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Hormones are indispensable for bone development, growth, and maintenance. While many of the genes associated with osteogenesis are well established, it is the recent findings in endocrinology that are advancing the fields of bone biology and toxicology. Endocrine-disrupting chemicals (EDCs) are defined as chemicals that interfere with the function of the endocrine system. Here, we report recent discoveries describing key hormone pathways involved in osteogenesis and the EDCs that alter these pathways. EDCs can lead to bone morphological changes via altering hormone receptors, signaling pathways, and gene expression. The objective of this review is to highlight the recent discoveries of the harmful effects of environmental toxicants on bone formation and the pathways impacted. Understanding the mechanisms of how EDCs interfere with bone formation contributes to providing a comprehensive toxicological profile of a chemical.

The pancreas plays a key role in regulating the digestion of macronutrients and, consequently, metabolism/energy homeostasis by secreting various digestive enzymes and pancreatic hormones. It is located behind the stomach in the upper left part of the abdominal cavity and is divided into a head, body and tail. Most of this secretory organ consists of acinar or exocrine cells that secrete pancreatic juice containing digestive enzymes such as amylase, pancreatic lipase and trypsinogen into the ducts, that is, into the main pancreatic and auxiliary pancreatic ducts.

Prelinguistic babbling is a critical phase in infant language development and is best understood in temperate songbirds where it occurs primarily in males at reproductive maturity and is modulated by sex steroids. Parrots of both sexes are icons of tropical vocal plasticity, but vocal babbling is unreported in this group and whether the endocrine system is involved is unknown. Here we show that vocal babbling is widespread in a wild parrot population in Venezuela, ensues in both sexes during the nestling stage, occurs amidst a captive audience of mixed-aged siblings, and is modulated by corticosteroids. Spectrographic analysis and machine learning found phoneme diversity and combinatorial capacity increased precipitously for the first week, thereafter, crystalizing into a smaller repertoire, consistent with the selective attrition model of language development. Corticosterone-treated nestlings differed from unmanipulated birds and sham controls in several acoustic properties and crystallized a larger repertoire post-treatment. Our findings indicate babbling occurs during an early life-history stage in which corticosteroids help catalyse the transition from a universal learning programme to one finely tuned for the prevailing ecological environment, a potentially convergent scenario in human prelinguistic development.

Bilateria have bilateral symmetry and are subdivided into Deuterostomia (animals like vertebrates) and Protostomia (animals like insects and mollusks). Neuropeptides occur in both Proto- and Deuterostomia and they are frequently structurally related across these two lineages. For example, peptides belonging to the oxytocin/vasopressin family exist in both clades. The same is true for the G protein-coupled receptors (GPCRs) of these peptides. These observations suggest that these neuropeptides and their GPCRs were already present in the common ancestor of Proto- and Deuterostomia, which lived about 700 million years ago (MYA). Furthermore, neuropeptides and their GPCRs occur in two early-branching phyla that diverged before the emergence of Bilateria: Cnidaria (animals like corals and sea anemones), and Placozoa (small disk-like animals, feeding on algae). The sequences of these neuropeptides and their GPCRs, however, are not closely related to those from Bilateria. In addition, cnidarian neuropeptides and their receptors are not closely related to those from Placozoa. We propose that the divergence times between Cnidaria, Placozoa, and Bilateria might be too long for recognizing sequence identities. Leucine-rich repeats-containing GPCRs (LGRs) are a special class of GPCRs that are characterized by a long N-terminus containing 10-20 leucine-rich domains, which are used for ligand binding. Among the ligands for LGRs are dimeric glycoprotein hormones, and insulin-like peptides, such as relaxin. LGRs have been found not only in Proto- and Deuterostomia, but also in early emerging phyla, such as Cnidaria and Placozoa. Humans have eight LGRs. In our current review, we have revisited the annotations of LGRs from the sea anemone Nematostella vectensis and the placozoan Trichoplax adhaerens. We identified 13 sea anemone LGRs and no less than 46 LGRs from T. adhaerens. All eight human LGRs appear to have orthologues in sea anemones and placozoans. LGRs and their ligands, t

Bilateria have bilateral symmetry and are subdivided into Deuterostomia (animals like vertebrates) and Protostomia (animals like insects and mollusks). Neuropeptides occur in both Proto- and Deuterostomia and they are frequently structurally related across these two lineages. For example, peptides belonging to the oxytocin/vasopressin family exist in both clades. The same is true for the G protein-coupled receptors (GPCRs) of these peptides. These observations suggest that these neuropeptides and their GPCRs were already present in the common ancestor of Proto- and Deuterostomia, which lived about 700 million years ago (MYA). Furthermore, neuropeptides and their GPCRs occur in two early-branching phyla that diverged before the emergence of Bilateria: Cnidaria (animals like corals and sea anemones), and Placozoa (small disk-like animals, feeding on algae). The sequences of these neuropeptides and their GPCRs, however, are not closely related to those from Bilateria. In addition, cnidarian neuropeptides and their receptors are not closely related to those from Placozoa. We propose that the divergence times between Cnidaria, Placozoa, and Bilateria might be too long for recognizing sequence identities. Leucine-rich repeats-containing GPCRs (LGRs) are a special class of GPCRs that are characterized by a long N-terminus containing 10-20 leucine-rich domains, which are used for ligand binding. Among the ligands for LGRs are dimeric glycoprotein hormones, and insulin-like peptides, such as relaxin. LGRs have been found not only in Proto- and Deuterostomia, but also in early emerging phyla, such as Cnidaria and Placozoa. Humans have eight LGRs. In our current review, we have revisited the annotations of LGRs from the sea anemone Nematostella vectensis and the placozoan Trichoplax adhaerens. We identified 13 sea anemone LGRs and no less than 46 LGRs from T. adhaerens. All eight human LGRs appear to have orthologues in sea anemones and placozoans. LGRs and their ligands, t

