1 00:00:09,005 --> 00:00:11,207 WELCOME TO THE CLINICAL CENTER GRAND ROUNDS, 2 00:00:11,207 --> 00:00:15,011 A WEEKLY SERIES OF EDUCATIONAL LECTURES FOR PHYSICIANS AND 3 00:00:15,011 --> 00:00:17,647 HEALTH CARE PROFESSIONALS BROADCAST FROM THE CLINICAL 4 00:00:17,647 --> 00:00:20,617 CENTER AT THE NATIONAL INSTITUTES OF HEALTH IN 5 00:00:20,617 --> 00:00:22,419 BETHESDA, MD. 6 00:00:22,419 --> 00:00:25,955 THE NIH CLINICAL CENTER IS THE WORLD'S LARGEST HOSPITAL TOTALLY 7 00:00:25,955 --> 00:00:29,659 DEDICATED TO INVESTIGATIONAL RESEARCH AND LEADS THE GLOBAL 8 00:00:29,659 --> 00:00:32,595 EFFORT IN TRAINING TODAY'S INVESTIGATORS AND DISCOVERING 9 00:00:32,595 --> 00:00:34,764 TOMORROW'S CURES. 10 00:00:34,764 --> 00:00:44,062 LEARN MORE BY VISITING US ONLINE AT HTTP://CLINICALCENTER.NIH.GOV 11 00:00:44,062 --> 00:00:46,231 GOOD AFTERNOON AND WELCOME TO 12 00:00:46,231 --> 00:00:52,337 TODAY CLINICAL CENTER GRAND 13 00:00:52,337 --> 00:00:58,309 GROUNDS THE CME CODE IS 50560 14 00:00:58,309 --> 00:01:00,278 AND TEXT IT TO THE CODE ON THE 15 00:01:00,278 --> 00:01:02,447 SLIDE TO RECEIVE CREDIT. 16 00:01:02,447 --> 00:01:03,948 SCAN THE QR CODE SHOWN ON THE 17 00:01:03,948 --> 00:01:05,016 CME SLIDE. 18 00:01:05,016 --> 00:01:07,552 FOR THOSE APPLYING FOR CME, 19 00:01:07,552 --> 00:01:09,454 YOU'LL RECEIVE A FEEDBACK SURVEY 20 00:01:09,454 --> 00:01:11,256 LINK VIA E-MAIL. 21 00:01:11,256 --> 00:01:13,725 THE SURVEY WILL PROVIDE US WITH 22 00:01:13,725 --> 00:01:15,193 IMPORTANT FEEDBACK ABOUT THE 23 00:01:15,193 --> 00:01:17,028 PRESENTATION AND SUBMIT 24 00:01:17,028 --> 00:01:18,596 SUGGESTIONS FOR FUTURE GRAND 25 00:01:18,596 --> 00:01:20,799 ROUNDS TOPICS. 26 00:01:20,799 --> 00:01:21,599 FOLLOWING THE PRESENTATION 27 00:01:21,599 --> 00:01:23,401 QUESTIONS WILL BE TAKEN FROM THE 28 00:01:23,401 --> 00:01:26,704 MICROPHONES IN THE AISLES. 29 00:01:26,704 --> 00:01:27,806 AND VIDEOCAST VIEWERS MAY SUBMIT 30 00:01:27,806 --> 00:01:29,674 QUESTIONS ANY TIME BY CLICKING 31 00:01:29,674 --> 00:01:32,844 LIVE FEEDBACK BUTTON ON THE 32 00:01:32,844 --> 00:01:33,344 VIDEOCAST WEBSITE. 33 00:01:33,344 --> 00:01:34,379 QUESTIONS WILL BE ANSWERED AS 34 00:01:34,379 --> 00:01:35,513 TIME PERMITS AT THE CONCLUSION 35 00:01:35,513 --> 00:01:38,783 OF THE PRESENTATION. 36 00:01:38,783 --> 00:01:40,718 TODAY WE ARE HONORED TO HOST 37 00:01:40,718 --> 00:01:43,087 DR. CATHERINE GORDON THE 38 00:01:43,087 --> 00:01:45,490 CLINICAL DIRECTOR AND SENIOR 39 00:01:45,490 --> 00:01:47,659 INVESTIGATOR IN THE DIVISION OF 40 00:01:47,659 --> 00:01:49,194 INTRAMURAL RESEARCH AT THE 41 00:01:49,194 --> 00:01:49,861 EUNICE KENNEDY SHRIVER NATIONAL 42 00:01:49,861 --> 00:01:51,663 INSTITUTE OF CHILD HEALTH AND 43 00:01:51,663 --> 00:01:52,630 HUMAN DEVELOPMENT. 44 00:01:52,630 --> 00:01:55,300 SHE RECEIVE HER BACHELOR'S FROM 45 00:01:55,300 --> 00:01:56,034 NORTH CAROLINA STATE UNIVERSITY 46 00:01:56,034 --> 00:01:58,036 AND HER MEDICAL DEGREE FROM THE 47 00:01:58,036 --> 00:02:00,972 UNIVERSITY OF NORTH CAROLINA AT 48 00:02:00,972 --> 00:02:06,845 CHAPEL HILL AND COMPLETED HER 49 00:02:06,845 --> 00:02:11,516 FELLOWSHIP IN CAN ADOLESCENT 50 00:02:11,516 --> 00:02:13,251 MEDICINE BOSTON HOSPITAL AND 51 00:02:13,251 --> 00:02:14,719 SUBSEQUENTLY JOINED THE FACULTY 52 00:02:14,719 --> 00:02:16,654 AT HARVARD RISING TO ASSOCIATE 53 00:02:16,654 --> 00:02:18,423 PROFESSOR OF PEDIATRICS BEFORE 54 00:02:18,423 --> 00:02:20,091 BEING APPOINTED TO PROFESSOR OF 55 00:02:20,091 --> 00:02:22,026 PEDIATRICS AT THE MEDICAL SCHOOL 56 00:02:22,026 --> 00:02:23,461 OF BROWN UNIVERSITY THEN THE 57 00:02:23,461 --> 00:02:25,296 UNIVERSITY OF CINCINNATI, 58 00:02:25,296 --> 00:02:26,898 HARVARD AND FINALLY THE BAYLOR 59 00:02:26,898 --> 00:02:30,368 COLLEGE OF MEDICINE BEFORE 60 00:02:30,368 --> 00:02:32,303 JOINING NICHD AS THE CLINICAL 61 00:02:32,303 --> 00:02:34,839 DIRECTOR IN SEPTEMBER 2023. 62 00:02:34,839 --> 00:02:37,609 SHE'S BOARD CERTIFIED IN 63 00:02:37,609 --> 00:02:42,046 PEDIATRIC ENCRINOLOGY AND 64 00:02:42,046 --> 00:02:43,681 ADOLESCENT MEDICINE AND HAS 65 00:02:43,681 --> 00:02:45,984 WORKED IN SCIENTIFIC MENTORING 66 00:02:45,984 --> 00:02:46,918 AND DIRECTED BONE HEALTH 67 00:02:46,918 --> 00:02:48,419 PROGRAMS AND CLINICAL RESEARCH 68 00:02:48,419 --> 00:02:51,256 CENTERS, CLINICAL DIVISIONS AND 69 00:02:51,256 --> 00:02:52,790 PEDIATRICS DEPARTMENT. 70 00:02:52,790 --> 00:02:55,460 SHE PROVIDED CLINICAL CARE TO 71 00:02:55,460 --> 00:02:57,362 CHILDREN AND ADOLESCENTS AND IS 72 00:02:57,362 --> 00:02:58,763 AN ADOLESCENT MEDICINE 73 00:02:58,763 --> 00:03:01,032 SPECIALIST AND RESEARCH ENJOYED 74 00:03:01,032 --> 00:03:04,402 SUPPORT FROM THE NIH, DEPARTMENT 75 00:03:04,402 --> 00:03:06,404 OF DEFENSE AND HER RESEARCH 76 00:03:06,404 --> 00:03:08,573 FOCUSES ON THE MODIFIABLE FACTOR 77 00:03:08,573 --> 00:03:11,676 DURING ADOLESCENT THAT INFLUENCE 78 00:03:11,676 --> 00:03:14,946 BONE DENSE ITY AND OTHER ASPECT 79 00:03:14,946 --> 00:03:16,281 OF HEALTH AND OPTIMIZING THE 80 00:03:16,281 --> 00:03:17,515 TRANSITION OF HEALTH CARE FOR 81 00:03:17,515 --> 00:03:18,416 YOUNG ADULTS. 82 00:03:18,416 --> 00:03:22,921 HER GROUP STUDIES DISEASE MODELS 83 00:03:22,921 --> 00:03:28,126 FOR ANOREXIA NERVOSA AND BONE 84 00:03:28,126 --> 00:03:34,732 INEFFICIENCY AND ENDOMETRIOSIS 85 00:03:34,732 --> 00:03:36,267 AND LOOKS AT PEDIATRIC CHRONIC 86 00:03:36,267 --> 00:03:39,904 DISEASE GROUP AND HOW 87 00:03:39,904 --> 00:03:41,806 MEDICATIONS MAY AFFECT BONE 88 00:03:41,806 --> 00:03:46,945 HEALTH IN CHILDREN AND 89 00:03:46,945 --> 00:03:48,413 ADOLESCENTS. 90 00:03:48,413 --> 00:03:51,749 SHE RECEIVED AN AWARD FOR 91 00:03:51,749 --> 00:03:53,217 OUTSTANDING MEDICINE AND 92 00:03:53,217 --> 00:03:55,420 AUTHORED OVER 200 MAN YU 93 00:03:55,420 --> 00:03:58,156 AUTHORED OVER 200 MAN SCRIPTS 94 00:03:58,156 --> 00:04:01,859 AND BOOK CHAPTERS AND HAS BEEN 95 00:04:01,859 --> 00:04:05,496 AN EDITOR OF NUMEROUS BOARD 96 00:04:05,496 --> 00:04:08,399 PANELS AND SERVED ON THE 97 00:04:08,399 --> 00:04:10,201 ADOLESCENT AND YOUNG ADULT 98 00:04:10,201 --> 00:04:12,303 HEALTH CARE BOARD AND THE TITLE 99 00:04:12,303 --> 00:04:13,338 OF HER PRESENTATION IS 100 00:04:13,338 --> 00:04:13,972 ADOLESCENT BONE HEALTH. 101 00:04:13,972 --> 00:04:15,340 JOIN ME IN WELCOMING OUR 102 00:04:15,340 --> 00:04:25,583 SPEAKER, DR. GORDON. 103 00:04:25,583 --> 00:04:28,353 >> THANK YOU, TOM, FOR THE 104 00:04:28,353 --> 00:04:29,320 SPECIAL INTRODUCTION AND THANK 105 00:04:29,320 --> 00:04:31,456 YOU FOR COMING THOSE HERE AND 106 00:04:31,456 --> 00:04:38,630 ALSO ONLINE WITH US. 107 00:04:38,630 --> 00:04:40,331 OVER THE NEXT 45 MINUTES OR SO 108 00:04:40,331 --> 00:04:42,233 AND I'LL LEAVE TIME FOR 109 00:04:42,233 --> 00:04:43,668 QUESTIONS BECAUSE I WANT THIS TO 110 00:04:43,668 --> 00:04:46,204 BE AN INTERACTIVE DISCUSSION AND 111 00:04:46,204 --> 00:04:48,439 THINK OF BONE DENSITY AND BODY 112 00:04:48,439 --> 00:04:49,707 COMPOSITION IN CHILDREN AND 113 00:04:49,707 --> 00:04:54,545 ADOLESCENTS GROWING AND THINK 114 00:04:54,545 --> 00:04:57,582 ABOUT THREE DIAGNOSES AND 115 00:04:57,582 --> 00:04:59,550 TREATMENTS THAT CLEARLY HAVE AN 116 00:04:59,550 --> 00:05:01,753 AFFECT ON BONE HEALTH. 117 00:05:01,753 --> 00:05:12,296 FIRST ANOREXIA NERVOSA AND LEADS 118 00:05:12,497 --> 00:05:17,235 AND PUBERTAL BLOCKADE IN 119 00:05:17,235 --> 00:05:21,105 TRANSGENDER YOUTH AND CAN HELP 120 00:05:21,105 --> 00:05:24,108 PREMATURE CHILDREN AND PREMATURE 121 00:05:24,108 --> 00:05:25,076 OVARIAN INSUFFICIENCY. 122 00:05:25,076 --> 00:05:28,746 I'M LEAVE YOU WITH PROVOCATIVE 123 00:05:28,746 --> 00:05:30,314 NEW RESEARCH WITH SKIN TONE AND 124 00:05:30,314 --> 00:05:31,916 PIGMENTATION AND BONE HEALTH. 125 00:05:31,916 --> 00:05:34,952 SO AS I'M SPEAKING REMEMBER I 126 00:05:34,952 --> 00:05:36,454 REALIZE THERE ARE PEOPLE AT NIH 127 00:05:36,454 --> 00:05:38,990 THAT HAVE MANY BACKGROUNDS AND 128 00:05:38,990 --> 00:05:40,558 SKILL SETS SO I'M TALKING TODAY 129 00:05:40,558 --> 00:05:43,027 THROUGH THE LENS OF A PEDIATRIC 130 00:05:43,027 --> 00:05:46,431 ENDOCRINOLOGIST AND ADOLESCENT 131 00:05:46,431 --> 00:05:46,998 HEALTH SPECIALIST. 132 00:05:46,998 --> 00:05:50,601 SO I ALWAYS LIKE TO START WITH 133 00:05:50,601 --> 00:05:53,004 THE SLIDE ADOLESCENCE IS A 134 00:05:53,004 --> 00:05:55,373 CRITICAL TIME FOR BONE HEALTH. 135 00:05:55,373 --> 00:05:59,043 THIS IS BONE MASS AND THE Y AXIS 136 00:05:59,043 --> 00:06:01,679 IN AGE IN YEARS AND SEE THE 137 00:06:01,679 --> 00:06:03,915 SLOPE OF THE LINE IS VERY STEEP 138 00:06:03,915 --> 00:06:05,983 BETWEEN 10 AND 20 THE ADOLESCENT 139 00:06:05,983 --> 00:06:09,821 YOUNG ADULT PERIOD AT LEAST HALF 140 00:06:09,821 --> 00:06:11,122 THE SKELETON SHOULD BE LAID DOWN 141 00:06:11,122 --> 00:06:12,657 DURING THAT PERIOD AND THIS 142 00:06:12,657 --> 00:06:14,392 MIRRORS THE GROWTH CURVES THAT 143 00:06:14,392 --> 00:06:17,428 WE USE AS PEDIATRIC 144 00:06:17,428 --> 00:06:17,795 ENDOCRINOLOGIST. 145 00:06:17,795 --> 00:06:20,798 CHILDREN SHOULD BE GROWING, 146 00:06:20,798 --> 00:06:26,337 DEVELOPING AND ADOLESCENTS ARE 147 00:06:26,337 --> 00:06:27,371 REACHING THEIR HIGHEST BONE 148 00:06:27,371 --> 00:06:28,506 DENSITY OF THE PEAK BONE MASS 149 00:06:28,506 --> 00:06:31,709 AROUND THE AGE OF 20 AND 150 00:06:31,709 --> 00:06:32,376 UNFORTUNATELY FOR BOTH GROUPS 151 00:06:32,376 --> 00:06:35,880 ALL OF US ARE GOING TO LOSE BONE 152 00:06:35,880 --> 00:06:37,548 EVENTUALLY SO I'M OFTEN TALKING 153 00:06:37,548 --> 00:06:39,650 TO YOUNG PEOPLE ABOUT THE BONE 154 00:06:39,650 --> 00:06:40,818 BANK ABOUT GETTING AS MUCH AS 155 00:06:40,818 --> 00:06:43,254 BONE IN YOUR BANK BY EATING WELL 156 00:06:43,254 --> 00:06:45,723 AND EXERCISING AND BY MANAGING 157 00:06:45,723 --> 00:06:46,557 THE CHRONIC HEALTH CONDITION 158 00:06:46,557 --> 00:06:47,658 THAT MAY BE PUTTING THEM AT 159 00:06:47,658 --> 00:06:51,329 RISK. 160 00:06:51,329 --> 00:06:53,097 I'VE HAD A WONDERFUL OPPORTUNITY 161 00:06:53,097 --> 00:06:57,568 COMING OUT OF MY FELLOWSHIP AT 162 00:06:57,568 --> 00:06:59,403 BOSTON CHILDREN'S TO FOUND THE 163 00:06:59,403 --> 00:07:01,906 BONE HEALTH PROGRAM THERE MANY 164 00:07:01,906 --> 00:07:03,541 YEARS AGO. 165 00:07:03,541 --> 00:07:06,444 WHEN I WAS TRAINING OSTEOPOROSIS 166 00:07:06,444 --> 00:07:08,146 WAS A CONSIDERATION OF FOCUS OF 167 00:07:08,146 --> 00:07:11,349 ADULT PROVIDERS. 