco and alcohol use, medical comorbidities (e.g., coronary artery disease, congestive heart failure, chronic kidney disease, rheumatoid arthritis) and medications (e.g., insulin, metformin, thiazolidinediones).
Results: 107 incident fractures were identified by self-reported questionnaire and EMR query; 210 controls were matched. The study population was predominantly female (71.8%) and white (90.6%) with mean (SD) age 65.0 (7.7) years and BMI 31.8 (6.2) kg/m2. PCA identified 2 amino acid (AA) profiles: profile 1 (AA1) consisted of the branched chain amino acids, phenylalanine and tyrosine; profile 2 (AA2) consisted of serine, arginine, asparagine/aspartate (Asx) and glutamine/glutamate (Glx). After controlling for multiple risk factors, AA2 was significantly associated with incident fracture (OR 1.72, 95% CI: 1.17 – 2.54). NEFA were associated with lower odds of fracture (OR 0.06, 95% CI: 0.01 – 0.31). There was no association of fracture with other conventional metabolites, acylcarnitine factors, nor AA1.
Conclusion: Given association of NEFA and AA2 with incident fracture, our results indicate novel biomarkers, as well as potential mechanisms of fracture risk among older adults with DM. Higher level of NEFA was associated with lower fracture odds; though not further classified in this study, prior studies have shown direct effects of polyunsaturated and monounsaturated fatty acids on osteoclasts. Higher level of AA2, including the amino acids Glx and Asx, was associated with increased fracture odds. Prior studies have shown direct effects of Glx on both osteoblasts and osteoclasts, and Glx and Asx have also been associated with muscle mass and strength.

Management of Hereditary Medullary Thyroid Cancer

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