Trillions of commensal microbes live in our body, the majority in the gut. This gut microbiota is in constant interaction with the homeostatic systems, the nervous, immune and endocrine systems, being fundamental for their appropriate development and function as well as for the neuroimmunoendocrine communication. The health state of an individual is understood in the frame of this communication, in which the microbiota-gut-brain axis is a relevant example. This bidirectional axis is constituted in early age and is affected by many environmental and lifestyle factors such as diet and stress, among others, being involved in the adequate maintenance of homeostasis and consequently in the health of each subject and in his/her rate of aging. For this, an alteration of gut microbiota, as occurs in a dysbiosis, and the associated gut barrier deterioration and the inflammatory state, affecting the function of immune, endocrine and nervous systems, in gut and in all the locations, is in the base of a great number of pathologies as those that involve alterations in the brain functions. There is an age-related deterioration of microbiota and the homeostatic systems due to oxi-inflamm-aging, and thus the risk of aging associated pathologies such as the neurodegenerative illness. Currently, this microbiota-gut-brain axis has been considered to have a relevant role in the pathogenesis of Alzheimer’s disease and represents an important target in the prevention and slowdown of the development of this pathology. In this context, the use of probiotics seems to be a promising help., Depto. de Genética, Fisiología y Microbiología, Fac. de Ciencias Biológicas, TRUE, pub

Healthy Male [formerly Andrology Australia] was created in 2000 to improve community and professional awareness and education in male reproductive health [MRH]. Supported by the Federal Government, this national 'virtual centre' brings together experts to implement a collaborative strategy. Initially focussing on MRH issues [androgen use/ abuse, infertility, ED, testis cancer, prostate disease] HM recognised the linkages to chronic disease [cardiovascular disease, diabetes, mental health] and expanded its focus. The overall approach has been to first understand consumer needs, then assess the evidence, educate and upskill health professionals and finally "close the loop" through community education of what and how help can be accessed. Although not resourced as a research organisation the longitudinal "Men in Australia telephone survey" [MATeS, Lancet 2006] identified knowledge gaps for future attention. Core material was generated by expert advisory groups and collaborative programs developed with primary health practitioners and disadvantaged groups, such as indigenous people. Strong demand from grassroots organisations for evidence-based information has occurred for local and national use. Rebranding to "Healthy Male" in 2018, a new website and social media engagement expanded its profile. Most effort has been given to the primary care workforce, but specialist issues are being addressed e.g. IVF gynaecologists in male fertility care, the Endocrine Society re androgen guidelines, and HM trainee fellowships. A close relationship has been forged with the Federal Health Department with HM as a trusted resource for policy development, notably overseeing National Men's Health Strategy 2020-2030. Recognizing the need to better support young men from preconception though their first year of fatherhood, the "Plus Paternal Project" is currently developing a roadmap for action. HM is now well-recognized as a trusted resource in all sectors: its innovative, responsive and f

The endocrine system – communication system in the body is a network of glands in the body that produce hormones, chemical substances released into the bloodstream to guide processes such as metabolism, growth, and sexual development. Hormones are also involved in regulating emotional life. They’re responsible for almost every cell, organ, and function in the body. If endocrine system isn't healthy, might have problems developing during puberty, getting pregnant or managing stress. Also might gain weight easily, have weak bones, or lack energy because too much sugar stays in the blood instead of moving into cells where it's needed for energy.

The endocrine system, together with the nervous system, participates in the regulation of the basic physiological processes in the body. Violation of the central mechanisms of regulation of the functional activity of the endocrine glands, pathological processes in the glands themselves or a violation of the peripheral mechanism of action of hormones lead to a violation of the metabolism, growth, development and reproduction of the body

The endocrine system – communication system in the body is a network of glands in the body that produce hormones, chemical substances released into the bloodstream to guide processes such as metabolism, growth, and sexual development. Hormones are also involved in regulating emotional life. They’re responsible for almost every cell, organ, and function in the body. If endocrine system isn't healthy, might have problems developing during puberty, getting pregnant or managing stress. Also might gain weight easily, have weak bones, or lack energy because too much sugar stays in the blood instead of moving into cells where it's needed for energy.

The endocrine system, together with the nervous system, participates in the regulation of the basic physiological processes in the body. Violation of the central mechanisms of regulation of the functional activity of the endocrine glands, pathological processes in the glands themselves or a violation of the peripheral mechanism of action of hormones lead to a violation of the metabolism, growth, development and reproduction of the body

Find resources for Endocrinology, evidence-based practice, and related topics, including databases, journals, web recommendations, and a wide range of publications.