168 00:07:11,349 --> 00:07:13,251 OB-GYN AND INTERNAL MEDICINE 169 00:07:13,251 --> 00:07:16,754 SPECIALISTS AND I'VE BEEN ON A 170 00:07:16,754 --> 00:07:20,124 MISSION TO RAISE AWARENESS OF 171 00:07:20,124 --> 00:07:21,692 THE CHILDHOOD AND ADOLESCENCE 172 00:07:21,692 --> 00:07:23,661 YEAR AS PREVENTION FOR HEALTH 173 00:07:23,661 --> 00:07:27,298 ISSUES AND A TIME TO OPTIMIZE 174 00:07:27,298 --> 00:07:28,533 PEAK BONE MASS WE JUST TALKED 175 00:07:28,533 --> 00:07:28,733 ABOUT. 176 00:07:28,733 --> 00:07:29,867 OVER THE COURSE OVER THE TALK 177 00:07:29,867 --> 00:07:32,370 WE'LL TALK ABOUT THE TOOLS THAT 178 00:07:32,370 --> 00:07:33,938 WE'VE BEEN PIONEERING AND IN 179 00:07:33,938 --> 00:07:36,407 PARTICULAR TRYING TO GET AWAY 180 00:07:36,407 --> 00:07:38,609 INTEREST INVASIVE BONE BIOPSIES. 181 00:07:38,609 --> 00:07:40,945 THAT USED TO BE THE WAY WHEN I 182 00:07:40,945 --> 00:07:43,614 WAS IN MEDICAL SCHOOL WHERE WE 183 00:07:43,614 --> 00:07:46,250 ASSESSED THE SKELETON AND WHAT 184 00:07:46,250 --> 00:07:48,553 CAN WE DO NONINVASIVELY BECAUSE 185 00:07:48,553 --> 00:07:50,321 CHILDREN WON'T COME BACK IF WE 186 00:07:50,321 --> 00:07:54,625 DO SOMETHING INVASIVE. 187 00:07:54,625 --> 00:07:58,563 THESE ARE MODELS AROUND IT'S A 188 00:07:58,563 --> 00:07:59,730 BUSY SLIDE OF AT RISK CHILDREN 189 00:07:59,730 --> 00:08:01,899 AND ADOLESCENTS. 190 00:08:01,899 --> 00:08:04,235 IN THE ACADEMIC CENTERS AND 191 00:08:04,235 --> 00:08:07,338 PRACTICES AND AT THE CLINICAL 192 00:08:07,338 --> 00:08:08,739 CENTER, CHILDREN AND ADOLESCENTS 193 00:08:08,739 --> 00:08:10,975 WE MAY SEE THE BOLDED DIAGNOSES 194 00:08:10,975 --> 00:08:12,743 ARE THOSE THAT TOM MENTIONED. 195 00:08:12,743 --> 00:08:15,213 SOME I HAVE STUDIED, MY RESEARCH 196 00:08:15,213 --> 00:08:16,447 GROUP HAS FOCUSSED ON AND TODAY 197 00:08:16,447 --> 00:08:18,449 AS I MENTIONED WE'RE GOING TO 198 00:08:18,449 --> 00:08:23,321 THINK ABOUT RESEARCH OF EATING 199 00:08:23,321 --> 00:08:33,831 DISORDERS, PUBERTAL BLOCKADE. 200 00:08:34,465 --> 00:08:36,133 I SAW MANY PATIENTS WITH 201 00:08:36,133 --> 00:08:39,070 ANOREXIA AND AMENORRHEA AND GOT 202 00:08:39,070 --> 00:08:41,305 INTERESTED IN THE MENSTRUAL 203 00:08:41,305 --> 00:08:41,572 COMPONENT. 204 00:08:41,572 --> 00:08:44,075 THERE USED TO BE WHAT WAS CALLED 205 00:08:44,075 --> 00:08:47,645 THE FEMALE ATHLETE TRIAD WHICH 206 00:08:47,645 --> 00:08:50,815 MIGRATED TO A NEW TERMINOLOGY 207 00:08:50,815 --> 00:08:54,051 ENERGY DEFICIENCY IN SPORT AND 208 00:08:54,051 --> 00:08:57,154 IMPORTANT TO DETECT IN YOUNG 209 00:08:57,154 --> 00:08:57,455 ADOLESCENTS. 210 00:08:57,455 --> 00:08:59,590 IN FACT THERE'S A CAMPAIGN TO 211 00:08:59,590 --> 00:09:01,926 HAVE THE MENSTRUAL CYCLE AND 212 00:09:01,926 --> 00:09:04,295 ASKING ABOUT IT AS IMPORTANT AS 213 00:09:04,295 --> 00:09:05,596 CHECKING FOR BLOOD PRESSURE OR 214 00:09:05,596 --> 00:09:05,796 PULSE. 215 00:09:05,796 --> 00:09:08,432 IT SHOULD BE A VITAL SIGN 216 00:09:08,432 --> 00:09:12,436 BECAUSE IT COULD BE AN EARLY 217 00:09:12,436 --> 00:09:15,539 SIGN OF ESTROGEN DEFICIENCY AND 218 00:09:15,539 --> 00:09:17,842 IT COULD BE EXERCISE INDUCED AND 219 00:09:17,842 --> 00:09:19,644 WEIGHT LOSS AND MANY ADOLESCENTS 220 00:09:19,644 --> 00:09:23,614 HAVE A COMBINATION OF ALL THREE. 221 00:09:23,614 --> 00:09:31,656 THIS IS A GREAT FIGURE BY MARY 222 00:09:31,656 --> 00:09:37,495 JANE D'SOUZA AT PENN STATE AND 223 00:09:37,495 --> 00:09:48,039 WE WANT ALL TO HAVE NORMAL ME 224 00:09:51,709 --> 00:09:56,013 MENSES AND THIS IS WHERE WE HAVE 225 00:09:56,013 --> 00:09:58,115 THE LOW ENERGY AVAILABILITY AND 226 00:09:58,115 --> 00:10:00,051 PUTS THEM AT RISK FOR 227 00:10:00,051 --> 00:10:00,584 OSTEOPOROSIS. 228 00:10:00,584 --> 00:10:02,153 IT SHOWS AS A SPECTRUM. 229 00:10:02,153 --> 00:10:11,495 I LIKE THE SLOPE OF THE LINE. 230 00:10:11,495 --> 00:10:13,764 ARCHED WE NEED TO GET THEM TO 231 00:10:13,764 --> 00:10:15,733 THE GREEN ZONE AND IF WE DON'T 232 00:10:15,733 --> 00:10:18,569 KEEP AN EYE ON THEM THEY CAN 233 00:10:18,569 --> 00:10:20,438 SLIP BACK DOWN. 234 00:10:20,438 --> 00:10:23,975 HOW DO WE EVALUATE BONE HEALTH 235 00:10:23,975 --> 00:10:24,976 IN CHILDREN? 236 00:10:24,976 --> 00:10:27,678 AS I MENTIONED I HAVE TO SHOW 237 00:10:27,678 --> 00:10:29,981 THIS WE LOOK AT GROWTH CHARTS 238 00:10:29,981 --> 00:10:32,616 AND STUDY GROWTH CHART AND THINK 239 00:10:32,616 --> 00:10:36,487 OF THE GAIN IN WEIGHT AND HEIGHT 240 00:10:36,487 --> 00:10:37,788 AND THINK OF THE GRID VELOCITY 241 00:10:37,788 --> 00:10:41,959 AND AS I MENTIONED EARLIER THAT 242 00:10:41,959 --> 00:10:46,263 SHOULD MIRROR THE BONE ACCRUAL 243 00:10:46,263 --> 00:10:50,368 CURVE AS DEXTA MEASUREMENTS AND 244 00:10:50,368 --> 00:10:54,005 A PATIENT OF MINE AT 14 1/2 HAD 245 00:10:54,005 --> 00:11:00,011 ANOREXIA AND CAME TO MY PRACTICE 246 00:11:00,011 --> 00:11:03,180 AND STARTED TO LOSE BONE AND HER 247 00:11:03,180 --> 00:11:03,814 GROWTH CHART LOOKED DIFFERENT 248 00:11:03,814 --> 00:11:08,519 WITH THE PLATEAU OF HER WEIGHT. 249 00:11:08,519 --> 00:11:11,655 AND HOW DO WE MEASURE BONE 250 00:11:11,655 --> 00:11:11,889 HEALTH? 251 00:11:11,889 --> 00:11:19,663 HOW DO WE DO THAT NON INVASIVELY 252 00:11:19,663 --> 00:11:30,207 AND WE LOOK AT DUAL-ENERGY X-RAY 253 00:11:30,541 --> 00:11:40,751 ABSORPTIOMETRY. 254 00:11:43,721 --> 00:11:49,493 WE LOOK AT THE MUSCLES AND WHAT 255 00:11:49,493 --> 00:11:51,462 AFFECTS THE BONE. 256 00:11:51,462 --> 00:11:54,498 AND DXA HAS A TWO MEASURE OF 257 00:11:54,498 --> 00:11:55,132 BONE DENSITY. 258 00:11:55,132 --> 00:11:57,568 WE USE IT BECAUSE WE CAN GET 259 00:11:57,568 --> 00:12:02,673 AWAY WITH A TINY RADIATION DOSE 260 00:12:02,673 --> 00:12:05,376 AND HAVE PEDIATRIC REFERENCE 261 00:12:05,376 --> 00:12:06,444 DATA AND KNOW HOW TO INTERPRET 262 00:12:06,444 --> 00:12:09,947 THE MEASUREMENTS BASED ON THE 263 00:12:09,947 --> 00:12:13,818 WEALTH OF DATA IN ALMOST 2,000 264 00:12:13,818 --> 00:12:14,085 CHILDREN. 265 00:12:14,085 --> 00:12:15,920 CHILDREN AND ADOLESCENTS WITH A 266 00:12:15,920 --> 00:12:17,922 CHRONIC DISEASE CAN HAVE A 267 00:12:17,922 --> 00:12:19,657 DISTORT THE BODY COMPOSITION 268 00:12:19,657 --> 00:12:30,201 WHICH AFFECTS THE BONE HEALTH SO 269 00:12:30,701 --> 00:12:35,372 WHAT DO WE DO WITH THE 270 00:12:35,372 --> 00:12:38,676 MEASUREMENTS AND THE ISCT 271 00:12:38,676 --> 00:12:39,677 DEFINES OSTEOPOROSIS IN A 272 00:12:39,677 --> 00:12:47,651 PEDIATRIC PATIENT AS YOU LOOK AT 273 00:12:47,651 --> 00:12:49,954 THE Z SCORE FROM THE DXA SCAN 274 00:12:49,954 --> 00:12:54,158 AND HAVE TO HAVE SIGNS OF 275 00:12:54,158 --> 00:12:55,326 SKELETAL FERTILITY AND WE DON'T 276 00:12:55,326 --> 00:12:56,760 JUST TREAT THE SCAN BUT PATIENT. 277 00:12:56,760 --> 00:13:02,833 THE CHILD HAS TO HAVE CLINICALLY 278 00:13:02,833 --> 00:13:06,470 SIGNIFICANT FRACTURES TWO OR 279 00:13:06,470 --> 00:13:11,509 MORE BY THE TIME THEIR 10 AND 280 00:13:11,509 --> 00:13:15,379 DEFINE MANY THE LOW ABOUT BMD AS 281 00:13:15,379 --> 00:13:17,281 A LOW SCORE OF 2. 282 00:13:17,281 --> 00:13:19,550 THE AMERICAN COLLEGE OF SPORTS 283 00:13:19,550 --> 00:13:20,951 MEDICINE SAYS AN ATHLETE IS 284 00:13:20,951 --> 00:13:26,957 WEIGHT BEARING MORE THAN A 285 00:13:26,957 --> 00:13:29,393 TYPICAL CHILD OR ADOLESCENT. 286 00:13:29,393 --> 00:13:32,429 AT MINUS ONE IS A CHILD THEY'D 287 00:13:32,429 --> 00:13:33,998 PUT ON WATCH. 288 00:13:33,998 --> 00:13:39,336 MINUS 1 TO MINUS 1.9 IS LOW DONE 289 00:13:39,336 --> 00:13:43,040 DENSITY AND OSTEOPOROSIS IS 290 00:13:43,040 --> 00:13:44,041 MINUS 2. 291 00:13:44,041 --> 00:13:45,209 IT'S IMPORTANT TO TAKE THE 292 00:13:45,209 --> 00:13:46,877 HISTORY AND WHAT DO YOU LIKE TO 293 00:13:46,877 --> 00:13:48,078 DO IN YOUR SPARE TIME? 294 00:13:48,078 --> 00:13:50,781 WHAT ACTIVITIES ARE YOU INVOLVED 295 00:13:50,781 --> 00:13:52,049 WITH IN SCHOOL AND HOW MUCH DO 296 00:13:52,049 --> 00:13:55,920 YOU BECAUSE IT'S GOING TO CHANGE 297 00:13:55,920 --> 00:14:03,861 HOW WE INTERPRET THE DXA SCAN. 298 00:14:03,861 --> 00:14:06,463 BEYOND DXA THERE'S BEEN A MOVE 299 00:14:06,463 --> 00:14:07,631 IN THE BONE FIELD. 300 00:14:07,631 --> 00:14:08,532 IT'S CLINICALLY RELEVANT BUT 301 00:14:08,532 --> 00:14:10,968 WHAT'S GOING ON INSIDE THE BONE 302 00:14:10,968 --> 00:14:12,269 AND WHAT ABOUT THE 303 00:14:12,269 --> 00:14:13,470 MICROARCHITECTURE AND STRUCTURE 304 00:14:13,470 --> 00:14:16,073 OF BONE ITSELF DRIVING OUR 305 00:14:16,073 --> 00:14:16,740 RESEARCH? 306 00:14:16,740 --> 00:14:19,410 SO THE FIRST TOOL THAT I HAVE 307 00:14:19,410 --> 00:14:21,745 THE OPPORTUNITY TO WORK WITH 308 00:14:21,745 --> 00:14:24,582 ACTUALLY GIVEN TO ME BY A 309 00:14:24,582 --> 00:14:25,649 GRATEFUL PATIENT AT BOSTON 310 00:14:25,649 --> 00:14:25,950 CHILDREN'S. 311 00:14:25,950 --> 00:14:27,484 I'M THANKFUL FOR THAT. 312 00:14:27,484 --> 00:14:30,654 IT WAS A STANDARD PERIPHERAL 313 00:14:30,654 --> 00:14:33,891 SCANNER IN WHICH WE WERE ABLE TO 314 00:14:33,891 --> 00:14:36,994 GET ARM AND LEG MEASUREMENT. 315 00:14:36,994 --> 00:14:39,563 THE RADIUS IN THE TIBIA IN 316 00:14:39,563 --> 00:14:41,498 PATIENTS WE WERE FOLLOWING WITH 317 00:14:41,498 --> 00:14:44,401 ANOREXIA NERVOSA AND OTHER 318 00:14:44,401 --> 00:14:47,571 DISEASES AND IT'S A THREE 319 00:14:47,571 --> 00:14:48,505 DIMENSIONAL MEASUREMENT BUT 320 00:14:48,505 --> 00:14:54,011 BECAUSE IT'S AN EXTREMITY IT'S 321 00:14:54,011 --> 00:14:56,447 IT'S AWAY FROM THE CENTRAL 322 00:14:56,447 --> 00:15:01,485 ORGANS AND MINIMAL SIGNIFICANT 323 00:15:01,485 --> 00:15:03,887 IONIZING RADIATION AND GETS TO 324 00:15:03,887 --> 00:15:06,190 THE COMPARTMENT OF BONE ABOUT 325 00:15:06,190 --> 00:15:08,726 20% OF THE SKELETON AND THE 326 00:15:08,726 --> 00:15:10,861 CORTICAL COMPARTMENT WHICH IS 327 00:15:10,861 --> 00:15:11,028 80%. 