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Dr. Joseph Lorenzo

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Everything posted by Dr. Joseph Lorenzo

  1. In a recent article, Gina Kolata, a science reporter for the New York Times (1), writes about a disturbing new development in science, the rising number of predatory publishers and for profit conferences that masquerade as legitimate scientific enterprises. These are journals and conferences that are organized for what appears to be the sole purpose of generating profits for their publishers or conference organizers. Often they originate in third world countries and create titles for their enterprises that mimic or even plagiarize established scientific endeavors. Their goal is to dupe scie
  2. Calcium is vital for bone health and normal physiologic function. Hence, its consumption in the diet is important, as is an adequate level of vitamin D, which aids in calcium absorption. To address the issue of what constitutes adequate dietary calcium and vitamin D intake, the Institute of Medicine (IOM) issued guidelines in 2010 (1) that recommended a daily intake of calcium for most adults of 1000 to 1200 mg per day and vitamin D of 600 to 800 IUs per day. A variety of foods are good sources of dietary calcium. These include dairy products, sardines and dark leafy green vegetables like sp
  3. I recently came across the editorial work of Ferric Fang and Arturo Casadevall through a profile in the magazine Science (1). They are well-known microbiologists and editors of publications for the American Society of Microbiology. In addition to their scientific contributions, they have authored a series of editorials and papers about the current state of science and the pressures that confront scientists. Some of their publications have explored the problem of scientific fraud and the stresses that many scientists feel to publish in high impact journals in order to better assure success i
  4. As 2012 fades into memory, it is a good time to reflect on events of the past twelve months that influenced to our field. As is typical, the past year brought both high and low points. The best news is that our Society continues to be strong. Both our Annual Meeting and Journal remain the leaders of their respective categories and our membership is strong. In addition, the last twelve months brought exciting new advances in both clinical and basic research related to diseases of bone and mineral metabolism. However, there are also a number of challenges to the continued advancement of our
  5. Male osteoporosis is a significant clinical problem that is often not diagnosed until patients suffer a fragility fracture. Approximately 20% of the 44 million Americans with osteoporosis (defined as a DXA bone mineral density T-score below 2.5) are men (1). However, men disproportionately account for 30-40% of the osteoporotic fractures (1-2). In addition, mortality rates in men with hip fractures are two to three times greater than in women (3) and this difference increases with age (2). Hence, improvements in the diagnosis and treatment of men at high risk for osteoporosis would signific
  6. Probably no function that a scientist performs is more important than being a mentor for trainees. Science is taught primarily by apprenticeships rather than by classroom learning. Graduate students and post-doctoral fellows who are pursuing a career in basic science need hands-on training in the laboratory to master the techniques of modern science. They achieve this by working on a project under the close supervision of a mentor. Similarly, students who are developing an academic career in clinical research need to be in highly supervised environments where their activities can be observe
  7. The mysteries of the human genome are slowly being unraveled. Since shortly after the discoveries of Watson and Crick, it has been known that DNA uses a 4 base code alphabet to encode the information for assembling proteins. However, it was not until the complete sequencing of the human genome (roughly three billion base pairs of DNA) over 10 years ago that we became aware of how little of our genetic code is directly involved in protein coding. Current estimates are that roughly 3 percent of our genetic information is dedicated to coding for between 20,000 and 25,000 genes. So what is the
  8. Osteoporosis is a common disease. One study in the United Kingdom estimated that the lifetime risk of any fracture after age 50 was 53% for women and 21 % for men (1). However, identifying which individuals will develop fractures is an imperfect science. The analysis of who is at risk relies, for the most part, on measurements of bone mineral density, typically by DEXA, and assessment of additional risk factors, including but not limited to: age, family history, medication history and the level of circulating sex steroids or the age when these were lost. However, no event is more definitive
  9. Vitamin D is essential for the maintenance of bone health. However, its role in the prevention of osteoporotic fractures has been controversial. Previous published trials have been inconsistent in their results. Now Bischoff-Ferrari et al (1) have performed an extensive meta-analysis of 11 previous double blind, randomized placebo controlled trials of vitamin D supplementation, encompassing 31,022 participants. These involved people 65 years of age or older (predominantly women) in which vitamin D supplementation (with or without calcium) was compared to a control (non-treated) group. Sig
  10. The association between the use of calcium supplements and the development of cardiovascular disease in individuals without renal failure has been a topic of much controversy and the subject of a number of my blogs (1, 2, 3). Originally identified by Bolland et al (4), this association has been seen in a number of additional studies from this group (5, 6). However, others in separate analyses have failed to confirm this effect (7, 8). Last year the Professional Practice Committee of the ASBMR published a position paper on this topic (9) and decided that: “…the weight of evidence is insuffic
  11. The United States Food and Drug Administration (FDA) recently published a prospective article about the benefits and risks of long-term bisphosphonate use for the treatment and prevention of osteoporosis (1). This was the result of a reanalysis by the FDA of three previous studies of post-menopausal women, which examined long-term (6-10 years) bisphosphonate use (FLEX (2), HORIZON-PET (3) and VERT-MN (4)) and the testimony at a joint meeting last year of two FDA advisory committees (7, 8). In all studies there were similar results with regard to increases in bone mineral density (BMD) throug
  12. Wnt proteins and the canonical Wnt signaling pathway are now known to play a critical role in the development of the skeleton. Studies over the last 15 to 20 years have demonstrated that mutations in human low-density lipoprotein (LDL) receptor-related protein (LRP) 5, which is a component of the canonical Wnt receptor, are associated with altered bone mass (1, 2) . In addition, two human diseases of high bone mass, sclerosteosis (3) and Van Buchem disease (4) result from mutations in the SOST gene, which produces a protein, sclerostin, that interferes with Wnt signaling. These latter two c