Healthy Male [formerly Andrology Australia] was created in 2000 to improve community and professional awareness and education in male reproductive health [MRH]. Supported by the Federal Government, this national 'virtual centre' brings together experts to implement a collaborative strategy. Initially focussing on MRH issues [androgen use/ abuse, infertility, ED, testis cancer, prostate disease] HM recognised the linkages to chronic disease [cardiovascular disease, diabetes, mental health] and expanded its focus. The overall approach has been to first understand consumer needs, then assess the evidence, educate and upskill health professionals and finally "close the loop" through community education of what and how help can be accessed. Although not resourced as a research organisation the longitudinal "Men in Australia telephone survey" [MATeS, Lancet 2006] identified knowledge gaps for future attention. Core material was generated by expert advisory groups and collaborative programs developed with primary health practitioners and disadvantaged groups, such as indigenous people. Strong demand from grassroots organisations for evidence-based information has occurred for local and national use. Rebranding to "Healthy Male" in 2018, a new website and social media engagement expanded its profile. Most effort has been given to the primary care workforce, but specialist issues are being addressed e.g. IVF gynaecologists in male fertility care, the Endocrine Society re androgen guidelines, and HM trainee fellowships. A close relationship has been forged with the Federal Health Department with HM as a trusted resource for policy development, notably overseeing National Men's Health Strategy 2020-2030. Recognizing the need to better support young men from preconception though their first year of fatherhood, the "Plus Paternal Project" is currently developing a roadmap for action. HM is now well-recognized as a trusted resource in all sectors: its innovative, responsive and f

n this thesis, I aim to identify the social factors that cause men with disordered eating and negative body images to be neglected in research, explain a possible mechanism for bone injuries in male endurance athletes, and identify sociocultural factors that could make subpopulations of athletes more susceptible to disordered eating, hormone dysfunction, and bone injuries. The consequences of the physiological dysfunction resulting from disordered eating is not limited to the time in which the individual has disordered eating, but can impact the individual for the rest of their life. I will summarize research about female athletes’ patterns of disordered eating and bone injury, and compare and contrast it with research about male athletes. I will then propose some steps to remedy the research gaps and societal unawareness in this topic. I will advocate for including men in research about disordered eating, body image, and relative energy deficiency in sport (RED-S) and better education of coaches, medical practitioners, and athletic trainers. The evidence presented here demonstrates that men are subject to a similar hormone dysfunction as women when operating in caloric deficits and are at an increased risk for bone injury.

The endocrine system – communication system in the body is a network of glands in the body that produce hormones, chemical substances released into the bloodstream to guide processes such as metabolism, growth, and sexual development. Hormones are also involved in regulating emotional life. They’re responsible for almost every cell, organ, and function in the body. If endocrine system isn't healthy, might have problems developing during puberty, getting pregnant or managing stress. Also might gain weight easily, have weak bones, or lack energy because too much sugar stays in the blood instead of moving into cells where it's needed for energy.

The endocrine system, together with the nervous system, participates in the regulation of the basic physiological processes in the body. Violation of the central mechanisms of regulation of the functional activity of the endocrine glands, pathological processes in the glands themselves or a violation of the peripheral mechanism of action of hormones lead to a violation of the metabolism, growth, development and reproduction of the body

n this thesis, I aim to identify the social factors that cause men with disordered eating and negative body images to be neglected in research, explain a possible mechanism for bone injuries in male endurance athletes, and identify sociocultural factors that could make subpopulations of athletes more susceptible to disordered eating, hormone dysfunction, and bone injuries. The consequences of the physiological dysfunction resulting from disordered eating is not limited to the time in which the individual has disordered eating, but can impact the individual for the rest of their life. I will summarize research about female athletes’ patterns of disordered eating and bone injury, and compare and contrast it with research about male athletes. I will then propose some steps to remedy the research gaps and societal unawareness in this topic. I will advocate for including men in research about disordered eating, body image, and relative energy deficiency in sport (RED-S) and better education of coaches, medical practitioners, and athletic trainers. The evidence presented here demonstrates that men are subject to a similar hormone dysfunction as women when operating in caloric deficits and are at an increased risk for bone injury.

n this thesis, I aim to identify the social factors that cause men with disordered eating and negative body images to be neglected in research, explain a possible mechanism for bone injuries in male endurance athletes, and identify sociocultural factors that could make subpopulations of athletes more susceptible to disordered eating, hormone dysfunction, and bone injuries. The consequences of the physiological dysfunction resulting from disordered eating is not limited to the time in which the individual has disordered eating, but can impact the individual for the rest of their life. I will summarize research about female athletes’ patterns of disordered eating and bone injury, and compare and contrast it with research about male athletes. I will then propose some steps to remedy the research gaps and societal unawareness in this topic. I will advocate for including men in research about disordered eating, body image, and relative energy deficiency in sport (RED-S) and better education of coaches, medical practitioners, and athletic trainers. The evidence presented here demonstrates that men are subject to a similar hormone dysfunction as women when operating in caloric deficits and are at an increased risk for bone injury.