328 00:15:11,028 --> 00:15:12,896 IT CAN BE VERY HELPFUL TO TRACK 329 00:15:12,896 --> 00:15:14,632 WITH AN UNDERSTANDING OF THE 330 00:15:14,632 --> 00:15:16,333 DISEASE PROCESS THE TWO 331 00:15:16,333 --> 00:15:19,670 COMPARTMENTS AND IN PARTICULAR 332 00:15:19,670 --> 00:15:22,373 WHAT HAPPENS WHEN WE START AN 333 00:15:22,373 --> 00:15:23,641 INTERVENTION SUCH AS A NEW 334 00:15:23,641 --> 00:15:26,977 HORMONAL THERAPY. 335 00:15:26,977 --> 00:15:32,416 THEN OVER THE YEARS THE DREAM 336 00:15:32,416 --> 00:15:34,118 MACHINE EVOLVED HIGH RESOLUTION 337 00:15:34,118 --> 00:15:36,020 AND SOME KNOW WE HAVE ONE OF 338 00:15:36,020 --> 00:15:38,656 THESE SCANNERS ON THE 7th FLOOR 339 00:15:38,656 --> 00:15:39,790 IN A STORAGE AREA THAT THE GOING 340 00:15:39,790 --> 00:15:40,791 TO BE ROLLED OUT. 341 00:15:40,791 --> 00:15:46,597 I SAW MY PROGRAM OFFICER COMING 342 00:15:46,597 --> 00:15:52,102 HERE AND PROBABLY WILL BE ABLE 343 00:15:52,102 --> 00:15:54,438 TO START SCANNING PATIENTS IN 344 00:15:54,438 --> 00:15:58,075 SEPTEMBER AND GIVES A BONE 345 00:15:58,075 --> 00:15:59,610 BIOPSY AND SEE THE RESOLUTION OF 346 00:15:59,610 --> 00:16:01,945 THE IMAGES AND WE CAN SEE HOW 347 00:16:01,945 --> 00:16:05,482 THE BONE IS WOVEN TOGETHER. 348 00:16:05,482 --> 00:16:08,285 IT'S A CORTICAL SHELL AND LOOK 349 00:16:08,285 --> 00:16:11,989 AT THE UPPER EXTREMITY AND 350 00:16:11,989 --> 00:16:14,825 RADIUS AND LOWER EXTREMITY AND 351 00:16:14,825 --> 00:16:15,826 LOOK AT WEIGHT BEARING VERSUS 352 00:16:15,826 --> 00:16:22,733 NOT AND WHETHER IT MAKES A 353 00:16:22,733 --> 00:16:23,067 DIFFERENCE. 354 00:16:23,067 --> 00:16:24,134 WE CAN COMFORTABLY MEASURE 355 00:16:24,134 --> 00:16:26,603 PATIENTS AND WE GET THE LEG 356 00:16:26,603 --> 00:16:28,405 COMFORTABLE IN THE SCANNER AND 357 00:16:28,405 --> 00:16:30,507 WHAT'S NICE FROM A SAFETY 358 00:16:30,507 --> 00:16:31,542 STANDPOINT THERE'S VERY LITTLE 359 00:16:31,542 --> 00:16:34,511 RADIATION EMITTED BECAUSE THAT 360 00:16:34,511 --> 00:16:37,481 THE EXTREMITY GOES INSIDE THE 361 00:16:37,481 --> 00:16:40,250 SCANNER AND SELF SHIELDS AND 362 00:16:40,250 --> 00:16:41,719 MAKE THE RADIATION COMMITTEE 363 00:16:41,719 --> 00:16:41,919 HAPPY. 364 00:16:41,919 --> 00:16:43,520 IT'S EASIER TO FIND A PLACE IN 365 00:16:43,520 --> 00:16:45,055 THE CLINICAL CENTER AND ACADEMIC 366 00:16:45,055 --> 00:16:45,589 CENTER FOR THESE. 367 00:16:45,589 --> 00:16:50,961 I WANT TO SHOW OFF THE SCANNER 368 00:16:50,961 --> 00:16:55,366 AND I WANT SO SHOW OFF THE 369 00:16:55,366 --> 00:17:03,640 SCANNER AND THANK YOU TO DIANA 370 00:17:03,640 --> 00:17:04,808 BIANCHI AND THE DIVISION BECAUSE 371 00:17:04,808 --> 00:17:09,179 FOR GETTING THE SCANNER. 372 00:17:09,179 --> 00:17:10,447 MASS GENERAL HOSPITAL IN BOSTON 373 00:17:10,447 --> 00:17:12,616 I HAD TO WORK WITH AN ADULT 374 00:17:12,616 --> 00:17:15,519 GROUP OF PATIENTS WITH CYSTIC 375 00:17:15,519 --> 00:17:15,786 FIBROSIS. 376 00:17:15,786 --> 00:17:17,154 I PROBABLY DON'T NEED TO POINT 377 00:17:17,154 --> 00:17:19,757 TO IT, THIS IS A 28-YEAR-OLD 378 00:17:19,757 --> 00:17:22,593 WITH CF AND THIS IS A HEALTHY 379 00:17:22,593 --> 00:17:24,261 CONTROL AND THE ADULT. 380 00:17:24,261 --> 00:17:28,232 WE'RE ALSO ABLE TO COLOR THE ROD 381 00:17:28,232 --> 00:17:30,234 AND PLATE LIKE STRUCTURES THAT 382 00:17:30,234 --> 00:17:32,035 EXPLAIN THE MICROARCHITECTURE 383 00:17:32,035 --> 00:17:34,772 AND SEE CLEARLY HOW THEY DROP 384 00:17:34,772 --> 00:17:35,906 OUT IN THE YOUNG ADULT WITH 385 00:17:35,906 --> 00:17:36,407 CHRONIC DISEASE. 386 00:17:36,407 --> 00:17:38,709 OTHER PICTURES THAT SHOW YOU 387 00:17:38,709 --> 00:17:41,445 SOME OF THE MICROARCHITECTURE 388 00:17:41,445 --> 00:17:43,180 AND IN PARTICULAR THE CORTICAL 389 00:17:43,180 --> 00:17:45,682 RIM OF THE BONE WHICH CAN BE 390 00:17:45,682 --> 00:17:48,318 VERY IMPORTANT FOR FRACTURE RISK 391 00:17:48,318 --> 00:17:52,222 IF IT THINS THEN THE BONE IS APT 392 00:17:52,222 --> 00:17:54,124 TO FRACTURE. 393 00:17:54,124 --> 00:17:58,562 SO OUR TEAM, AS I WAS ALLUDING 394 00:17:58,562 --> 00:18:01,331 TO, IS INTERESTED IN THE CONCEPT 395 00:18:01,331 --> 00:18:03,367 OF THE MUSCLE BONE UNIT AND 396 00:18:03,367 --> 00:18:04,568 WE'RE STUDYING THE RELATION OF 397 00:18:04,568 --> 00:18:06,503 BONE STRENGTH AND THE BIO 398 00:18:06,503 --> 00:18:08,138 MECHANICAL FORCES AND HOW THE 399 00:18:08,138 --> 00:18:09,573 MUSCLE AROUND THE BONE MAKES IT 400 00:18:09,573 --> 00:18:12,476 STRONG AND ALSO HELPS US TO 401 00:18:12,476 --> 00:18:14,845 UNDERSTAND IF A DIAGNOSIS IS A 402 00:18:14,845 --> 00:18:16,046 PRIMARY BONE DISORDER. 403 00:18:16,046 --> 00:18:17,981 THERE'S A PROBLEM WITH THE BONE 404 00:18:17,981 --> 00:18:20,517 SUCH AS PATIENTS WITH 405 00:18:20,517 --> 00:18:22,219 OSTEOGENESIS AND SOME ARE 406 00:18:22,219 --> 00:18:23,654 WORKING WITH THAT IN THE 407 00:18:23,654 --> 00:18:25,656 AUDIENCE VERSUS A SECONDARY BONE 408 00:18:25,656 --> 00:18:28,459 DISEASE THAT MAY BE AFFECTING 409 00:18:28,459 --> 00:18:29,293 THE MUSCLE AROUND THE BONE THERE 410 00:18:29,293 --> 00:18:33,597 ARE MAKING IT WEAK. 411 00:18:33,597 --> 00:18:38,202 A PATIENT WITH DUCHENNE MUSCULAR 412 00:18:38,202 --> 00:18:41,738 DYSTROPHY AND IT'S AGGREGATED 413 00:18:41,738 --> 00:18:44,141 BECAUSE WE START USING 414 00:18:44,141 --> 00:18:50,481 CORTICOIDS AND IN PART OF AN UL 415 00:18:50,481 --> 00:18:51,982 1 AT JOHNS HOPKINS IN JULY WE'LL 416 00:18:51,982 --> 00:18:54,284 START SEEING PATIENTS WITH A 417 00:18:54,284 --> 00:19:00,657 CANCER SUSCEPTIBILITY SYNDROMES 418 00:19:00,657 --> 00:19:03,660 OLLIER DISEASE AND MAFFUCCI 419 00:19:03,660 --> 00:19:06,497 SYNDROME IN ADDITION TO THE 420 00:19:06,497 --> 00:19:11,635 MUSCLE LEAN BODY MASS BY DXA 421 00:19:11,635 --> 00:19:12,870 WE'LL LOOK AT MUSCLE GRIP 422 00:19:12,870 --> 00:19:14,271 STRENGTH THAT SEEMS LIKE A 423 00:19:14,271 --> 00:19:14,972 SIMPLE MEASURE BUT IT'S 424 00:19:14,972 --> 00:19:18,509 IMPORTANT BECAUSE IN PEDIATRICS 425 00:19:18,509 --> 00:19:19,743 ADOLESCENT MEDICINE WE HAVEN'T 426 00:19:19,743 --> 00:19:20,777 THOUGHT A LOT ABOUT MUSCLE 427 00:19:20,777 --> 00:19:21,311 FUNCTION. 428 00:19:21,311 --> 00:19:22,679 IT'S BEEN CONSIDERED AN ADULT 429 00:19:22,679 --> 00:19:24,748 MEDICINE BUT WE'RE EXCITED TO 430 00:19:24,748 --> 00:19:26,283 LOOK AT MUSCLE FUNCTION AND 431 00:19:26,283 --> 00:19:27,451 WATCH THAT EVOLVE OVER TIME AND 432 00:19:27,451 --> 00:19:29,286 TO THINK ABOUT HOW IT PLAYS INTO 433 00:19:29,286 --> 00:19:30,320 THE BONE LOSS OF SOME OF THESE 434 00:19:30,320 --> 00:19:37,561 MODELS. 435 00:19:37,561 --> 00:19:39,630 AGAIN THE MUSCLE BONE UNIT AND 436 00:19:39,630 --> 00:19:41,999 COME TO THE 8th FLOOR AND WE'LL 437 00:19:41,999 --> 00:19:44,101 HAVE DXA DATA LOOKING AT THE 438 00:19:44,101 --> 00:19:46,837 LEAN BODY MASS AND THE DATA FROM 439 00:19:46,837 --> 00:19:51,642 A SCAN WHOLE BODY AND ASSESSING 440 00:19:51,642 --> 00:19:52,809 MUSCLE GRIP STRENGTH. 441 00:19:52,809 --> 00:19:55,178 I HOPE TO HAVE MORE DATA TO 442 00:19:55,178 --> 00:19:55,946 SHARE SOON. 443 00:19:55,946 --> 00:20:00,918 CHANGING GEARS, MY TEAM IN 444 00:20:00,918 --> 00:20:03,620 BOSTON 15 PLUS YEARS AGO GOT 445 00:20:03,620 --> 00:20:06,523 INTERESTED IN WHAT WAS HAPPENING 446 00:20:06,523 --> 00:20:14,932 WITHIN BONE MARROW HOW THE 447 00:20:14,932 --> 00:20:19,870 MESENCHYMAL STEM CELLS AND LOOK 448 00:20:19,870 --> 00:20:22,239 AT FAT INSTEAD OF OSTEOBLASTS. 449 00:20:22,239 --> 00:20:24,508 THEY'RE CRITICALLY IMPORTANT FOR 450 00:20:24,508 --> 00:20:26,209 THE BONE FORMATION IN 451 00:20:26,209 --> 00:20:29,780 ADOLESCENCE TO ACHIEVE THE PEAK 452 00:20:29,780 --> 00:20:30,981 BONE MASS AND THE BONE FORMATION 453 00:20:30,981 --> 00:20:32,816 IS IMPORTANT TO GET THERE AND 454 00:20:32,816 --> 00:20:34,785 WHAT HAPPENED WHAT HAPPENS IN 455 00:20:34,785 --> 00:20:36,987 THE PATIENTS IS OVER AND OVER WE 456 00:20:36,987 --> 00:20:38,889 AND OTHER GROUPS SAW THE BONE 457 00:20:38,889 --> 00:20:42,859 FORMATION WAS DEPRESSED AND IGF1 458 00:20:42,859 --> 00:20:52,970 WAS LOW AND ESTROGEN AND HIGH 459 00:20:52,970 --> 00:20:58,008 CORTISOL CAN SHIFT THEM TOWARDS 460 00:20:58,008 --> 00:20:59,643 FAT. 461 00:20:59,643 --> 00:21:03,647 WE NON INVASIVELY STUDIED THIS 462 00:21:03,647 --> 00:21:05,248 AND LOOKED AT THE DISTAL FEMUR 463 00:21:05,248 --> 00:21:07,651 TO SEE HOW MUCH FAT IS THERE AND 464 00:21:07,651 --> 00:21:14,691 RED IS CELLULAR MARROW AND ALSO 465 00:21:14,691 --> 00:21:15,826 MR SPECTROSCOPY AND HOW MUCH 466 00:21:15,826 --> 00:21:18,662 WATER AND SATURATED FATS ARE 467 00:21:18,662 --> 00:21:19,630 THERE. 468 00:21:19,630 --> 00:21:22,799 THERE ARE NUMEROUS HORMONAL 469 00:21:22,799 --> 00:21:25,669 ALTERATIONS OF ANOREXIA NERVOSA. 470 00:21:25,669 --> 00:21:27,638 EATING DISORDERS ARE COMMON IN 471 00:21:27,638 --> 00:21:28,672 THE U.S. 472 00:21:28,672 --> 00:21:30,540 THERE'S TIMES MORE PREVALENT 473 00:21:30,540 --> 00:21:31,642 SINCE THE PANDEMIC. 474 00:21:31,642 --> 00:21:36,113 A WAY YOUNG PEOPLE TRY TO GAIN 475 00:21:36,113 --> 00:21:38,749 CONTROL THIS IS THE FAR END OF 476 00:21:38,749 --> 00:21:41,018 THE FEMALE ATHLETE FOR THE RED 477 00:21:41,018 --> 00:21:43,654 SPECTRUM I TALKED ABOUT IN 478 00:21:43,654 --> 00:21:44,087 ATHLETES. 479 00:21:44,087 --> 00:21:46,123 THEY CAN HAVE A HORMONE 480 00:21:46,123 --> 00:21:49,826 RESISTANCE AND A COUNTER 481 00:21:49,826 --> 00:21:52,462 REGULATORY HORMONE IN THE FACE 482 00:21:52,462 --> 00:21:56,066 OF STARVATION AND LOW IGF-1 AND 483 00:21:56,066 --> 00:21:58,802 IT'S A SIGNALLING FACTOR FOR 484 00:21:58,802 --> 00:22:00,170 OSTEOBLASTS AND EXPLAINS IN PART 485 00:22:00,170 --> 00:22:07,344 WHY THE FORMATION IS LOW AND LOW 486 00:22:07,344 --> 00:22:11,682 ESTRADIOL AND AMENORRHEA AND 487 00:22:11,682 --> 00:22:13,917 HIGH CORTISOL RELATED TO THE 488 00:22:13,917 --> 00:22:15,652 DEPRESSION AND STARVATION 489 00:22:15,652 --> 00:22:17,020 ITSELF. 