  13. A recent article in Cell (1) outlined the prospects for research funding in many countries around the world. While there were some where funding was expanding, the immediate overall picture was not encouraging. In most countries research is largely sponsored through government agencies and this funding has generally suffered because of the “great recession” of 2008. In the United States the Federal Government’s main agency for biomedical research, the National Institutes of Health (NIH) has seen little or no increase in its core budget for at least 3 years. Apropos of this trend, the Pres
  14. The recent paper by Gourlay et al (1), which I commented upon in my previous blog (2), has received much media coverage because it suggested that women in their mid-to-late sixties with a low risk of developing osteoporosis could safely wait as long as 15 years before undergoing repeat bone mineral density (BMD) testing. However, what was sometimes lost in that coverage was the additional finding in the same study that women with more advanced disease most certainly need their BMD retested at more frequent intervals. It is imperative to appreciate that too many women (and men) who are at sign
  15. The measurement of bone mineral density (BMD) by dual energy absorptiometry is a powerful tool to assess the risk of developing osteoporotic fractures. However, multiple additional factors influence this risk including: age, a history of a previous fracture, a maternal history of a fracture, increased levels of bone resorption markers and very low serum estradiol levels (1). Because it is well established that fracture risk increases as BMD decreases, clinicians have used changes in BMD, together with analysis of the independent risk factors, to help decide when individuals should be treated
  16. I was listening to the local public radio station last week when I heard a discussion about how the Internet has changed the way information is obtained and is altering the importance of traditional media sources. The author of a recent book on this subject (1) was being interviewed and argued that because there is essentially unlimited information on the Internet, individuals have become empowered to use sources outside traditional media outlets. The essence of his argument was that for all of written language, until the development of the Internet, there were a limited number of sources
  17. The pace of scientific advancement is often unpredictable. Major scientific insights most frequently occur because new technologies are developed, which allow hypotheses to be tested in ways that provide, for the first time, definitive interpretations of experimental results. However, great leaps also happen because creative people, when presented with seemingly contradictory or confusing experimental data, identify novel paradigms. It is the ability to see order where others see chaos that defines a creative mind and occasionally leads to great advancements in science. What concerns m
  18. Predicting who will experience untoward events to therapies or when they will occur is often impossible, given the limits of our technology and the inevitable randomness of many of these occurrences. In our field, much debate has occurred concerning the risks and benefits of the use of bisphosphonates and other antiresorptive therapies for the prevention and treatment of osteoporosis. Over the last year I have written a number of blogs about this subject. Recently, two articles were published, which try and bring clarity to the use of antiresorptive agents in the treatment of low bone mass c
  19. The New York Times recently published an article describing a psychology researcher who, over the last ten years, was accused of publishing a substantial body of fraudulent scientific papers (1). An investigating committee accused this individual of academic fraud in several dozen published papers, which appeared in numerous high profile journals. Coincidently, the journal Science posted an "editorial expression of concern" (2) about a study by this author that it published last April. In addition, the same issue of Science contained an article about a major dispute in the literature concer
  20. Unless you were living in complete isolation for the past two weeks, you probably are well aware of the untimely death of Steven Jobs, the charismatic founder of Apple Incorporated. Like many of you, I use his products extensively. In fact, this blog is being written on an Apple computer. By now the story of his life is well known. As an infant, he was given up for adoption by his unmarried graduate student birth parents and raised by adoptive parents in the heart of what he would someday help define as the “Silicon Valley” of California. Early on, he developed an appreciation for computer
  21. Osteoporosis can be a devastating disease that is believed to affect approximately 200 million women worldwide (1). Over the last 15 to 20 years a number of therapies have been developed for this condition. Prior to the 2002, estrogens were widely used. However, after the release of the Women’s Health Initiative results, demonstrating an unacceptably high incidence of cardiovascular diseases and breast cancer in women who were treated with estrogens (2), bisphosphonates became the mainstay of anti-osteoporosis therapy. Now, a number of studies have implicated bisphosphonate use with signi
  22. One of the mysteries that emerged from sequencing the human genome over ten years ago was the relative paucity of protein-encoding genes that it contained. Prior to the completion of its sequencing, estimates were made that the human genome needed between 50,000 and 100,000 genes to produce the complex pattern of gene expression that is necessary for the entirety of our cellular functions. Unexpectedly, most recent estimates of our genome place its number of protein-encoding genes at between 20,000 and 25,000, a value that is only roughly twice that found in the genomes of some of the simple
  23. In the US, the President and the Congress have just finished a long and acrimonious debate about the amount of debt that is appropriate for the country. The major disagreement between the opposing political parties is centered on how best to deal with the large US Federal Government budget deficit. While there are a number of reasons why the deficit is growing rapidly, one of the most prominent is the escalating cost of health care and the projections that, as the “baby boomers” move into their senior years, they will require increasing amounts of medical services. Medical care expenses
  24. In the US, the President and the Congress have just finished a long and acrimonious debate about the amount of debt that is appropriate for the country. The major disagreement between the opposing political parties is centered on how best to deal with the large US Federal Government budget deficit. While there are a number of reasons why the deficit is growing rapidly, one of the most prominent is the escalating cost of health care and the projections that, as the “baby boomers” move into their senior years, they will require increasing amounts of medical services. Medical care expenses
  25. Rosalyn Yalow, the second woman to win the Nobel Prize in Physiology and Medicine died, on May 30, 2011. She was 89 years old. In many ways her life is commentary on the changes that have occurred in American science and society over the last 100 years. She was born in the "Melting Pot for Eastern European Immigrants" on the Lower East Side of Manhattan in New York City in 1921. There she attended public schools and distinguished herself as an outstanding student, eventually graduating in 1941 with the first degree in physics ever awarded by Hunter College of the City University of New York
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