OBJECTIVE: There is evidence that placebo effects may influence hormone secretion. However, only few studies examined placebo effects in the endocrine system, including oxytocin placebo effects. We studied whether it is possible to trigger oxytocin placebo effects using a classical conditioning paradigm.METHODS: Ninety-nine females were assigned to a conditioned, control or drug-control group. In the two-phase conditioning paradigm, participants in the conditioned and drug-control groups received an oxytocin nasal spray combined with a distinctive smell (conditioned stimulus, CS) during three acquisition days, while the control group received placebo spray. Subsequently, the conditioned and control groups received placebo spray with the CS and the drug-control group- oxytocin spray during three evocation days. Salivary oxytocin was measured several times during each day. Pain sensitivity and facial evaluation tests previously used in oxytocin research were also administered.RESULTS: On evocation day 1, in the conditioned group oxytocin significantly increased from baseline to 5 minutes after CS (B[slope]=19.55, S.E.=5.88, p<.001) and remained increased from 5 to 20 (B=-10.42, S.E.=5.81, p=.071) and 50 minutes (B=-0.70, S.E.=3.37, p=.84). On evocation day 2, a trend for increase in oxytocin was found at 5 minutes (B=15.22, S.E.= 8.14, p=0.062). No placebo effect was found on evocation day 3 (B=3.57, S.E.=3.26, p=0.28). Neither exogenous nor conditioned oxytocin affected pain or facial tasks.CONCLUSIONS: Results indicate that oxytocin release can be conditioned and that this response extinguishes over time. Triggering hormonal release by placebo manipulation offers various clinical possibilities, such as enhancing effects of pharmacological treatments or reducing dosages of medications.TRIAL REGISTRATION: The study was registered as a clinical trial on www.trialregister.nl (number NTR5596).

Oil sands process-affected water (OSPW) is a byproduct of bitumen extraction in the surface-mining oil sands industry in Alberta, Canada. Organic compounds in OSPW can be acutely or chronically toxic to aquatic organisms, so part of a long-term strategy for remediation of OSPW is ageing of water in artificial lakes, termed end-pit lakes. BaseMine Lake (BML) is the first oil sands end-pit lake, commissioned in 2012. At the time of its establishment, an effects-directed analysis of BML-OSPW showed that naphthenic acids and polar organic chemical species containing sulfur or nitrogen contributed to its acute lethality. However, the chronic toxicity of these same chemical fractions has not yet been investigated. In this work, the short-term fathead minnow reproductive bioassay was used to assess endocrine-system effects of two fractions of BML-OSPW collected in 2015. One of the fractions (F1) contained predominantly naphthenic acids, while the other (F2) contained non-acidic polar organic chemical species. Exposure of minnows to F1 or F2 at concentrations equivalent to 25% (v/v) of the 2015 BML-OSPW sample (5-15% of the 2012 BML-OSPW sample) did not alter reproductive performance, fertilization success, or concentrations of sex steroids in female or male minnows. Additionally, there were no significant differences in fertility, hatching success, or incidence of morphological indices of embryos collected on day 7 or 14 from exposed breeding trios. However, exposure of male fathead minnow to 25% (v/v) intact 2015 BML-OSPW resulted in a significantly greater hepatosomatic index. Exposure of fathead minnow to refined fractions of dissolved organic chemicals in 2015 BML-OSPW, or a 25% (v/v) of the intact mixture did not affect fertility or fecundity as measured by use of the 21-day reproductive bioassay. These data will be useful in setting future threshold criteria for OSPW reclamation and treatment.

OBJECTIVE: There is evidence that placebo effects may influence hormone secretion. However, few studies have examined placebo effects in the endocrine system, including oxytocin placebo effects. We studied whether it is possible to trigger oxytocin placebo effects using a classical conditioning paradigm. METHODS: Ninety-nine women were assigned to a conditioned, control, or drug control group. In the two-phase conditioning paradigm, participants in the conditioned and drug control groups received an oxytocin nasal spray combined with a distinctive smell (conditioned stimulus [CS]) for three acquisition days, whereas the control group received placebo spray. Subsequently, the conditioned and control groups received placebo spray with the CS and the drug control group received oxytocin spray for three evocation days. Salivary oxytocin was measured several times during each day. Pain sensitivity and facial evaluation tests previously used in oxytocin research were also administered. RESULTS: On evocation day 1, in the conditioned group, oxytocin significantly increased from baseline to 5 minutes after CS (B[slope] = 19.55, SE = 5.88, p < .001) and remained increased from 5 to 20 (B = -10.42, SE = 5.81, p = .071) and 50 minutes (B = -0.70, SE = 3.37, p = .84). On evocation day 2, a trend for increase in oxytocin was found at 5 minutes (B = 15.22, SE = 8.14, p = .062). No placebo effect was found on evocation day 3 (B = 3.57, SE = 3.26, p = .28). Neither exogenous nor conditioned oxytocin affected pain or facial tasks. CONCLUSIONS: Results indicate that oxytocin release can be conditioned and that this response extinguishes over time. Triggering hormonal release by placebo manipulation offers various clinical possibilities, such as enhancing effects of pharmacological treatments or reducing dosages of medications. TRIAL REGISTRATION: The study was registered as a clinical trial on www.trialregister.nl (number NTR5596).

Hear Me Roar, a compilation of personal essays interspersed with short forms, grapples with the nuances of compliance versus autonomy in the context of the male gaze, beauty standards, and pop culture. The collection also explores what it means to treasure something—another person, an object—and how to express and deepen that affection.