490 00:22:17,020 --> 00:22:19,189 I HAD THE OPPORTUNITY A LONG 491 00:22:19,189 --> 00:22:23,627 TIME AGO NOW IN 2010 TO WRITE A 492 00:22:23,627 --> 00:22:26,596 REVIEW FOR THE NEW ENGLAND 493 00:22:26,596 --> 00:22:29,733 JOURNAL ON AMENORRHEA AND I WENT 494 00:22:29,733 --> 00:22:31,601 DOWN THE STREET TO TALK TO THE 495 00:22:31,601 --> 00:22:33,804 MEDICAL ILLUSTRATOR BECAUSE I'M 496 00:22:33,804 --> 00:22:37,507 NOT ARTISTIC AND ON A NAPKIN I 497 00:22:37,507 --> 00:22:39,376 HAD THIS STICK FIGURE AND VOILA, 498 00:22:39,376 --> 00:22:40,811 LOOK WHAT HE DID. 499 00:22:40,811 --> 00:22:44,981 I LOVE TO SHOW THE FIGURE 500 00:22:44,981 --> 00:22:48,251 BECAUSE IT SHOWS HOW MANY 501 00:22:48,251 --> 00:22:50,420 HORMONAL AXES ARE ALTERED AND 502 00:22:50,420 --> 00:22:53,790 TISSUES ARE AFFECTED IN PATIENTS 503 00:22:53,790 --> 00:22:56,860 WITH AMENORRHEA AND SOME MEET 504 00:22:56,860 --> 00:22:58,328 CRITERIA FOR AN EATING DISORDER 505 00:22:58,328 --> 00:22:59,663 HAVE THE MOST EXTREME 506 00:22:59,663 --> 00:23:01,231 ALTERATIONS AND THE ONES 507 00:23:01,231 --> 00:23:06,570 IMPORTANT TO POINT OUT ARE THE 508 00:23:06,570 --> 00:23:13,076 OAF -- OVARY IS NOT MAKING 509 00:23:13,076 --> 00:23:16,246 ENOUGH ESTRADIOL AND 510 00:23:16,246 --> 00:23:16,913 NEUROTRANSMITTERS ARE AFFECTED. 511 00:23:16,913 --> 00:23:18,448 IT'S IMPORTANT TO REMEMBER AS WE 512 00:23:18,448 --> 00:23:19,883 TALK ABOUT HOW WE TREAT THESE 513 00:23:19,883 --> 00:23:25,355 PATIENTS. 514 00:23:25,355 --> 00:23:28,325 SO, WE ALREADY MENTIONED BONE 515 00:23:28,325 --> 00:23:29,893 DENSITY IS 25% BELOW THAT 516 00:23:29,893 --> 00:23:31,895 EXPECTED FOR AGE AND GENDER IN 517 00:23:31,895 --> 00:23:35,265 THESE ADD ADOLESCENTS. 518 00:23:35,265 --> 00:23:38,869 FRACTURE RISK COULD BE SEVENFOLD 519 00:23:38,869 --> 00:23:42,539 INCREASE AND SOME DEFICITS CAN 520 00:23:42,539 --> 00:23:49,312 BE IRREVERSIBLE AND AS PATIENTS 521 00:23:49,312 --> 00:23:52,315 GET OLDER BONE ABSORPTION CAN 522 00:23:52,315 --> 00:23:57,687 GET HIGHER AND AN UNCOUPLING OF 523 00:23:57,687 --> 00:24:01,258 THE OSTEOBLAST FUNCTION. 524 00:24:01,258 --> 00:24:03,527 THIS IS A PATIENT WITH ANOREXIA 525 00:24:03,527 --> 00:24:06,563 AND WE ALL AGREE THEY HAVE A LOW 526 00:24:06,563 --> 00:24:09,266 BONE MASS FOR AGE AND OUR 527 00:24:09,266 --> 00:24:10,901 RESEARCH IN ENROLLING A PATIENT 528 00:24:10,901 --> 00:24:12,102 LIKE THIS IS TO FIGURE OUT 529 00:24:12,102 --> 00:24:14,004 WHAT'S GOING TO ON IN THE BONE 530 00:24:14,004 --> 00:24:16,006 MARROW THAT MIGHT BE EXPLAINING 531 00:24:16,006 --> 00:24:20,076 WHAT WE SEE ON THE DXA SCAN. 532 00:24:20,076 --> 00:24:24,781 OVER A DECADE AGO DR. MISHRA NOW 533 00:24:24,781 --> 00:24:29,653 AT UVA LOOKED AT TRANS DERMAL 534 00:24:29,653 --> 00:24:31,454 ESTROGEN IN YOUNG ADOLESCENTS 535 00:24:31,454 --> 00:24:35,125 WITH ANOREXIA NERVOSA AND LOOKED 536 00:24:35,125 --> 00:24:38,929 AT THE LUMBAR SPINE BY DXA AND 537 00:24:38,929 --> 00:24:42,132 6, 12 AND 18 MONTHS INTO THERAPY 538 00:24:42,132 --> 00:24:45,101 WITH AN ESTRADIOL PATCH. 539 00:24:45,101 --> 00:24:46,970 AROUND 12 MONTHS SHE ADDED AN 540 00:24:46,970 --> 00:24:50,040 ORAL PROGESTERONE TO BRING BACK 541 00:24:50,040 --> 00:24:52,309 WHAT WOULD HAPPEN IN THE FACE OF 542 00:24:52,309 --> 00:24:55,278 NORMAL OR VARYING FUNCTION AND 543 00:24:55,278 --> 00:24:57,247 YOU CAN SEE THE RED COLUMNS 544 00:24:57,247 --> 00:24:59,616 THERE WAS A LOSS OF BONE. 545 00:24:59,616 --> 00:25:03,620 NOT MUCH OF A CHANGE WHICH COULD 546 00:25:03,620 --> 00:25:06,089 BE PATHOLOGICAL IN AN ADOLESCENT 547 00:25:06,089 --> 00:25:09,192 AND THE GREEN BAR ARE THE 548 00:25:09,192 --> 00:25:11,561 PATIENTS RECEIVING TRANS DERMAL 549 00:25:11,561 --> 00:25:13,496 ESTROGEN AND THE BLUE BAR ARE 550 00:25:13,496 --> 00:25:14,531 THE HEALTHY CONTROLS. 551 00:25:14,531 --> 00:25:17,367 THESE ARE ENCOURAGING DATA IF WE 552 00:25:17,367 --> 00:25:19,669 GIVE BACK TRANS DERMAL ESTROGEN 553 00:25:19,669 --> 00:25:22,839 AND ESTRADIOL THEY ALMOST 554 00:25:22,839 --> 00:25:25,508 APPROACH THAT OF THE HEALTHY 555 00:25:25,508 --> 00:25:27,244 CONTROLS OVER 18 MONTHS AND THE 556 00:25:27,244 --> 00:25:29,980 SAFETY PROFILE WAS ALSO VERY 557 00:25:29,980 --> 00:25:30,547 POSITIVE FOR THIS CLINICAL 558 00:25:30,547 --> 00:25:36,019 TRIAL. 559 00:25:36,019 --> 00:25:39,556 MEANWHILE ACROSS TO THE CITY 560 00:25:39,556 --> 00:25:42,158 DR. AMY DEVOS AT BOSTON 561 00:25:42,158 --> 00:25:43,426 CHILDREN'S WERE LOOKING AT AN 562 00:25:43,426 --> 00:25:47,631 ORAL REGIMENT FOR ADULTS WITH 563 00:25:47,631 --> 00:25:51,701 ANOREXIA AND DHEA, ADRENAL 564 00:25:51,701 --> 00:25:56,072 STEROID IS A PRECURSOR OF 565 00:25:56,072 --> 00:25:58,108 ESTROGENS AND WE DID PILOT 566 00:25:58,108 --> 00:26:00,710 STUDIES ALL FDA SPONSORED TO 567 00:26:00,710 --> 00:26:02,178 DETERMINE WHAT A SAFE DOSE WOULD 568 00:26:02,178 --> 00:26:05,815 BE AND GAVE IT WITH A 569 00:26:05,815 --> 00:26:08,652 COMBINATION OF A 20 MICROGRAM 570 00:26:08,652 --> 00:26:11,121 ESTRADIOL PILL SO COMBINATION 571 00:26:11,121 --> 00:26:11,354 THERAPY. 572 00:26:11,354 --> 00:26:12,188 THESE WERE ALL OLDER ADOLESCENTS 573 00:26:12,188 --> 00:26:15,392 AND YOUNG ADULTS AND THESE ARE 574 00:26:15,392 --> 00:26:17,460 SPINE CURVES SHOW THE LUMBAR 575 00:26:17,460 --> 00:26:20,297 SPINE AT THE HIP AND BODY. 576 00:26:20,297 --> 00:26:22,666 THERE WAS AN ARREST IN BONE LOSS 577 00:26:22,666 --> 00:26:24,034 AND IN OUR PLACEBO THERE WAS 578 00:26:24,034 --> 00:26:26,803 MORE NOISE BUT A TREND OF A 579 00:26:26,803 --> 00:26:30,206 DECREASE AND THIS WAS AN ORAL 580 00:26:30,206 --> 00:26:31,574 THERAPY AND SOMETHING USED IN 581 00:26:31,574 --> 00:26:33,677 THE CLINICAL SETTING FOR YOUNG 582 00:26:33,677 --> 00:26:34,644 ADULTS WITH STRESS FRACTURES AND 583 00:26:34,644 --> 00:26:40,016 HAVE HAD SOME SUCCESS. 584 00:26:40,016 --> 00:26:43,954 IN THE SAME STUDY WE TOOK OUR 585 00:26:43,954 --> 00:26:49,659 DXA SCANS AND TURNED THEM AND 586 00:26:49,659 --> 00:26:50,894 EMPLOYED THE STRUCTURAL ANALYSIS 587 00:26:50,894 --> 00:26:52,696 PROGRAM I STARTED IN ENGINEERING 588 00:26:52,696 --> 00:26:55,999 SO COME BACK TO IT AND. 589 00:26:55,999 --> 00:26:59,569 STRENGTH OF BONE AND BONE 590 00:26:59,569 --> 00:27:01,237 STRENGTH INDEX AND LOOKING AT 591 00:27:01,237 --> 00:27:03,974 INERTIA AND IN OUR TREATED GROUP 592 00:27:03,974 --> 00:27:05,942 THERE WAS A POSITIVE CHANGE IN 593 00:27:05,942 --> 00:27:08,278 ALL THE PATIENTS OVER TIME OVER 594 00:27:08,278 --> 00:27:09,579 18 MONTHS. 595 00:27:09,579 --> 00:27:12,515 A DECREASE IN ALL PARAMETERS IN 596 00:27:12,515 --> 00:27:14,351 THE PLACEBO GROUP AND ALL THE 597 00:27:14,351 --> 00:27:17,654 END POINTS WERE STATISTICALLY 598 00:27:17,654 --> 00:27:17,954 SIGNIFICANT. 599 00:27:17,954 --> 00:27:21,358 VERY ENCOURAGING DATA. 600 00:27:21,358 --> 00:27:22,659 SO NOW SWITCHING GEARS, ANYTIME 601 00:27:22,659 --> 00:27:26,129 OVER THE PAST DECADE I HAVE 602 00:27:26,129 --> 00:27:27,230 SPOKEN ON ADOLESCENT BONE HEALTH 603 00:27:27,230 --> 00:27:29,933 I GET A QUESTION OR TWO OR THREE 604 00:27:29,933 --> 00:27:31,634 ABOUT TRANSGENDER YOUTH. 605 00:27:31,634 --> 00:27:34,104 WE BLOCK PUBERTY WHAT HAPPENS TO 606 00:27:34,104 --> 00:27:35,305 THE SKELETON? 607 00:27:35,305 --> 00:27:37,741 OFTEN THESE ARE COMPLETELY 608 00:27:37,741 --> 00:27:40,243 HEALTHY ADOLESCENTS AND VERY 609 00:27:40,243 --> 00:27:42,045 VULNERABLE AND DEVELOP GENDER 610 00:27:42,045 --> 00:27:44,414 DYSPHORIA AND NOT SURE ABOUT 611 00:27:44,414 --> 00:27:46,449 THEIR GENDER ASSIGNMENT AND WANT 612 00:27:46,449 --> 00:27:54,591 TO BE THE OPPOSITE GENDER AND AS 613 00:27:54,591 --> 00:27:56,259 ENDOCRINOLOGISTS WE HAVE THE 614 00:27:56,259 --> 00:27:58,128 ABILITY TO BLOCK PUBERTY IN THE 615 00:27:58,128 --> 00:28:01,064 A YOUNG PERSON WITH THEIR FAMILY 616 00:28:01,064 --> 00:28:06,336 DECIDES WHAT TO AS THE NEXT 617 00:28:06,336 --> 00:28:06,603 STEP. 618 00:28:06,603 --> 00:28:13,276 WE USE A HORMONE THAT BOOKS 619 00:28:13,276 --> 00:28:18,548 FOLLICLE STIMULATING FEMALE AND 620 00:28:18,548 --> 00:28:22,519 AFFECTS OVARIAN FUNCTION AND IN 621 00:28:22,519 --> 00:28:23,653 A MALE TESTOSTERONE. 622 00:28:23,653 --> 00:28:28,658 I WAS A P.I. ON A TWO-SITE STUDY 623 00:28:28,658 --> 00:28:30,527 IN CINCINNATI CHILDREN'S AND WHO 624 00:28:30,527 --> 00:28:32,896 OF MY MENTEES BECAME THE SITE 625 00:28:32,896 --> 00:28:34,597 P.I.s AND CONTINUE TO DO THIS 626 00:28:34,597 --> 00:28:35,965 WORK AND I HAVE PERMISSION TO 627 00:28:35,965 --> 00:28:41,671 CONTINUE TO HELP THEM. 628 00:28:41,671 --> 00:28:47,310 SOME KNOW WHEN WE THINK OF 629 00:28:47,310 --> 00:28:47,877 GENDER-AFFIRMING HORMONES. 630 00:28:47,877 --> 00:28:48,344 THERE'S TWO STEPS. 631 00:28:48,344 --> 00:28:49,946 THE TIME PERIOD IT MAKE THE 632 00:28:49,946 --> 00:28:51,648 DECISION IS OVER MANY MONTHS. 633 00:28:51,648 --> 00:28:54,384 THIS IS NOT A RASH DECISION AT 634 00:28:54,384 --> 00:28:56,886 4:30 ON A FRIDAY AFTERNOON. 635 00:28:56,886 --> 00:29:00,990 THESE ARE PATIENTS WE MEET AND 636 00:29:00,990 --> 00:29:01,791 EMPLOYEE SOMEONE FROM THE 637 00:29:01,791 --> 00:29:03,626 BEHAVIORAL HEALTH SIDE TO HELP 638 00:29:03,626 --> 00:29:05,261 US ASSESS WHETHER THIS IS A 639 00:29:05,261 --> 00:29:09,065 TRANSIENT PHASE OR NOT AND 640 00:29:09,065 --> 00:29:10,400 IMPORTANTLY BECAUSE THEY HAVE 641 00:29:10,400 --> 00:29:12,235 GENDER DYSPHORIA THEY NEED HELP 642 00:29:12,235 --> 00:29:15,004 WITH ANXIETY AND DEPRESSION AND 643 00:29:15,004 --> 00:29:16,239 HELP COPING WITH NEXT STEPS. 644 00:29:16,239 --> 00:29:18,942 IF WE MAKE THE DECISION TO BLOCK 645 00:29:18,942 --> 00:29:22,712 PUBERTY IT BUYS TIME TO THINK 646 00:29:22,712 --> 00:29:24,614 ABOUT EVENTUALLY GENDER 647 00:29:24,614 --> 00:29:27,217 AFFIRMING HORMONES AND 648 00:29:27,217 --> 00:29:31,054 MASCULINIZING HORMONES AND I'M 649 00:29:31,054 --> 00:29:37,160 INTERESTED IN THE FAT 650 00:29:37,160 --> 00:29:38,828 DISTRIBUTION AND WHAT HAPPENS TO 651 00:29:38,828 --> 00:29:41,464 FAT DISTRIBUTION AND TO LEAN 652 00:29:41,464 --> 00:29:45,702 BODY MASS AND OTHER CHANGES THAT 653 00:29:45,702 --> 00:29:48,605 MIGHT AFFECT SKELETAL ACCRUAL. 