News & Views in 2012

Vitamin D supplementation can reduce fracture risk. However, the risk reduction is minimal, and existing trials and meta-analyses of the effect of vitamin D on fracture risk have several limitations, mainly owing to lack of placebo groups for comparison or use of calcium, which could also affect fracture risk, as control.

Are high body iron stores associated with an increased risk of type 2 diabetes mellitus? Researchers from Germany suggest such an association exists, but in this population-based study, most participants had a serum ferritin level within the reference range. Furthermore, many factors contribute to serum ferritin level.

Smoking is a risk factor for Graves disease. However, Carlé et al. have demonstrated that individuals have a transient increased risk of developing overt autoimmune hypothyroidism in the first 2 years after quitting smoking. The mechanisms involved in these two opposing effects of smoking on the immune system are intriguing.

Acromegaly is caused by a growth-hormone-secreting pituitary adenoma. Mutations in the AIP gene predispose patients to young-onset pituitary adenomas that are resistant to somatostatin analogue therapy. Chalal et al. describe a potential mechanism by which AIP modulates responsiveness to somatostatin analogues and identify PLAGL1 as a potential modulator of therapeutic activity.

Type 2 diabetes mellitus (T2DM) is a major public health problem. However, few clinicians screen routinely to detect this problem early or manage hyperglycaemia aggressively if it is found. As even transient normalization of glucose levels in prediabetes reduces the risk of developing T2DM, these practices should change.

Whether treatment of hyperglycaemia prevents progression of diabetic nephropathy is controversial. Intensive glycaemic control reduces the risk of microalbuminuria and macroalbuminuria, but there is no clear-cut evidence showing that it reduces doubling of serum creatinine levels or risk of death from kidney disease. Larger studies or further follow-up of previous trials are required to better assess renal outcomes.

Trend analyses reveal an increase in the absolute number of hospitalizations for fragility fractures in Ireland in the past decade, and further increases are projected to occur up to 2025. The economic consequences of this trend must be closely monitored to inform future policy and resource allocation.

Skeletal-related events (SREs) are important measures of morbidity and mortality in patients with solid tumour bone metastases. The high rate of SREs in patients with differentiated thyroid cancer bone metastases reported by Farooki et al. indicates that routine use of antiresorptive therapy in these patients could result in reduced SREs.

Reducing gestational weight gain is possible and may avoid some obstetric, perinatal and long-term metabolic risks for the mother and offspring. Reducing gestational weight gain, however, is not a panacea for all outcomes and all pregnancies. More research is needed to identify mother–infant pairs who will benefit.

Radioactive iodine ablation therapy is a standard treatment for most patients with differentiated thyroid cancer to prevent relapse. The effective dose of radioactive iodine and optimal preparation has been investigated in two recent studies but these factors still need to be confirmed.

When insulin therapy is introduced in advanced stages of type 2 diabetes mellitus many patients are already being treated with metformin and continue to receive this oral antihyperglycaemic agent. In a systematic review and meta-analysis, Hemmingsen et al. have evaluated the evidence for the benefits of this combination therapy.

The incidence of osteoporosis induced by glucocorticoid treatment is second only to that owing to oestrogen deficiency. Treatment and prevention of glucocorticoid-induced osteoporosis are, however, problematic. Can a new framework for the development of national guidelines help steer the diagnosis and management of glucocorticoid-induced osteoporosis towards calmer seas?

BRAF mutation detection in cytological samples from thyroid nodules increases the sensitivity of cytology for the diagnosis of thyroid cancer and is believed to be a marker of aggressive disease. Lee et al. demonstrate high-sensitivity detection of the BRAF mutation with a new assay technique, but disprove the association with tumour aggressiveness.

Holman et al. describe regional variation in lower limb amputation rates across England. In addition to confirming a >20-fold increased amputation risk associated with diabetes mellitus, they also report a 10-fold difference in amputation rates in individuals with diabetes mellitus between 151 Primary Care Trusts of the National Health Service.

Type 2 diabetes mellitus (T2DM), obesity and vitamin D deficiency are pandemic. Two new studies confirm the diabetes–vitamin D connection by demonstrating a >1.4-fold increase in risk of the metabolic syndrome in vitamin-D-deficient Australians and a 62% reduction in progression of prediabetes to T2DM with vitamin D sufficiency.

Bone adapts to mechanical loading regularly imposed on it. The faster we move, the greater are the ground reaction impacts and the stresses on our weight-bearing bones. Deere et al. suggest that only habitual levels of high-impact activity, such as jumping, are sufficient to substantially improve hip bone strength in adolescents.

A recent consensus workshop did not include metformin in the recommended therapeutic approach for the treatment of infertility in women with PCOS. However, encouraging findings by Morin-Papunen et al. suggest that metformin could reclaim its place, especially for the infertility treatment of women with PCOS who are obese.

Peptide-receptor radionuclide therapy with radiolabelled somatostatin analogues is a successful new treatment modality for patients with neuroendocrine tumours. Usually, ⁹⁰yttrium (⁹⁰Y)-coupled or ¹⁷⁷lutetium (¹⁷⁷Lu)-coupled somatostatin analogues are used, but a new study claims that combining the two radiopharmaceuticals results in improved overall survival.

Glomerular hyperfiltration has long been thought of as indicative of progression to albuminuria and nephropathy in type 1 diabetes mellitus. However, a new study supports other research in the past few years that has highlighted flaws in this model for kidney disease pathogenesis in type 1 diabetes mellitus.

Hypopituitarism, including growth hormone (GH) deficiency, is accompanied by increased morbidity and mortality. These factors may be due to the underlying disease and treatments such as surgery or radiotherapy, but can also arise from GH substitution therapy at nonphysiological doses. Nevertheless, emerging long-term data on GH replacement therapy now indicate benefits for bone health.