Objective: Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. Study design: Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. Result(s): In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups. Conclusion(s): An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.Copyright © 2020 John Wiley & Sons Ltd

Linoleic acid (LA) is the most abundant polyunsaturated fatty acid found in the Western diet. Cytochrome P450-derived LA metabolites 9,10-epoxyoctadecenoic acid (9,10-EpOME), 12,13-epoxyoctadecenoic acid (12,13-EpOME), 9,10-dihydroxy-12Z-octadecenoic acid (9,10-DiHOME) and 12,13-dihydroxy-9Z-octadecenoic acid (12,13-DiHOME) have been studied for their association with various disease states and biological functions. Previous studies of the EpOMEs and DiHOMEs have focused on their roles in cytotoxic processes, primarily in the inhibition of the neutrophil respiratory burst. More recent research has suggested the DiHOMEs may be important lipid mediators in pain perception, altered immune response and brown adipose tissue activation by cold and exercise. The purpose of this review is to summarize the current understanding of the physiological and pathophysiological roles and modes of action of the EpOMEs and DiHOMEs in health and disease.

The interplay between pancreatic epithelium and the surrounding microenvironment is pivotal for pancreas formation and differentiation as well as adult organ homeostasis. The mesenchyme is the main component of the embryonic pancreatic microenvironment, yet its cellular identity is broadly defined, and whether it comprises functionally distinct cell subsets is not known. Using genetic lineage tracing, transcriptome, and functional studies, we identified mesenchymal populations with different roles during pancreatic development. Moreover, we showed that Pbx transcription factors act within the mouse pancreatic mesenchyme to define a pro-endocrine specialized niche. Pbx directs differentiation of endocrine progenitors into insulin- and glucagon-positive cells through non-cell-autonomous regulation of ECM-integrin interactions and soluble molecules. Next, we measured functional conservation between mouse and human pancreatic mesenchyme by testing identified mesenchymal factors in an iPSC-based differentiation model. Our findings provide insights into how lineage-specific crosstalk between epithelium and neighboring mesenchymal cells underpin the generation of different pancreatic cell types.

Coronavirus disease 2019 (COVID-19) is caused by infection with severe acute respiratory syndrome corona virus 2. High age, hypertension, diabetes, and obesity are risk factors for severe COVID-19 with increased mortality. In this review, we discuss potential mechanisms by which diabetes and obesity modulate the host viral interactions and host-immune response. Glucose levels should be monitored rigorously, and patient-tailored aggressive treatment of hyperglycaemia is recommended, often with the use of insulin. Persons with diabetes and obesity are susceptible to severe outcomes from COVID-19.

BACKGROUND: Whether low plasma 25-hydroxyvitamin D concentrations cause osteoporotic fractures is unclear. We tested the hypothesis that low plasma 25-hydroxyvitamin D concentrations are associated with increased risk of osteoporotic fractures using a Mendelian randomization analysis. METHODS: We genotyped 116 335 randomly chosen white Danish persons aged 20-100 years in 2 population-based cohort studies for plasma 25-hydroxyvitamin D decreasing genotypes in CYP2R1 (rs117913124 and rs12794714), DHCR7 (rs7944926 and rs11234027), GEMIN2 (rs2277458), and HAL (rs3819817); 35 833 had information on plasma 25-hydroxyvitamin D. We assessed risk of total, osteoporotic, and anatomically localized fractures from 1981 through 2017. Information on fractures and vital status was obtained from nationwide registries. RESULTS: During up to 36 years of follow-up, we observed 17 820 total fractures, 10 861 osteoporotic fractures, and 3472 fractures of hip or femur. Compared with individuals with 25-hydroxyvitamin D ≥ 50nmol/L, multivariable adjusted hazard ratios (95% CIs) for total fractures were 1.03 (0.97-1.09) for individuals with 25-49.9 nmol/L, 1.19 (1.10-1.28) for individuals with 12.5-24.9 nmol/L, and 1.39 (1.21-1.60) for individuals with 25-hydroxyvitamin D < 12.5 nmol/L. Corresponding hazard ratios were 1.07 (1.00-1.15), 1.25 (1.13-1.37), and 1.49 (1.25-1.77) for osteoporotic fractures and 1.09 (0.98-1.22), 1.37 (1.18-1.57), and 1.41 (1.09-1.81) for fractures of hip or femur, respectively. Hazard ratios per 1 increase in vitamin D allele score, corresponding to 3.0% (approximately 1.6 nmol/L) lower 25-hydroxyvitamin D concentrations, were 0.99 (0.98-1.00) for total fractures, 0.99 (0.97-1.00) for osteoporotic fractures, and 0.98 (0.95-1.00) for fractures of hip or femur. CONCLUSIONS: Low plasma 25-hydroxyvitamin D concentrations were associated with osteoporotic fractures; however, Mendelian randomization analysis provided no evidence supporting a causal role for vita

Type 2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections. Emerging evidence demonstrates an important direct metabolic and endocrine mechanistic link to the viral disease process. Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19.