654 00:29:48,605 --> 00:29:52,342 IT'S VERY COMPLICATED TO 655 00:29:52,342 --> 00:29:54,477 INTERPRET DXA SCANS IN THESE 656 00:29:54,477 --> 00:29:54,978 PATIENTS. 657 00:29:54,978 --> 00:29:57,347 WHICH SCORE DO WE USE AND WHICH 658 00:29:57,347 --> 00:29:59,315 REFERENCE DATA SET? 659 00:29:59,315 --> 00:30:02,185 DO WE USE ASSIGNED SEX AT BIRTH 660 00:30:02,185 --> 00:30:09,959 AND WE DO IN THE PUBERTAL STABLE 661 00:30:09,959 --> 00:30:12,262 AND WE USED THE AFFIRMED GENDER 662 00:30:12,262 --> 00:30:13,897 AND IN THE RESEARCH SETTING WE 663 00:30:13,897 --> 00:30:15,698 USE BOTH AND IT'S INTERESTING TO 664 00:30:15,698 --> 00:30:18,635 SEE HOW CLOSELY THEY MIRROR THE 665 00:30:18,635 --> 00:30:21,371 ASSIGNED SEX AT BIRTH AND HOW 666 00:30:21,371 --> 00:30:23,373 CLOSE THEY GET TO THE PREFERRED 667 00:30:23,373 --> 00:30:26,409 GENDER, THE AFFIRMED GENDER. 668 00:30:26,409 --> 00:30:28,811 IN EVERY SEARCH PROTOCOL WE HAVE 669 00:30:28,811 --> 00:30:33,383 THE LUXURY OF LOOKING BOTH WAYS. 670 00:30:33,383 --> 00:30:38,788 IF WE HAVE A CHILD OR ADOLESCENT 671 00:30:38,788 --> 00:30:41,791 WE MAY INTERPRET FOR BONE AND WE 672 00:30:41,791 --> 00:30:43,326 USE THE HEIGHT FROM CDC GROWTH 673 00:30:43,326 --> 00:30:45,995 CHARTS AND IF WE HAD A CHILD OR 674 00:30:45,995 --> 00:30:49,499 ADOLESCENT WITH SHORT STATURE WE 675 00:30:49,499 --> 00:30:51,634 WOULD USE THAT AS WELL. 676 00:30:51,634 --> 00:30:58,141 I LOVE THE CARTOON BECAUSE IT'S 677 00:30:58,141 --> 00:30:58,474 HO 678 00:30:58,474 --> 00:30:59,375 OFTEN HOW I FEEL? 679 00:30:59,375 --> 00:31:01,678 DO THEY HAVE INITIAL THREATS TO 680 00:31:01,678 --> 00:31:02,879 BONE HEALTH STARTING OUT? 681 00:31:02,879 --> 00:31:04,914 THE STAGE OF THE TREATMENT AND 682 00:31:04,914 --> 00:31:06,716 GENDER AFFIRMING THERAPY, THE 683 00:31:06,716 --> 00:31:09,385 ASSIGNED SEX AT BIRTH, WHAT'S 684 00:31:09,385 --> 00:31:10,720 THEIR AFFIRMED GENDER AND WHAT 685 00:31:10,720 --> 00:31:12,555 ARE WE GOING TOWARDS AND WHICH 686 00:31:12,555 --> 00:31:15,525 GENDER AND ARE WE PROVIDING 687 00:31:15,525 --> 00:31:18,261 CLINICAL CARE OR ARE WE IN THE 688 00:31:18,261 --> 00:31:20,029 RESEARCH SETTING AND THERE'S 689 00:31:20,029 --> 00:31:22,565 ASSIGNED MALE AT BIRTH AND 690 00:31:22,565 --> 00:31:25,401 ASSIGNED FEMALE AT BIRTH AS FAAB 691 00:31:25,401 --> 00:31:26,102 AND TAKE YOU THROUGH STUDIES OF 692 00:31:26,102 --> 00:31:29,872 WHAT WE KNOW. 693 00:31:29,872 --> 00:31:32,075 SO TRANSGENDER FEMALES ASSIGNED 694 00:31:32,075 --> 00:31:33,476 MALES AT BIRTH HAVE BEEN SHOWN 695 00:31:33,476 --> 00:31:35,712 IN NUMEROUS STUDIES INCLUDING MY 696 00:31:35,712 --> 00:31:38,414 GROUPS AS HAVING A LOWER LUMBAR 697 00:31:38,414 --> 00:31:44,120 SPINE BONE DENSITY EVEN AT 698 00:31:44,120 --> 00:31:46,389 BASELINE BEFORE PUBERTAL 699 00:31:46,389 --> 00:31:47,390 BLOCKADE AND AS A GROUP THEY 700 00:31:47,390 --> 00:31:52,729 TEND TO HAVE LOWER ENGAGEMENT IN 701 00:31:52,729 --> 00:31:54,864 EXERCISE AND MORE CONCERNED 702 00:31:54,864 --> 00:31:56,165 ABOUT TEASING IN THE BALL FIELD 703 00:31:56,165 --> 00:31:58,101 AND NOT SIGNED UP FOR 704 00:31:58,101 --> 00:32:00,670 COMPETITIVE OR GROUP SPORTS AND 705 00:32:00,670 --> 00:32:02,972 AT HIGH RISK FOR RESTRICTIVE 706 00:32:02,972 --> 00:32:03,439 EATING DISORDERS. 707 00:32:03,439 --> 00:32:09,579 I'VE TAKEN CARE OF NUMEROUS 708 00:32:09,579 --> 00:32:12,482 TRANSGENDER FEMALES TRYING TO 709 00:32:12,482 --> 00:32:14,083 RESTRICT AND CAN START AT A 710 00:32:14,083 --> 00:32:16,286 LOWER BONE DENSITY AND THEN 711 00:32:16,286 --> 00:32:17,887 RESTRICT AND START LOSING BONE 712 00:32:17,887 --> 00:32:19,455 AS WE TALKED ABOUT A MINUTE AGO. 713 00:32:19,455 --> 00:32:24,060 THEY'RE NOT AS ENGAGED IN WEIGHT 714 00:32:24,060 --> 00:32:25,795 BEARING EXERCISE IS IMPORTANT IN 715 00:32:25,795 --> 00:32:27,630 OUR HISTORY TO EVALUATE PHYSICAL 716 00:32:27,630 --> 00:32:28,831 ACTIVITY AND NUTRITION. 717 00:32:28,831 --> 00:32:31,134 IT'S PART OF THEIR CLINICAL CARE 718 00:32:31,134 --> 00:32:32,268 FOR US AS RESEARCHERS WHEN THEY 719 00:32:32,268 --> 00:32:36,005 COME INTO OUR PROTOCOL. 720 00:32:36,005 --> 00:32:38,007 THIS HAS BEEN SHOWN AGAIN 721 00:32:38,007 --> 00:32:39,175 ASSIGNED MALES. 722 00:32:39,175 --> 00:32:43,046 THESE ARE ASSIGNED FEMALES AND 723 00:32:43,046 --> 00:32:44,280 ASSIGNED MALES. 724 00:32:44,280 --> 00:32:45,315 WIDE BARS HERE. 725 00:32:45,315 --> 00:32:46,783 CONFIDENCE INTERVALS BUT YOU CAN 726 00:32:46,783 --> 00:32:47,684 SEE THE TREND. 727 00:32:47,684 --> 00:32:50,586 THE ASSIGNED MALES ON AVERAGE 728 00:32:50,586 --> 00:32:53,423 HAD A LOWER BONE DENSITY SCORE 729 00:32:53,423 --> 00:32:57,093 DEPENDING ON HOW YOU INTERPRETED 730 00:32:57,093 --> 00:32:57,327 IT. 731 00:32:57,327 --> 00:33:00,229 THE SEX ASSIGNED AT BIRTH, 732 00:33:00,229 --> 00:33:02,098 AFFIRMED GENDER AND THEY LOOKED 733 00:33:02,098 --> 00:33:08,204 AT IT A LOT OF DIFFERENT WAYS. 734 00:33:08,204 --> 00:33:14,477 THIS IS JANET LEE AND COLLEAGUES 735 00:33:14,477 --> 00:33:16,446 AND SAW NO DIFFERENCES IN THE 736 00:33:16,446 --> 00:33:17,413 NON-WEIGHT BEARING RADIUS WHICH 737 00:33:17,413 --> 00:33:20,616 IS DIFFERENT SO MAYBE THE 738 00:33:20,616 --> 00:33:22,285 DIFFERENCE IN WEIGHT BEARING I 739 00:33:22,285 --> 00:33:22,952 TALKED ABOUT SEEMED TO BEAR OUT 740 00:33:22,952 --> 00:33:31,828 IN THE STUDY. 741 00:33:31,828 --> 00:33:36,232 WE SAW THE SAME AND HAD A CASE 742 00:33:36,232 --> 00:33:38,034 SERIES OF SEX TRANS FEMALES AND 743 00:33:38,034 --> 00:33:41,938 ALL HAD A LOWER BONE DENSITY 744 00:33:41,938 --> 00:33:43,306 COMPARED TO REFERENCE DATA AND 745 00:33:43,306 --> 00:33:44,374 LOW Z SCORES COMPARED TO 746 00:33:44,374 --> 00:33:45,708 CONTROLS AND THERE'S OTHER 747 00:33:45,708 --> 00:33:47,877 REPORTS AND THEY'RE MORE IN THE 748 00:33:47,877 --> 00:33:51,547 LITERATURE NOW. 749 00:33:51,547 --> 00:33:54,417 OTHER DETERMINATES THE ROLE OF 750 00:33:54,417 --> 00:33:54,951 NUTRITION. 751 00:33:54,951 --> 00:33:59,622 TRANS FEMALES ARE AT HIGH RISK 752 00:33:59,622 --> 00:34:05,228 FOR EATING DISORDERS BUT A GROUP 753 00:34:05,228 --> 00:34:07,563 SHOWED THAT VITAMIN D DEFICIENCY 754 00:34:07,563 --> 00:34:11,100 WAS COMMON AND NEGATIVELY 755 00:34:11,100 --> 00:34:12,568 ASSOCIATED WITH LUMBAR SPINE 756 00:34:12,568 --> 00:34:14,504 SCORES AND BMI WAS AN IMPORTANT 757 00:34:14,504 --> 00:34:19,909 PROS -- POSITIVE PREDICTOR AND 758 00:34:19,909 --> 00:34:24,981 ASSIGNED MALE AT BIRTH WAS A 759 00:34:24,981 --> 00:34:28,885 STATISTICAL TREND. 760 00:34:28,885 --> 00:34:31,087 LASTLY, AS PART OF THE R01 WE'RE 761 00:34:31,087 --> 00:34:32,789 LOOKING AT BONE MARROW 762 00:34:32,789 --> 00:34:33,089 COMPOSITION. 763 00:34:33,089 --> 00:34:37,593 WE ARE ENGAGED IN THE STUDIES 764 00:34:37,593 --> 00:34:38,060 NOW. 765 00:34:38,060 --> 00:34:39,529 ANOREXIA REPORTS ARE OUT. 766 00:34:39,529 --> 00:34:43,633 I HAVE A K23 RECIPIENT LOOKING 767 00:34:43,633 --> 00:34:46,602 AT MARROW COMPOSITION IN 768 00:34:46,602 --> 00:34:47,503 INFLAMMATORY BOWEL DISEASE OUT 769 00:34:47,503 --> 00:34:49,939 OF BOSTON CHILDREN'S AND 770 00:34:49,939 --> 00:34:52,074 FINISHING WITH BOSTON AND 771 00:34:52,074 --> 00:34:56,479 CINCINNATI LOOKING AT TRANS 772 00:34:56,479 --> 00:34:58,181 GENDER YOUTH AND LOOKING AT 773 00:34:58,181 --> 00:35:00,550 GENDER AFFIRMING THERAPY SO STAY 774 00:35:00,550 --> 00:35:00,750 TUNED. 775 00:35:00,750 --> 00:35:03,853 I THINK PART OF THE PROBLEM IS 776 00:35:03,853 --> 00:35:05,688 THERE'S MYTHS CIRCULATING TO 777 00:35:05,688 --> 00:35:06,656 WHAT HAPPENS TO BONE BECAUSE 778 00:35:06,656 --> 00:35:07,390 NONE OF US KNOW. 779 00:35:07,390 --> 00:35:09,192 I HOPE WE'RE GOING TO GET 780 00:35:09,192 --> 00:35:10,526 SCIENTIFIC DATA THAT'S GOING TO 781 00:35:10,526 --> 00:35:11,627 HELP CLINICIANS MAKING 782 00:35:11,627 --> 00:35:16,699 DECISIONS. 783 00:35:16,699 --> 00:35:18,701 LAST BUT NOT LEAST, I WITH MY 784 00:35:18,701 --> 00:35:20,870 GREAT TEAM IN THE AUDIENCE, WE 785 00:35:20,870 --> 00:35:22,839 WERE TRYING TO ESTABLISH NICHD 786 00:35:22,839 --> 00:35:26,042 AS THE NUMBER ONE RESEARCH 787 00:35:26,042 --> 00:35:27,510 DESTINATION CENTER FOR POI. 788 00:35:27,510 --> 00:35:31,681 IT'S BEEN A KNOWN CENTER FOR 789 00:35:31,681 --> 00:35:34,484 ADULT WOMEN WITH THIS DIAGNOSIS 790 00:35:34,484 --> 00:35:37,220 AND COLLEAGUES PUT NIH ON THE 791 00:35:37,220 --> 00:35:39,622 MAP FOR ADULT WOMEN ESPECIALLY 792 00:35:39,622 --> 00:35:42,124 THOSE COMING OUT OF REPRODUCTIVE 793 00:35:42,124 --> 00:35:45,228 ENDOCRINE INFERTILITY CLINICS 794 00:35:45,228 --> 00:35:47,630 AND WOULD LIKE TO SPAN RESEARCH 795 00:35:47,630 --> 00:35:50,733 IN ADOLESCENTS BECAUSE THEY GO 796 00:35:50,733 --> 00:35:51,434 FROM CENTER TO CENTER BEFORE 797 00:35:51,434 --> 00:35:53,569 IT'S KNOWN WHAT IS GOING ON AND 798 00:35:53,569 --> 00:35:55,972 BEING IN THE HAND OF AN 799 00:35:55,972 --> 00:36:06,516 ENDOCRINOLOGIST OR GYNECOLOGIST 800 00:36:07,350 --> 00:36:09,852 AND WHAT WE DO IS ANECDOTAL AND 801 00:36:09,852 --> 00:36:13,556 WHAT EXPERTS DO AROUND THE 802 00:36:13,556 --> 00:36:14,757 COUNTRY AND IT'S NOT EVIDENCE 803 00:36:14,757 --> 00:36:15,024 BASED. 804 00:36:15,024 --> 00:36:17,426 THEY PRESENT WITH LOW DENSITY 805 00:36:17,426 --> 00:36:19,629 AND SOMETIMES FRACTURES AND 806 00:36:19,629 --> 00:36:21,430 ALMOST ALL HAVE FATIGUE. 807 00:36:21,430 --> 00:36:24,267 AND THE MAJORITY OF THE PATIENTS 808 00:36:24,267 --> 00:36:28,571 IS IDIOPATHIC WE DON'T 809 00:36:28,571 --> 00:36:29,772 UNDERSTAND WHY THEY HAVE IT AND 810 00:36:29,772 --> 00:36:31,507 WOULD LIKE TO PUT A GENETIC NAME 811 00:36:31,507 --> 00:36:35,278 TO WHAT THEY HAVE CLINICALLY AND 812 00:36:35,278 --> 00:36:38,347 SEE A LARGE GROUP OF PATIENTS 813 00:36:38,347 --> 00:36:48,824 FROM NCI AND THOSE WHO HAVE 814 00:36:49,892 --> 00:36:52,562 CHEMOTHERAPY INDUCED MANY 815 00:36:52,562 --> 00:36:55,464 FAILURE AND POI IS A MORE 816 00:36:55,464 --> 00:36:57,600 HOPEFUL TERM AND MORE ACCURATE 817 00:36:57,600 --> 00:37:00,202 BECAUSE THE FUNCTION CAN WAX AND 818 00:37:00,202 --> 00:37:01,637 WANE IN A WOMAN. 819 00:37:01,637 --> 00:37:04,173 IT ENCOMPASSES THE VARIATION 820 00:37:04,173 --> 00:37:06,042 PRESENTATION AND ESPECIALLY WHEN 821 00:37:06,042 --> 00:37:07,510 I WORKED WITH CANCER SURVIVORS 822 00:37:07,510 --> 00:37:09,979 WHO BATTLED THAT PRIMARY 823 00:37:09,979 --> 00:37:11,547 MALIGNANCY AND TO BE TOLD THEY 824 00:37:11,547 --> 00:37:12,848 HAVE A FAILURE. 825 00:37:12,848 --> 00:37:14,951 I'VE HAD THEM TELL ME THEY FEEL 826 00:37:14,951 --> 00:37:18,421 LIKE A FAILURE SO INSUFFICIENCY 827 00:37:18,421 --> 00:37:20,856 IS SOMETHING WE CAN TREAT AND 828 00:37:20,856 --> 00:37:24,894 ADD BACK HORMONAL THERAPY AND 829 00:37:24,894 --> 00:37:30,733 PART OF A WIDER SYNDROME AND SEE 830 00:37:30,733 --> 00:37:34,170 MANY WITH A DIAGNOSIS AND POI 831 00:37:34,170 --> 00:37:35,504 COULD BE PART OF THAT. 832 00:37:35,504 --> 00:37:39,842 THEY OFTEN COME IN WITH 833 00:37:39,842 --> 00:37:46,115 AMENORRHEA OR LENGTHENING CYCLE 834 00:37:46,115 --> 00:37:49,619 AND YOUNGER TEENS WITH DELAYED 835 00:37:49,619 --> 00:37:54,390 PUBERTY AND PURE ESTROGEN 836 00:37:54,390 --> 00:38:03,933 DEFICIENCY AND OTHER HORMONAL 837 00:38:03,933 --> 00:38:09,205 VARIANCES AND AND A DIAGNOSIS IS 838 00:38:09,205 --> 00:38:12,742 MADE MEASURING LH OVER THE UPPER 839 00:38:12,742 --> 00:38:16,145 LIMIT ON TWO SEPARATE OCCASIONS. 840 00:38:16,145 --> 00:38:17,413 SO WE GET IT ONCE AND CONFIRM IT 841 00:38:17,413 --> 00:38:20,216 A SECOND TIME. 842 00:38:20,216 --> 00:38:27,390 WE DID A CASE CONTROL STUDY AT 843 00:38:27,390 --> 00:38:29,392 CINCINNATI CHILDREN'S AND SHOWED 844 00:38:29,392 --> 00:38:31,060 THE TRANS GENDER BONE STUDY. 845 00:38:31,060 --> 00:38:34,897 I'M SHOWING YOU THIS IN NINE 846 00:38:34,897 --> 00:38:38,200 ADOLESCENTS WITH NEWLY DIAGNOSED 847 00:38:38,200 --> 00:38:39,902 IDIOPATHIC POI AND SOME HEALTHY 848 00:38:39,902 --> 00:38:41,570 CONTROLLED BECAUSE THE PILOT 849 00:38:41,570 --> 00:38:42,705 STUDY INFORMED THE STUDY WE HAVE 850 00:38:42,705 --> 00:38:44,674 PLANNED FOR THE CLINICAL CENTER. 851 00:38:44,674 --> 00:38:47,343 OUR ADOLESCENTS WERE 11 TO 18. 852 00:38:47,343 --> 00:38:50,212 ALMOST 80% OF THEM REPORTED LOW 853 00:38:50,212 --> 00:38:50,613 ENERGY. 854 00:38:50,613 --> 00:38:53,282 WE HAD A MENOPAUSAL RATING SCALE 855 00:38:53,282 --> 00:38:55,618 WE USED AND THAT'S ALWAYS BEEN 856 00:38:55,618 --> 00:38:57,386 MY IMPRESSION THAT A DIAGNOSIS 857 00:38:57,386 --> 00:38:59,822 ALL OF THEM ARE VERY TIRED. 858 00:38:59,822 --> 00:39:02,124 AS A CLINICIAN IT'S REWARDING TO 859 00:39:02,124 --> 00:39:04,026 TAKE CARE OF THEM BECAUSE YOU 860 00:39:04,026 --> 00:39:05,394 PHYSICALLY SEE A DIFFERENCE WHEN 861 00:39:05,394 --> 00:39:07,463 THEY COME BACK THREE MONTHS 862 00:39:07,463 --> 00:39:09,965 LATER AFTER STARTING ESTROGEN. 863 00:39:09,965 --> 00:39:14,403 WE SAW A LOW SPINAL BONE DENSITY 864 00:39:14,403 --> 00:39:15,337 BY DXA. 865 00:39:15,337 --> 00:39:17,940 I TRIED TO BOLD IT. 866 00:39:17,940 --> 00:39:21,510 THE LUMBAR SPINE AND HIPS AND 867 00:39:21,510 --> 00:39:22,978 SCORE ALL THREE WERE LOWER IN 868 00:39:22,978 --> 00:39:26,282 OUR PATIENT WITH POI. 869 00:39:26,282 --> 00:39:30,820 USING STANDARD PCTC THEY HAD A 870 00:39:30,820 --> 00:39:32,121 SMALLER CORTICAL AREA AT THE 871 00:39:32,121 --> 00:39:38,260 TIBIA AND REDUCED CORTICAL SHELL 872 00:39:38,260 --> 00:39:42,198 I SHOWED AND LOWER TRABECULAR 873 00:39:42,198 --> 00:39:45,267 BONE DENSITY THINKING ABOUT A 874 00:39:45,267 --> 00:39:46,702 WEIGHT BEARING AND NON-WEIGHT 875 00:39:46,702 --> 00:39:47,436 BEARING SITE. 876 00:39:47,436 --> 00:39:51,674 I WANT TO TAKE A MINUTE TO TALK 877 00:39:51,674 --> 00:39:53,075 ABOUT THE CANCER SURVIVORS POI 878 00:39:53,075 --> 00:39:56,612 IN THOSE PATIENTS DUE TO RECEIPT 879 00:39:56,612 --> 00:39:58,481 OF RADIATION AND THE AGENTS. 880 00:39:58,481 --> 00:40:01,751 WE STILL NEED TO RULE OUT 881 00:40:01,751 --> 00:40:11,627 SECONDARY CAUSES OF BONE LOSS 882 00:40:11,627 --> 00:40:18,768 AND SOME CAN HAVE CELIAC DISEASE 883 00:40:18,768 --> 00:40:22,271 AND THIS IS A FIGURE THAT I 884 00:40:22,271 --> 00:40:22,471 LOVE. 885 00:40:22,471 --> 00:40:27,376 IT SHOWS THE MECHANISMS OF BONE 886 00:40:27,376 --> 00:40:28,944 LOSS AND HOW THE OVARY IS 887 00:40:28,944 --> 00:40:29,979 AFFECTED. 888 00:40:29,979 --> 00:40:33,182 YOU CAN SEE HERE THERE'S 889 00:40:33,182 --> 00:40:36,652 PRENATAL LOSS OF OLIGONIA AND 890 00:40:36,652 --> 00:40:43,626 ACCELERATED LOSS OF THE 891 00:40:43,626 --> 00:40:44,693 PRIMORDIAL FOLLICLES AND LEADING 892 00:40:44,693 --> 00:40:47,196 TO A SHORTER HALF LIFE. 893 00:40:47,196 --> 00:40:48,430 THERE CAN BE DIRECT STROMAL 894 00:40:48,430 --> 00:40:54,370 DAMAGE AND ULTIMATELY THE PMFs 895 00:40:54,370 --> 00:40:59,008 UNDER GO ATRISIA AND A LOT OF 896 00:40:59,008 --> 00:41:02,945 MECHANISMS AT PLAY LEADING TO 897 00:41:02,945 --> 00:41:04,246 RAPID OVARIAN DAMAGE. 898 00:41:04,246 --> 00:41:05,581 WHERE DOES THIS FIT IN? 899 00:41:05,581 --> 00:41:09,185 I LIKE THIS FIGURE THAT SHOWS US 900 00:41:09,185 --> 00:41:12,655 THIS IS PEAK BONE MASS IMPAIRED 901 00:41:12,655 --> 00:41:14,023 BECAUSE THERE'S HORMONAL 902 00:41:14,023 --> 00:41:15,558 DEPRIVATION AND THERE COULD BE 903 00:41:15,558 --> 00:41:16,959 MOBILIZATION RELATED TO THE 904 00:41:16,959 --> 00:41:19,228 ILLNESS BECAUSE OF THE SURGERIES 905 00:41:19,228 --> 00:41:26,635 AND THERE'S CHEMO THERAPIES AND 906 00:41:26,635 --> 00:41:30,573 THE REGIMENT FOR THE 907 00:41:30,573 --> 00:41:31,874 TRANSPLANTATION AND DIRECT 908 00:41:31,874 --> 00:41:36,245 DAMAGE FROM RADIO THERAPY AND 909 00:41:36,245 --> 00:41:37,880 CYTOKINES CAN AFFECT BONE 910 00:41:37,880 --> 00:41:39,481 TURNOVER AND NUTRITION COULD BE 911 00:41:39,481 --> 00:41:39,715 ALTERED. 912 00:41:39,715 --> 00:41:42,785 THEY'RE NOT AS HUNGRY OR MAY BE 913 00:41:42,785 --> 00:41:44,186 COMPLIANT WITH THEIR VITAMIN D 914 00:41:44,186 --> 00:41:47,089 AND CALCIUM BECAUSE THEY DON'T 915 00:41:47,089 --> 00:41:53,696 FEEL WELL AND GLUCOCORDICOIDS 916 00:41:53,696 --> 00:41:55,197 AND HOW CAN WE INTERVENE AND 917 00:41:55,197 --> 00:41:58,834 HELP PATIENTS. 918 00:41:58,834 --> 00:42:01,971 SO WHAT WE PLANNED IS DEEP 919 00:42:01,971 --> 00:42:04,006 PHENOTYPING OF ADOLESCENTS WITH 920 00:42:04,006 --> 00:42:04,240 POI. 921 00:42:04,240 --> 00:42:06,909 MY SCANNER AND I ARE GOING 922 00:42:06,909 --> 00:42:10,446 THROUGH THE APPROVAL PROCESS. 923 00:42:10,446 --> 00:42:11,747 ALL THE DIFFERENT REGULATORY 924 00:42:11,747 --> 00:42:14,049 STEPS HAND IN HAND. 925 00:42:14,049 --> 00:42:16,819 WE NOT ONLY GET DXA SCANS OF 926 00:42:16,819 --> 00:42:20,189 BONE DENSITY AND BODY 927 00:42:20,189 --> 00:42:21,223 COMPOSITION AND GET THE RADIUS 928 00:42:21,223 --> 00:42:25,761 AND THE TIBIA TO STUDY THAT AND 929 00:42:25,761 --> 00:42:27,696 WE I HAVE BEEN HEARTENED BY THE 930 00:42:27,696 --> 00:42:28,964 SPIRIT OF COLLABORATION HERE. 931 00:42:28,964 --> 00:42:30,833 YOU ALL ARE AMAZING. 932 00:42:30,833 --> 00:42:34,236 I HAVE A GREAT GROUP OF 933 00:42:34,236 --> 00:42:36,739 CARDIOLOGISTS AND HEMATOLOGISTS 934 00:42:36,739 --> 00:42:38,374 AND LIPID SPECIALISTS. 935 00:42:38,374 --> 00:42:42,378 WE'RE GOING TO LOOK AT LIPIDS 936 00:42:42,378 --> 00:42:45,314 AND INFLAMMATION AND 937 00:42:45,314 --> 00:42:45,948 ELECTROPHYSIOLOGIC CHANGES AND 938 00:42:45,948 --> 00:42:48,550 PULSE WAVE VELOCITY AND THEN 939 00:42:48,550 --> 00:42:50,286 TAKE THE PHENOTYPE AND WE'RE 940 00:42:50,286 --> 00:42:52,354 DOING SEQUENCING DATA AND SEE 941 00:42:52,354 --> 00:42:55,057 HOW THE GENOTYPE RELATES TO THE 942 00:42:55,057 --> 00:42:56,225 PHENOTYPE AND WHETHER THE 943 00:42:56,225 --> 00:42:57,660 GENOTYPE MAY BE PREDICTIVE OF 944 00:42:57,660 --> 00:43:00,362 THE RESPONSE TO THERAPY. 945 00:43:00,362 --> 00:43:05,100 WE'RE ALSO WORKING WITH A TEAM 946 00:43:05,100 --> 00:43:06,602 THINKING ABOUT THE VAGINAL 947 00:43:06,602 --> 00:43:09,438 IMMUNITY AND MICROBIOME AND IT'S 948 00:43:09,438 --> 00:43:12,207 A WONDERFUL OPPORTUNITY TO 949 00:43:12,207 --> 00:43:14,410 COLLABORATE WITH PEDIATRIC GINE 950 00:43:14,410 --> 00:43:17,646 KOL GIFTS AND THINKING OF 951 00:43:17,646 --> 00:43:18,047 EMOTIONAL HEALTH. 952 00:43:18,047 --> 00:43:20,482 IT'S SO SHOCKING FOR THE YOUNG 953 00:43:20,482 --> 00:43:20,683 WOMEN. 954 00:43:20,683 --> 00:43:23,118 THEY'RE TIRED AND EXPECT ME TO 955 00:43:23,118 --> 00:43:29,658 SAY THEY HAVE HYPERTHYROIDISM OR 956 00:43:29,658 --> 00:43:31,627 SOMETHING ORDINARY AND FIND THEY 957 00:43:31,627 --> 00:43:33,362 HAVE SOMETHING CONSISTENT WITH 958 00:43:33,362 --> 00:43:34,763 THEIR MENOPAUSE AND WE NEED TO 959 00:43:34,763 --> 00:43:36,699 MAKE SURE AT BASELINE WHAT THEIR 960 00:43:36,699 --> 00:43:38,701 FUNCTIONING IS AND WELL BEING 961 00:43:38,701 --> 00:43:43,806 AND QUALITY OF LIFE AND HOW THAT 962 00:43:43,806 --> 00:43:46,742 CHANGES AS I GIVE BACK HORMONE 963 00:43:46,742 --> 00:43:48,010 REPLACEMENT THERAPY AND WILL BE 964 00:43:48,010 --> 00:43:49,078 IMPORTANT TO GUIDE US TO WHAT 965 00:43:49,078 --> 00:43:54,316 THE OPTIMAL THERAPY IS. 966 00:43:54,316 --> 00:43:58,053 WE'LL BE USING WHAT IS THE 967 00:43:58,053 --> 00:44:00,622 RECOMMENDED STANDARD OF CARE AND 968 00:44:00,622 --> 00:44:03,459 WE HAVE DATA ON WOMEN WITH 969 00:44:03,459 --> 00:44:03,892 TURNER'S SYNDROME. 970 00:44:03,892 --> 00:44:07,396 THEY'LL NOT BE IN OUR PLANNED 971 00:44:07,396 --> 00:44:10,599 TRIAL BECAUSE THEY HAVE 972 00:44:10,599 --> 00:44:12,634 CARDIOVASCULAR ABNORMALITIES AT 973 00:44:12,634 --> 00:44:12,935 BASELINE. 