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

The circadian rhythm is a rhythm which permeates all aspects of biological life and follows the hours of the sun. The pace of the rhythm is controlled by a collection of neurons in the hypothalamus, called the suprachiasmatic nucleus (SCN), whose signals affect rhythms throughout the body as can be seen in aspects of life from behavior down to oscillations of proteins in the cells. A disruption of this rhythm such as what happens during jet lag, where the rhythm of the SCN is out of synch with the rhythm of the rest of the body, is something that can have adverse effects on mental and physical health. To realign the SCN and the rhythm of the body, different methods and be implemented. This thesis investigated the effectiveness of glucocorticoids on re-aligning the rhythms of the body following a disruption through a meta-analysis and a qualitative review. The meta-analysis and review incorporated experiments from six articles investigating the hours of circadian rhythm shifts in the mouse model, after administering glucocorticoids. What was found was that the individual experiments presented results with high effect sizes; however, the direction of said effects was not uniform as the rhythms shifted in different directions. The lack of uniform direction caused no significant combined effect size to be found by this meta-analysis (MES=0.11 ± 0.06), showing that a statistical analysis based on hours shifted could not find a significant combined effect. The qualitative review, however, indicates that the administration of glucocorticoids shows an effect in re-entraining the rhythm of the peripheral parts of the body to that of the environmental cues and the SCN. Though no significant statistical effect was found in this analysis, the effect of glucocorticoids should not be discounted and could still prove a promising treatment for circadian disruptions, such as jet lag.

Western medicine has involved studies of environmental, social, and dietary stress that leads to the diagnosis of hereditary disorders. Even with pharmaceutical treatments, these disorders have risen. This short-term response does not benefit the long-term health of future generations. By refocusing with theories of “survival of the fittest,” adaptation starts when an individual perceives and responds to their built environment. Personal senses (vision, smell, touch, taste, etc.) gather information on a specific space and are subsequently expressed through an emotional response. This internal process, called the limbic system, is done through hormones that respond to sensory/ emotional information and give function to cells through the body. Disorders arise when there is too much or too little of a hormone that damages how the body reads the DNA within a cell, known as an epigenetic modification. The misreading and re-interpretation of epigenetic patterns are most crucial during exponential cell growth during in utero. Therefore, the architectural reading of an expecting mother may hinder or benefit the unborn child’s future health. How can we use the built environment to promote human’s fitness within the timeframe of in utero? Architecture can display multiplicities of emotional responses. Theories in biophilic design and cognitive architecture have listed multiple architectural elements and their spectrum of emotions. This information can be used at its full capacity when starting at the micro responses of cells due to macro atmospheric qualities. When imposing a new typology for pregnant women, their health and programmatic requirements connect to architectural elements, emotions, and senses that start to inform a design toolkit. This will assist in the design and development of a short-term residence for pregnant and post-partum women who require a secure and stimulating architecture. This new typology will investigate the use of data as a means to generate a b

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

Stress is well-known to inhibit a variety of reproductive processes, including the suppression of episodic Gonadotropin releasing hormone (GnRH) secretion, typically measured via downstream luteinizing hormone (LH) secretion. Since pulsatile secretion of GnRH and LH are necessary for proper reproductive function in both males and females, and stress is common for both human and animals, understanding the fundamental mechanisms by which stress impairs LH pulses is of critical importance. Activation of the hypothalamic-pituitary-adrenal axis, and its corresponding endocrine factors, is a key feature of the stress response, so dissecting the role of stress hormones, including corticotrophin releasing hormone (CRH) and corticosterone, in the inhibition of LH secretion has been one key research focus. However, some evidence suggests that these stress hormones alone are not sufficient for the full inhibition of LH caused by stress, implicating the additional involvement of other hormonal or neural signaling pathways in this process (including inputs from the brainstem, amygdala, parabrachial nucleus, and dorsomedial nucleus). Moreover, different stress types, such as metabolic stress (hypoglycemia), immune stress, and psychosocial stress, appear to suppress LH secretion via partially unique neural and endocrine pathways. The mechanisms underlying the suppression of LH pulses in these models offer interesting comparisons and contrasts, including the specific roles of amygdaloid nuclei and CRH receptor types. This review focuses on the most recent and emerging insights into endocrine and neural mechanisms responsible for the suppression of pulsatile LH secretion in mammals, and offers insights in important gaps in knowledge.

Western medicine has involved studies of environmental, social, and dietary stress that leads to the diagnosis of hereditary disorders. Even with pharmaceutical treatments, these disorders have risen. This short-term response does not benefit the long-term health of future generations. By refocusing with theories of “survival of the fittest,” adaptation starts when an individual perceives and responds to their built environment. Personal senses (vision, smell, touch, taste, etc.) gather information on a specific space and are subsequently expressed through an emotional response. This internal process, called the limbic system, is done through hormones that respond to sensory/ emotional information and give function to cells through the body. Disorders arise when there is too much or too little of a hormone that damages how the body reads the DNA within a cell, known as an epigenetic modification. The misreading and re-interpretation of epigenetic patterns are most crucial during exponential cell growth during in utero. Therefore, the architectural reading of an expecting mother may hinder or benefit the unborn child’s future health. How can we use the built environment to promote human’s fitness within the timeframe of in utero? Architecture can display multiplicities of emotional responses. Theories in biophilic design and cognitive architecture have listed multiple architectural elements and their spectrum of emotions. This information can be used at its full capacity when starting at the micro responses of cells due to macro atmospheric qualities. When imposing a new typology for pregnant women, their health and programmatic requirements connect to architectural elements, emotions, and senses that start to inform a design toolkit. This will assist in the design and development of a short-term residence for pregnant and post-partum women who require a secure and stimulating architecture. This new typology will investigate the use of data as a means to generate a b

INTRODUCTION: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. MATERIALS AND METHODS: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300 mL/min after 20 minutes of complete AO). After 90 minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. RESULTS: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180 minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. CONCLUSIONS: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.