974 00:44:12,935 --> 00:44:15,004 WE'RE EXCLUDING THAT GROUP AND 975 00:44:15,004 --> 00:44:18,207 LOOKING AT EVERYONE ELSE. 976 00:44:18,207 --> 00:44:20,542 TRANS DERMAL ESTROGEN AVOIDS 977 00:44:20,542 --> 00:44:24,980 FIRST PASS HEPATIC EFFECTS AND 978 00:44:24,980 --> 00:44:30,019 THERE'S A RISK OF THROMBOSIS AND 979 00:44:30,019 --> 00:44:31,286 AS A PATCH A YOUNG PERSON 980 00:44:31,286 --> 00:44:32,788 DOESN'T HAVE TO REMEMBER TO TAKE 981 00:44:32,788 --> 00:44:35,624 A PILL AND KNOW IT'S BETTER FOR 982 00:44:35,624 --> 00:44:39,094 BONE DENSITY THAN ORAL 983 00:44:39,094 --> 00:44:42,097 CONTRACEPTIVE PILL. 984 00:44:42,097 --> 00:44:43,332 THESE PATIENTS CAN GET PREGNANT 985 00:44:43,332 --> 00:44:47,302 SO IT'S NOT WRONG TO USE AN ORAL 986 00:44:47,302 --> 00:44:54,176 CO CONTRASEPTIVE AND WHAT WOULD 987 00:44:54,176 --> 00:44:56,678 BE BETTER IS A TRANS DERM 988 00:44:56,678 --> 00:44:56,912 SYSTEM. 989 00:44:56,912 --> 00:44:59,014 AND THE OTHER THING I'LL 990 00:44:59,014 --> 00:45:05,020 MENTION, THERE ARE TRIALS GOING 991 00:45:05,020 --> 00:45:06,021 TO ON. 992 00:45:06,021 --> 00:45:08,090 A TEAM IS LOOKING AT FERTILITY 993 00:45:08,090 --> 00:45:09,591 PRESERVATION AND SOME STUDIES IN 994 00:45:09,591 --> 00:45:15,164 THE TREATMENT TRIAL WHO ARE ALSO 995 00:45:15,164 --> 00:45:18,667 INVOLVED IN THESE IMPORTANT 996 00:45:18,667 --> 00:45:19,034 PROTOCOLS. 997 00:45:19,034 --> 00:45:21,470 I HOPE IN A YEAR OR TWO TO BE 998 00:45:21,470 --> 00:45:23,205 INVITED TO SHOW YOU DATA. 999 00:45:23,205 --> 00:45:27,776 WE'RE EXCITED TO HAVE THE 1000 00:45:27,776 --> 00:45:29,878 OPPORTUNITY HERE AND IT'S 1001 00:45:29,878 --> 00:45:31,613 WONDERFUL ON THE CAMPUS TO DO 1002 00:45:31,613 --> 00:45:33,916 THE DEEP GENOTYPES AND TO 1003 00:45:33,916 --> 00:45:35,284 PHENOTYPE THEM AND AS I 1004 00:45:35,284 --> 00:45:38,287 MENTIONED I'M VERY INTERESTED IN 1005 00:45:38,287 --> 00:45:39,621 HOW THAT MIGHT PREDICT RESPONSE 1006 00:45:39,621 --> 00:45:41,623 TO THERAPY AND LOOKING AT A 1007 00:45:41,623 --> 00:45:45,961 NUMBER OF TISSUES. 1008 00:45:45,961 --> 00:45:51,133 SO IN SUMMARY, POI IS A PUZZLING 1009 00:45:51,133 --> 00:45:51,633 DISORDER. 1010 00:45:51,633 --> 00:45:54,470 THE VARIATION CAN VARY WIDELY AS 1011 00:45:54,470 --> 00:45:58,740 WE MEET THESE PATIENTS. 1012 00:45:58,740 --> 00:46:09,284 THE ETIOLOGY IS HETEROUS AND WE 1013 00:46:13,255 --> 00:46:14,590 NEED TO UNDER THE WHAT THAT 1014 00:46:14,590 --> 00:46:16,892 REGIMENT IS FOR HORMONE 1015 00:46:16,892 --> 00:46:19,094 REPLACEMENT THERAPY. 1016 00:46:19,094 --> 00:46:22,097 BEFORE I CLOSE I WANTED TO SHARE 1017 00:46:22,097 --> 00:46:23,899 A COUPLE MORE SLIDES THINKING 1018 00:46:23,899 --> 00:46:24,900 ABOUT A NEW AREA. 1019 00:46:24,900 --> 00:46:27,669 AS I MENTIONED WITH THE 1020 00:46:27,669 --> 00:46:29,004 TRANSGENDER STUDY THIS IS ONE 1021 00:46:29,004 --> 00:46:30,606 WHERE I'VE HAD A LOT OF HANDS IN 1022 00:46:30,606 --> 00:46:34,076 THE AUDIENCE WHEN I GIVE TALKS 1023 00:46:34,076 --> 00:46:35,310 ON ADOLESCENT BONE HEALTH WHICH 1024 00:46:35,310 --> 00:46:39,648 HAS LED TO NEW COLLABORATIONS. 1025 00:46:39,648 --> 00:46:43,252 SO INTERESTINGLY, IT'S IN THE 1026 00:46:43,252 --> 00:46:44,987 LITERATURE BLACK CHILDREN -- 1027 00:46:44,987 --> 00:46:47,623 SELF-REPORTED BLACK CHILDREN AND 1028 00:46:47,623 --> 00:46:48,957 ADULTS HAVE A HIGHER BONE 1029 00:46:48,957 --> 00:46:51,727 DENSITY AND APPEAR TO HAVE FEWER 1030 00:46:51,727 --> 00:46:52,528 FRACTURES COMPARED TO WHITE 1031 00:46:52,528 --> 00:46:54,596 PEERS BUT THE QUESTION IS WHAT 1032 00:46:54,596 --> 00:46:56,231 IS RACE CAPTURING? 1033 00:46:56,231 --> 00:46:59,668 COULD THAT REALLY BE AND IS IT 1034 00:46:59,668 --> 00:47:01,470 SKIN PIGMENTATION OR UNDERLYING 1035 00:47:01,470 --> 00:47:03,539 GENETIC FACTORS? 1036 00:47:03,539 --> 00:47:06,375 IS IT ANCESTRY PREDICTING WHAT 1037 00:47:06,375 --> 00:47:08,143 WE'RE SEEING IN THE 1038 00:47:08,143 --> 00:47:11,180 SELF-REPORTED RACE AND MIGHT IT 1039 00:47:11,180 --> 00:47:12,881 REFLECT DIFFERENTIAL EXPERIENCES 1040 00:47:12,881 --> 00:47:15,617 DIFFERENT GROUPS HAVE? 1041 00:47:15,617 --> 00:47:18,787 IT'S ALSO AWKWARD FOR DXA TO ASK 1042 00:47:18,787 --> 00:47:20,088 ABOUT RACE AND FAMILIES TO 1043 00:47:20,088 --> 00:47:24,793 ANSWER IT AND INCREASINGLY AS 1044 00:47:24,793 --> 00:47:26,795 WE'VE HAD INCREASING SENSITIVELY 1045 00:47:26,795 --> 00:47:29,798 AROUND RACE AND HOW WE'RE USING 1046 00:47:29,798 --> 00:47:31,366 THE DATA AND IT'S CAUSED US ALL 1047 00:47:31,366 --> 00:47:33,302 TO QUESTION WHAT THE STANDARD 1048 00:47:33,302 --> 00:47:36,238 PRACTICES HAVE BEEN AND MOVING 1049 00:47:36,238 --> 00:47:39,841 AWAY IN HEALTH GUIDELINES FROM 1050 00:47:39,841 --> 00:47:41,076 IMPERIAL USE OF RACE. 1051 00:47:41,076 --> 00:47:43,679 I WANTED TO REVIEW WITH YOU HOW 1052 00:47:43,679 --> 00:47:44,046 IS RACE APPLIED IN 1053 00:47:47,716 --> 00:47:48,884 DXA. 1054 00:47:48,884 --> 00:47:53,055 IN THE PEEDS CLINIC CARE WE 1055 00:47:53,055 --> 00:47:54,723 MEASURE CHILDREN AND GET HEIGHT 1056 00:47:54,723 --> 00:47:56,625 AND WEIGHT AND GET A SCORE FOR 1057 00:47:56,625 --> 00:47:59,728 BOTH AND USE THE CDC OR HAVE 1058 00:47:59,728 --> 00:48:00,896 LONGITUDINAL GROWTH CHART AND WE 1059 00:48:00,896 --> 00:48:03,665 LOOK AT THE PERCENTILES OF 1060 00:48:03,665 --> 00:48:10,305 WHAT'S NORMAL AND ABNORMAL AND 1061 00:48:10,305 --> 00:48:12,241 PROVIDES US TO REFER TO A 1062 00:48:12,241 --> 00:48:15,677 SPECIALIST OR INTERVENE IN A 1063 00:48:15,677 --> 00:48:17,946 DIAGNOSTIC WORK UP. 1064 00:48:17,946 --> 00:48:28,490 HERE'S A DXA SCANNER AND WE GET 1065 00:48:29,291 --> 00:48:30,993 THE ASSIGNED SEX AND THE ABLE 1066 00:48:30,993 --> 00:48:34,062 AND RACE AND WE CALCULATE A C 1067 00:48:34,062 --> 00:48:34,263 SCORE. 1068 00:48:34,263 --> 00:48:37,199 TOLD YOU WHAT'S NORMAL AND 1069 00:48:37,199 --> 00:48:41,503 ABNORMAL AND THAT'S IMPORTANT 1070 00:48:41,503 --> 00:48:43,038 DATA BECAUSE IT IMPACTS WHERE WE 1071 00:48:43,038 --> 00:48:45,173 REFER THEM TO A SPECIALIST OR DO 1072 00:48:45,173 --> 00:48:46,275 A WORK UP. 1073 00:48:46,275 --> 00:48:48,810 EVEN HOW OFTEN WE BRING THEM 1074 00:48:48,810 --> 00:48:51,647 BACK TO HALF DXA SCANS. 1075 00:48:51,647 --> 00:48:55,651 WE ALSO KNOW IS A GOLD STANDARD 1076 00:48:55,651 --> 00:48:58,253 FOR PEDIATRIC DEFERENCE DATA 1077 00:48:58,253 --> 00:49:00,889 SETS IS BINARY BLACK VERSUS 1078 00:49:00,889 --> 00:49:01,156 NON-BLACK. 1079 00:49:01,156 --> 00:49:03,659 I'VE SEEN THE DATA AND SEE WHY I 1080 00:49:03,659 --> 00:49:04,960 WAS NOT INVOLVED IN GENERATION 1081 00:49:04,960 --> 00:49:07,663 OF THE DATA BUT HAVE SEEN THE 1082 00:49:07,663 --> 00:49:08,030 DATA. 1083 00:49:08,030 --> 00:49:09,131 THERE WAS CLEARLY WHEN THEY 1084 00:49:09,131 --> 00:49:11,667 PLOTTED THE DATA, THE BLACK 1085 00:49:11,667 --> 00:49:13,602 CHILDREN'S BONE DENSITY WAS HERE 1086 00:49:13,602 --> 00:49:16,104 AND EVERYONE ELSE, WHITE, ASIAN, 1087 00:49:16,104 --> 00:49:17,572 ANY OTHER RACIAL ETHNIC GROUP 1088 00:49:17,572 --> 00:49:18,707 WAS DOWN HERE. 1089 00:49:18,707 --> 00:49:20,776 AND SO THAT WAS THE REASON FOR 1090 00:49:20,776 --> 00:49:21,743 THAT BINARY SET UP. 1091 00:49:21,743 --> 00:49:24,880 THE DATA WERE PUBLISHED IN 2007 1092 00:49:24,880 --> 00:49:27,649 AND THEN 2011 AND HAVE BEEN 1093 00:49:27,649 --> 00:49:29,184 USING THE GOLD STANDARD AND 1094 00:49:29,184 --> 00:49:32,120 AROUND THE COUNTRY AND WORLD IN 1095 00:49:32,120 --> 00:49:36,925 DXA UNITS, RACE IS ASKED ABOUT 1096 00:49:36,925 --> 00:49:38,360 TO BE EMPLOYED TO FIGURE OUT 1097 00:49:38,360 --> 00:49:39,461 WHICH WAY TO GO. 1098 00:49:39,461 --> 00:49:42,064 THE BLACK OR NON BLACK AND THE 1099 00:49:42,064 --> 00:49:46,168 DECISIONS CAN VARY IN TERMS OF C 1100 00:49:46,168 --> 00:49:46,501 SCORES. 1101 00:49:46,501 --> 00:49:48,904 MY TEAM ON THE 8th FLOOR OF THE 1102 00:49:48,904 --> 00:49:51,239 CLINICAL CENTER IS VERY 1103 00:49:51,239 --> 00:49:52,407 INTERESTED IN TRYING TO 1104 00:49:52,407 --> 00:49:55,410 UNDERSTAND WHAT THE REFERENCE 1105 00:49:55,410 --> 00:50:00,716 DATA ARE CAPTURING. 1106 00:50:00,716 --> 00:50:04,486 SO WE HAVE THIS IN A CABINET 1107 00:50:04,486 --> 00:50:06,888 WE'LL START DOING SKIN TONE 1108 00:50:06,888 --> 00:50:08,523 MEASUREMENTS TO QUANTITATIVELY 1109 00:50:08,523 --> 00:50:11,059 LOOK AT SKIN TONE WITH THE HOPE 1110 00:50:11,059 --> 00:50:18,734 OF EVENTUALLY HAVING REFERENCE 1111 00:50:18,734 --> 00:50:20,035 DATA BY SKIN TONE AND MOVING 1112 00:50:20,035 --> 00:50:20,869 AWAY FROM RACE. 1113 00:50:20,869 --> 00:50:23,438 WE WONDER IF ABOUT WHAT IS 1114 00:50:23,438 --> 00:50:25,707 CAPTURED BY RACE IS SKIN TONE. 1115 00:50:25,707 --> 00:50:28,410 THE BEST IS PROBABLY GENOTYPING 1116 00:50:28,410 --> 00:50:29,745 PATIENTS BUT THAT'S NOT GOING TO 1117 00:50:29,745 --> 00:50:31,980 BE POSSIBLE IN CLINICS. 1118 00:50:31,980 --> 00:50:36,451 THINK OF RURAL CLINICS AROUND 1119 00:50:36,451 --> 00:50:37,652 THE U.S. THEY WON'T BE ABLE TO 1120 00:50:37,652 --> 00:50:40,822 SEQUENCE EVERYONE AND IF WE CAN 1121 00:50:40,822 --> 00:50:42,924 SHOW SKIN TONE IS AN EASY TOOL 1122 00:50:42,924 --> 00:50:46,595 AND RELATIVELY INEXPENSIVE IF IT 1123 00:50:46,595 --> 00:50:47,396 CORRELATES WITH THE GENOTYPE, 1124 00:50:47,396 --> 00:50:49,965 THIS IS A TOOL WE CAN EASILY 1125 00:50:49,965 --> 00:50:52,901 ROLL OUT TO PRACTICE AND QUICKLY 1126 00:50:52,901 --> 00:50:56,304 ACCUMULATE DATA FOR A NEW DXA 1127 00:50:56,304 --> 00:50:58,940 PEDIATRIC REFERENCE DATABASE AND 1128 00:50:58,940 --> 00:50:59,541 WILL BE PARTICULARLY VALUABLE 1129 00:50:59,541 --> 00:51:01,710 FOR CHILDREN AND ADOLESCENTS OF 1130 00:51:01,710 --> 00:51:02,978 MIXED RACE AND WHAT WE DO WITH 1131 00:51:02,978 --> 00:51:05,914 THEM AND IT DEPENDS ON HOW THEY 1132 00:51:05,914 --> 00:51:07,616 SELF-IDENTIFY AND THERE CAN BE 1133 00:51:07,616 --> 00:51:10,252 VARIABILITY IN HOW ONE LOOKS AND 1134 00:51:10,252 --> 00:51:11,820 THAT SELF-REPORTED DATA IS BEING 1135 00:51:11,820 --> 00:51:14,556 USED TO MAKE IMPORTANT CLINICAL 1136 00:51:14,556 --> 00:51:15,190 DECISIONS. 1137 00:51:15,190 --> 00:51:16,591 SO I'M VERY PASSIONATE ABOUT 1138 00:51:16,591 --> 00:51:17,893 THIS RESEARCH AND GRATEFUL TO MY 1139 00:51:17,893 --> 00:51:20,429 TEAM WHO IS HELPING ME CARRY IT 1140 00:51:20,429 --> 00:51:21,696 OUT AND HOPE WE'RE GOING TO BE 1141 00:51:21,696 --> 00:51:27,002 ABLE TO MOVE THE NEEDLE ON THIS. 1142 00:51:27,002 --> 00:51:29,838 I'D LIKE TO THANK MY 1143 00:51:29,838 --> 00:51:30,705 COLLABORATORS. 