The purpose of this study was to investigate the relationship of pre and post evening meal exercise in relation to postprandial blood glucose levels in type II diabetics. Fifteen participants diagnosed with type II diabetes volunteered to participate in this 21 day study. During the first seven days, participants were told to change nothing about their daily routine. Throughout the study they were asked to track all food consumption in the MyFitnessPal application and to record their blood glucose levels fasting, before their evening meal, and 120 minutes after their evening meal. At the end of day seven, each participant’s carbohydrate intake was classified into the following three diets according to the American Diabetes Association: moderately low-carbohydrate diet (30-40%), moderate carbohydrate diet (40-65%) or high carbohydrate diet (> 65%). The participants were then directed to eat within their carbohydrate allowance for the remainder of the 21 days. On day eight, participants were split into the three groups: the NA group made no alterations to their daily activities, the BEM group exercised before their evening meal, and the AEM group exercised 30 minutes after their evening meal. Participants completed the study with their given treatments. Data was collected and a one-way ANOVA was performed showing statistical significance. The Tukey-Kramer Post Hoc Test was performed to investigate. Statistical significance (alpha >.05) was found between the NA vs. BEM groups and the NA vs. AEM groups, but no significance was found between the BEM vs. AEM group.

Diabetic euglycaemic ketoacidosis is a possible adverse effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i). We report a case in which the combination of SGLT2i and a strict very low-carbohydrate diet led to severe diabetic ketoacidosis in a young Caucasian man with type 2 diabetes.

The circadian rhythm is a rhythm which permeates all aspects of biological life and follows the hours of the sun. The pace of the rhythm is controlled by a collection of neurons in the hypothalamus, called the suprachiasmatic nucleus (SCN), whose signals affect rhythms throughout the body as can be seen in aspects of life from behavior down to oscillations of proteins in the cells. A disruption of this rhythm such as what happens during jet lag, where the rhythm of the SCN is out of synch with the rhythm of the rest of the body, is something that can have adverse effects on mental and physical health. To realign the SCN and the rhythm of the body, different methods and be implemented. This thesis investigated the effectiveness of glucocorticoids on re-aligning the rhythms of the body following a disruption through a meta-analysis and a qualitative review. The meta-analysis and review incorporated experiments from six articles investigating the hours of circadian rhythm shifts in the mouse model, after administering glucocorticoids. What was found was that the individual experiments presented results with high effect sizes; however, the direction of said effects was not uniform as the rhythms shifted in different directions. The lack of uniform direction caused no significant combined effect size to be found by this meta-analysis (MES=0.11 ± 0.06), showing that a statistical analysis based on hours shifted could not find a significant combined effect. The qualitative review, however, indicates that the administration of glucocorticoids shows an effect in re-entraining the rhythm of the peripheral parts of the body to that of the environmental cues and the SCN. Though no significant statistical effect was found in this analysis, the effect of glucocorticoids should not be discounted and could still prove a promising treatment for circadian disruptions, such as jet lag.

PurposeHodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors.MethodsData for 5,085 patients aged 15-39 when diagnosed with HL during 1996-2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression.ResultsTwenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05-1.78] and circulatory system diseases (HR = 1.58, CI 1.17-2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04-1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death.ConclusionStrategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.

Introduction Current DLBCL prognostic scores are poor predictors of individual risk with 26% of "very good" and "good" risk patients having unfavourable outcomes. Hypercalcaemia has been associated with poor outcomes in several cancers including multiple myeloma, but is not included in current DLBCL prognostic scoring models. Aim To determine the prognostic significance of hypercalcaemia in newly diagnosed DLBCL and identify relationships between hypercalcaemia and other established prognostic variables including cell of origin, and the components of the revised international prognostic index (R-IPI including impaired performance status, older age, advanced stage, elevated lactate dehydrogenase, and extranodal involvement. Methods Retrospective cohort study at two academic healthcare networks in Melbourne, Australia. All patients with a newly diagnosed DLBCL by WHO 2008 criteria were eligible for inclusion. Cases were identified from hospital lymphoma databases. Only cases with adequate clinical information including baseline characteristics, therapy received and outcomes were included. Cell of origin was determined by the modified Hans criteria. At Monash Health, patients were included from September 2002 until December 2015, and from Western Health, patients were included from January 2012 until December 2015. Hypercalcaemia was defined as a serum calcium >2.6mmol/L within 30 days prior to, or 15 days following the diagnosis of DLBCL. Serum calcium levels were corrected for hypoalbuminaemia if present. Immunohistochemical cell of origin was recorded using modified Hans criteria (Meyer et al. 2011). Survival correlates were estimated by Kaplan-Meier log rank method. Multivariable analysis was performed by Cox regression. Relationships between serum calcium and other covariates were examined by t test for continuous variables and chi for categorical variables. This project was approved by the human research review boards at each institution. Results A total of 514 p