1144 00:51:30,705 --> 00:51:32,374 THESE ARE MY EXTRAMURAL 1145 00:51:32,374 --> 00:51:34,209 COLLABORATORS IN BOSTON 1146 00:51:34,209 --> 00:51:37,779 CHILDREN'S, BRIGHAM AND WOMEN'S, 1147 00:51:37,779 --> 00:51:39,648 PORTLAND MAIN AND BAYLOR COLLEGE 1148 00:51:39,648 --> 00:51:42,384 OF MEDICINE IN HOUSTON AND 1149 00:51:42,384 --> 00:51:43,585 IMPORTANTLY MY ADOLESCENT AND 1150 00:51:43,585 --> 00:51:44,352 BODY COMPOSITION LAB. 1151 00:51:44,352 --> 00:51:47,656 I'D HAVE THEM STAND UP BUT I 1152 00:51:47,656 --> 00:51:48,490 WON'T EMBARRASS THEM. 1153 00:51:48,490 --> 00:51:49,758 IN THE INTEREST OF TIME I'LL 1154 00:51:49,758 --> 00:51:53,728 POINT TO THEIR BOLDED NAMES AND 1155 00:51:53,728 --> 00:51:54,830 PICTURES. 1156 00:51:54,830 --> 00:51:56,031 IMPORTANTLY THE INCREDIBLE 1157 00:51:56,031 --> 00:51:57,933 COLLABORATORS I ALREADY HAVE. 1158 00:51:57,933 --> 00:52:00,902 I'VE ONLY BEEN HERE NINE MONTHS 1159 00:52:00,902 --> 00:52:03,004 AND I'VE ALREADY THROUGH 1160 00:52:03,004 --> 00:52:06,775 CONNECTIONS AND A COLLABORATIVE 1161 00:52:06,775 --> 00:52:10,979 SPIRIT HAVE INCREDIBLE 1162 00:52:10,979 --> 00:52:11,480 COLLABORATORS. 1163 00:52:11,480 --> 00:52:13,281 GRATEFUL FOR ALL OF YOU AND 1164 00:52:13,281 --> 00:52:15,150 EXCITED TO START DOING RESEARCH 1165 00:52:15,150 --> 00:52:15,917 TOGETHER. 1166 00:52:15,917 --> 00:52:16,485 THANK YOU AGAIN FOR THE 1167 00:52:16,485 --> 00:52:26,828 INVITATION TO SPEAK. 1168 00:52:40,275 --> 00:52:44,079 >> IT'S EXCITING AND THE ISSUES 1169 00:52:44,079 --> 00:52:45,647 OF WE TALK ABOUT RACE AND 1170 00:52:45,647 --> 00:52:49,851 SOMETIMES WE USE THAT AS A 1171 00:52:49,851 --> 00:52:50,852 SERVICE OF OTHER THINGS AND 1172 00:52:50,852 --> 00:52:53,021 LOOKING AT THAT IN MORE DETAIL. 1173 00:52:53,021 --> 00:52:55,390 WE DO HAVE QUESTIONS FROM THE 1174 00:52:55,390 --> 00:52:55,657 AUDIENCE. 1175 00:52:55,657 --> 00:53:01,029 WE HAVE TIME FOR QUESTIONS IN 1176 00:53:01,029 --> 00:53:11,273 THE AUDIENCE. 1177 00:53:30,992 --> 00:53:33,361 IS THERE A ROLE FOR BONE DENSITY 1178 00:53:33,361 --> 00:53:35,630 SCREENING AND WHAT DO YOU DO 1179 00:53:35,630 --> 00:53:46,007 WITH THE INFORMATION? 1180 00:53:47,042 --> 00:53:48,610 >> THERE'S OPTIMAL TIMES. 1181 00:53:48,610 --> 00:53:50,645 IT DEPENDS ON WHO YOU ASK. 1182 00:53:50,645 --> 00:53:56,318 I TEND TO AT THE BEGINNING OF 1183 00:53:56,318 --> 00:53:58,286 PUBERTY AND ADOLESCENCE AND SEE 1184 00:53:58,286 --> 00:54:02,524 WHERE WE ARE, 70% TO 80% OF BONE 1185 00:54:02,524 --> 00:54:03,992 DENSITY IS DICTATED FROM GENETIC 1186 00:54:03,992 --> 00:54:04,893 FACTORS AND I DON'T KNOW IF 1187 00:54:04,893 --> 00:54:07,562 SOMEONE IS COMING FROM A HIGH OR 1188 00:54:07,562 --> 00:54:09,064 LOW BONE MASS FAMILY AND I MAY 1189 00:54:09,064 --> 00:54:12,934 BE MORE AGGRESSIVE IN STARTING 1190 00:54:12,934 --> 00:54:14,936 MY HORMONE REPLACEMENT THERAPY 1191 00:54:14,936 --> 00:54:17,706 IF I KNOW SOMEONE HAS A LOW BONE 1192 00:54:17,706 --> 00:54:19,608 DENSITY AND SOME WILL TRY TO 1193 00:54:19,608 --> 00:54:21,710 GIVE THE OPTIMAL THERAPY AND 1194 00:54:21,710 --> 00:54:27,148 WE'LL TRY TO NAIL IT DOWN TO 1195 00:54:27,148 --> 00:54:29,818 CANCER SURVIVORS AND AT 18 OR 20 1196 00:54:29,818 --> 00:54:31,286 SEE WHERE THEY ARE AND SEE IF 1197 00:54:31,286 --> 00:54:33,455 THEY NEED TO BE FOLLOWED BY A 1198 00:54:33,455 --> 00:54:35,657 SPECIALIST. 1199 00:54:35,657 --> 00:54:43,632 GREAT QUESTION. 1200 00:54:43,632 --> 00:54:46,735 >> DO YOU KNOW OF DATA ON 1201 00:54:46,735 --> 00:54:50,105 DIFFERENCES IN SEXUAL 1202 00:54:50,105 --> 00:54:51,106 DEVELOPMENT BESIDES INTERSEX 1203 00:54:51,106 --> 00:54:52,641 THAT AFFECT BONE DENSITY OR IS 1204 00:54:52,641 --> 00:54:54,943 THAT SOMETHING YOU'RE INTERESTED 1205 00:54:54,943 --> 00:54:55,477 IN? 1206 00:54:55,477 --> 00:54:59,648 >> DR. VERONICA GOMEZ LOBO, MY 1207 00:54:59,648 --> 00:55:01,650 COLLABORATOR, IS ACTIVELY 1208 00:55:01,650 --> 00:55:04,619 STUDIES FOR YEARS ANDROGEN 1209 00:55:04,619 --> 00:55:06,321 SENSITIVITY AN INTERSECT 1210 00:55:06,321 --> 00:55:08,490 DIAGNOSES AS YOU KNOW. 1211 00:55:08,490 --> 00:55:11,660 WHAT WITH KNOW SO FAR IS 1212 00:55:11,660 --> 00:55:13,294 RESISTANCE TO ANDROGENS LEADS TO 1213 00:55:13,294 --> 00:55:15,664 A LOWER THAN EXPECTED BONE 1214 00:55:15,664 --> 00:55:18,133 DENSITY BUT THERE'S A BIG 1215 00:55:18,133 --> 00:55:18,933 SPECTRUM OF PRESENTATION OF 1216 00:55:18,933 --> 00:55:23,638 THOSE ADOLESCENTS AND ADULTS. 1217 00:55:23,638 --> 00:55:27,642 SO SHE'S ALSO INTERESTED IN THE 1218 00:55:27,642 --> 00:55:28,376 INTERSEX DISORDERS AS WELL. 1219 00:55:28,376 --> 00:55:29,511 IT'S AN IMPORTANT QUESTION 1220 00:55:29,511 --> 00:55:31,079 BECAUSE I THINK THAT WORK WILL 1221 00:55:31,079 --> 00:55:34,816 INFORM WHAT WE ULTIMATELY DECIDE 1222 00:55:34,816 --> 00:55:36,918 AS CLINICAL RECOMMENDATIONS FOR 1223 00:55:36,918 --> 00:55:38,753 TRANS GENDER YOUTH AND ADULTS. 1224 00:55:38,753 --> 00:55:43,658 >> THANK YOU. 1225 00:55:43,658 --> 00:55:44,559 >> THANK YOU. 1226 00:55:44,559 --> 00:55:48,763 ABOUT POI PATIENTS AND THOSE 1227 00:55:48,763 --> 00:55:52,567 POST-TRANS PLANT OR CHEMOTHERAPY 1228 00:55:52,567 --> 00:55:54,002 WE GET ASKED ALL THE TIME 1229 00:55:54,002 --> 00:55:57,238 WHETHER WE EXPECT THE POI TO BE 1230 00:55:57,238 --> 00:55:58,773 PERMANENT AND HOW CAN WE ANSWER 1231 00:55:58,773 --> 00:56:00,175 THAT QUESTION AND HOW DOES 1232 00:56:00,175 --> 00:56:03,211 THAT -- SHOULD THAT GUIDE HOW WE 1233 00:56:03,211 --> 00:56:06,915 REPLACE HORMONE REPLACEMENT? 1234 00:56:06,915 --> 00:56:09,250 >> I APPRECIATE THE QUESTION. 1235 00:56:09,250 --> 00:56:11,419 IN MOST CASES IT'S PERMANENT OR 1236 00:56:11,419 --> 00:56:16,291 IT'S ON THE WAY TO BEING 1237 00:56:16,291 --> 00:56:17,859 PERMANENT. 1238 00:56:17,859 --> 00:56:20,995 CERTAINLY WATCHING ESTRADIOL AND 1239 00:56:20,995 --> 00:56:22,230 MH HORMONE CAN GIVE US 1240 00:56:22,230 --> 00:56:24,132 INFORMATION AND THERE WAS A TALK 1241 00:56:24,132 --> 00:56:27,635 LAST WEEK ON THAT LAST WEEK. 1242 00:56:27,635 --> 00:56:28,837 SO UNDERSTANDING THAT PROFILE 1243 00:56:28,837 --> 00:56:31,072 IT'S ASSUMING ULTIMATELY IT WILL 1244 00:56:31,072 --> 00:56:33,942 LEAD TO ESTROGEN DEFICIENCY AND 1245 00:56:33,942 --> 00:56:35,643 EMBRACING THAT EARLY AND 1246 00:56:35,643 --> 00:56:36,878 STARTING THERAPY I THINK THE 1247 00:56:36,878 --> 00:56:39,647 ANSWER'S GOING TO BE WE'RE GOING 1248 00:56:39,647 --> 00:56:41,483 TO START EARLIER AND EARLIER 1249 00:56:41,483 --> 00:56:44,819 MAYBE EVEN TINY DOSES OF 1250 00:56:44,819 --> 00:56:46,354 ESTRADIOL THAT DON'T IMPACT 1251 00:56:46,354 --> 00:56:46,588 GROWTH. 1252 00:56:46,588 --> 00:56:47,922 A LOT OF IT DEPENDS ON THE HIGH 1253 00:56:47,922 --> 00:56:51,459 OF THE CHILD AND THE PREDICTED 1254 00:56:51,459 --> 00:56:53,695 HEIGHT AS AN ENDOCRINOLOGIST AND 1255 00:56:53,695 --> 00:56:55,363 WE HAVE A LOT OF TO LEARN THERE 1256 00:56:55,363 --> 00:56:57,298 BUT I WORRY WE'RE STARTING 1257 00:56:57,298 --> 00:56:58,666 TREATMENT TOO LATE WHICH IS THEN 1258 00:56:58,666 --> 00:57:01,770 GOING TO IMPACT BONE HEALTH IN 1259 00:57:01,770 --> 00:57:03,738 AN ADVERSE WAY. 1260 00:57:03,738 --> 00:57:06,040 >> THANK YOU. 1261 00:57:06,040 --> 00:57:06,407 >> THANK YOU. 1262 00:57:06,407 --> 00:57:08,209 >> HI, I HAVE A QUESTION FROM 1263 00:57:08,209 --> 00:57:09,010 THE VIRTUAL AUDIENCE. 1264 00:57:09,010 --> 00:57:11,045 THANK YOU FOR SHARING YOUR WORK. 1265 00:57:11,045 --> 00:57:14,949 YOU MENTIONED REGARDING THE SKIN 1266 00:57:14,949 --> 00:57:17,952 TONE AND BONE MINERAL DENSITY 1267 00:57:17,952 --> 00:57:19,654 AND THE USE IN UNDER SERVED 1268 00:57:19,654 --> 00:57:21,222 AREAS AND HIM ENVIRONMENTAL 1269 00:57:21,222 --> 00:57:24,926 FACTORS, SUN EXPOSURE, TANNING, 1270 00:57:24,926 --> 00:57:27,662 AFFECT THE SKIN TONE ASSESSMENT? 1271 00:57:27,662 --> 00:57:29,430 >> GREAT QUESTION. 1272 00:57:29,430 --> 00:57:29,898 . 1273 00:57:29,898 --> 00:57:31,432 THERE'S A LOT EMBEDDED IN THAT 1274 00:57:31,432 --> 00:57:34,736 QUESTION AND I'M INTERESTED IN 1275 00:57:34,736 --> 00:57:35,703 THE SOCIAL DETERMINATES AND HOW 1276 00:57:35,703 --> 00:57:39,040 TO DISSECT OUT HOW THEY PLAY IN 1277 00:57:39,040 --> 00:57:39,641 AS WELL. 1278 00:57:39,641 --> 00:57:43,211 AS MY TEAM KNOWS WITH OUR 1279 00:57:43,211 --> 00:57:46,447 SPECTRA PHOTOMETER WE DO THE 1280 00:57:46,447 --> 00:57:48,950 UNDER ARM WE'RE MORE APT THE 1281 00:57:48,950 --> 00:57:52,620 OTHER SIDE OF OUR ARM WILL 1282 00:57:52,620 --> 00:57:54,923 CAPTURE SUN EXPOSURE BUT THAT 1283 00:57:54,923 --> 00:57:56,758 SURFACE SHOULD BE LESS EXPOSED 1284 00:57:56,758 --> 00:58:00,361 AND THERE'S LESS FRECKLING. 1285 00:58:00,361 --> 00:58:02,197 IT'S TYPICALLY VARIES LESS BY 1286 00:58:02,197 --> 00:58:02,430 SEASON. 1287 00:58:02,430 --> 00:58:04,799 HAVING SAID THAT, WE'LL BE 1288 00:58:04,799 --> 00:58:07,068 CAPTURING THE SEASON OF THE 1289 00:58:07,068 --> 00:58:07,569 YEAR. 1290 00:58:07,569 --> 00:58:09,470 WE'RE ALSO INTERESTED IN 1291 00:58:09,470 --> 00:58:11,372 THINKING ABOUT VITAMIN D 1292 00:58:11,372 --> 00:58:14,442 CUTANEOUS SYNTHESIS AND HOW THAT 1293 00:58:14,442 --> 00:58:15,944 PLAYS IN. 1294 00:58:15,944 --> 00:58:18,179 AFRICAN AMERICANS TEND TO HAVE 1295 00:58:18,179 --> 00:58:20,114 LOWER VITAMIN D LEVELS AND CAN 1296 00:58:20,114 --> 00:58:21,549 HAVE AN ADVERSE EFFECT ON BONE 1297 00:58:21,549 --> 00:58:23,651 SO THINKING ABOUT THAT IN THE 1298 00:58:23,651 --> 00:58:30,859 MIX AS WELL. 1299 00:58:30,859 --> 00:58:35,330 >> ANY OTHER QUESTIONS FROM THE 1300 00:58:35,330 --> 00:58:35,630 AUDIENCE? 1301 00:58:35,630 --> 00:58:37,966 DR. GORDON I WANT TO THANK YOU 1302 00:58:37,966 --> 00:58:39,300 FOR YOUR TIME. 1303 00:58:39,300 --> 00:58:39,734 WE APPRECIATE IT. 1304 00:58:39,734 --> 00:58:40,301 >> THANK YOU FOR COMING. 1305 00:58:40,301 --> 00:58:42,871