Previously, one of the proposed benefits of obesity was a reduced risk for osteoporotic fractures, accompanied by a higher bone mineral density, compared with non-obese age-matched peers. However, this hypothesis is not supported by the literature which has instead identified amore complex relationship. While obesity defined by body mass index (BMI) is generally associated with a lower fracture incidence, fracture risk at specific sites may be increased. In the Global Longitudinal Osteoporosis in Women (GLOW) study, fracture prevalence and incidence were similar for obese and non-obese women, however, the risk of incident ankle and upper leg fractures were significantly higher in obese. BMI is a better indicator of lean than fat mass and in over 43,000 Canadian older adults, higher lean mass was positively associated with femoral neck bone mineral density (BMD), whereas fat mass had no effect on BMD and adversely affected femoral strength index. Thus, higher lean mass, not fat mass, likely explains positive associations between higher BMI with BMD in older adults. Body fat distribution may be more predictive of osteoporotic fractures thanBMI. Men with higher levels of visceral adipose tissue have poorer bone mechanical properties, despite having similar BMD compared with those with low visceral adipose tissue. A recent meta-analysis also demonstrated that high waist circumference, a measure of abdominal adiposity, was associated with an almost 60% increased relative risk of hip fracture. While men in the underweight category have the highest incidence of hip fracture, most hip fractures occur in overweight or obese men. Metabolic and endocrine factors associated with an increased fracture risk in obesity include a higher risk of type 2 diabetes mellitus, lower vitamin D levels, lower testosterone levels in men, and a higher falls risk. Obesity can also be related to abnormalities in muscle mass and function, including intra-and inter-muscular adipose tissue infiltra

The original version of this article unfortunately contained an mistake in country name in all the affiliations. The county name was inadvertently published as USA, it should be Australia instead. The affiliations are corrected in this erratum.Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Introduction Current DLBCL prognostic scores are poor predictors of individual risk with 26% of "very good" and "good" risk patients having unfavourable outcomes. Hypercalcaemia has been associated with poor outcomes in several cancers including multiple myeloma, but is not included in current DLBCL prognostic scoring models. Aim To determine the prognostic significance of hypercalcaemia in newly diagnosed DLBCL and identify relationships between hypercalcaemia and other established prognostic variables including cell of origin, and the components of the revised international prognostic index (R-IPI including impaired performance status, older age, advanced stage, elevated lactate dehydrogenase, and extranodal involvement. Methods Retrospective cohort study at two academic healthcare networks in Melbourne, Australia. All patients with a newly diagnosed DLBCL by WHO 2008 criteria were eligible for inclusion. Cases were identified from hospital lymphoma databases. Only cases with adequate clinical information including baseline characteristics, therapy received and outcomes were included. Cell of origin was determined by the modified Hans criteria. At Monash Health, patients were included from September 2002 until December 2015, and from Western Health, patients were included from January 2012 until December 2015. Hypercalcaemia was defined as a serum calcium >2.6mmol/L within 30 days prior to, or 15 days following the diagnosis of DLBCL. Serum calcium levels were corrected for hypoalbuminaemia if present. Immunohistochemical cell of origin was recorded using modified Hans criteria (Meyer et al. 2011). Survival correlates were estimated by Kaplan-Meier log rank method. Multivariable analysis was performed by Cox regression. Relationships between serum calcium and other covariates were examined by t test for continuous variables and chi for categorical variables. This project was approved by the human research review boards at each institution. Results A total of 514 p

Previously, one of the proposed benefits of obesity was a reduced risk for osteoporotic fractures, accompanied by a higher bone mineral density, compared with non-obese age-matched peers. However, this hypothesis is not supported by the literature which has instead identified amore complex relationship. While obesity defined by body mass index (BMI) is generally associated with a lower fracture incidence, fracture risk at specific sites may be increased. In the Global Longitudinal Osteoporosis in Women (GLOW) study, fracture prevalence and incidence were similar for obese and non-obese women, however, the risk of incident ankle and upper leg fractures were significantly higher in obese. BMI is a better indicator of lean than fat mass and in over 43,000 Canadian older adults, higher lean mass was positively associated with femoral neck bone mineral density (BMD), whereas fat mass had no effect on BMD and adversely affected femoral strength index. Thus, higher lean mass, not fat mass, likely explains positive associations between higher BMI with BMD in older adults. Body fat distribution may be more predictive of osteoporotic fractures thanBMI. Men with higher levels of visceral adipose tissue have poorer bone mechanical properties, despite having similar BMD compared with those with low visceral adipose tissue. A recent meta-analysis also demonstrated that high waist circumference, a measure of abdominal adiposity, was associated with an almost 60% increased relative risk of hip fracture. While men in the underweight category have the highest incidence of hip fracture, most hip fractures occur in overweight or obese men. Metabolic and endocrine factors associated with an increased fracture risk in obesity include a higher risk of type 2 diabetes mellitus, lower vitamin D levels, lower testosterone levels in men, and a higher falls risk. Obesity can also be related to abnormalities in muscle mass and function, including intra-and inter-muscular adipose tissue infiltra