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Schwartz AV, Chen H, Ambrosius WT, Sood A, Josse RG, Bonds DE, Schnall AM, Vittinghoff E, Bauer DC, Banerji MA, Cohen RM, Hamilton BP, Isakova T, Sellmeyer DE, Simmons DL, Shibli-Rahhal A, Williamson JD, Margolis KL. Effects of TZD Use and Discontinuation on Fracture Rates in ACCORD Bone Study. J Clin Endocrinol Metab 2015; 100:4059-66. [PMID: 26305617 PMCID: PMC4702444 DOI: 10.1210/jc.2015-1215] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/18/2015] [Indexed: 02/01/2023]
Abstract
CONTEXT In trials, thiazolidinediones (TZDs) increase fracture risk in women, but the effects of discontinuation are unknown. OBJECTIVE The objective was to investigate the effects of TZD use and discontinuation on fractures in women and men. DESIGN This was a longitudinal observational cohort study using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial bone ancillary study. Duration of TZD use and discontinuation during ACCORD, assessed every 2-4 months at clinic visits, were modeled as time-varying covariates in proportional hazards models for occurrence of first non-spine fracture. PARTICIPANTS We studied a total of 6865 participants in ACCORD BONE. MAIN OUTCOME MEASURES Main outcome measures were centrally adjudicated non-spine fracture. RESULTS Average age was 62.4 (SD, 6.6) years; average duration of diabetes was 11.1 (SD, 7.8) years. Rosiglitazone was used by 74% and pioglitazone by 13% of participants. During a mean follow-up of 4.8 (SD, 1.5) years, 262 men and 287 women experienced at least one non-spine fracture. The fracture rate was higher in women with 1-2 years of TZD use (hazard ratio [HR] = 2.32; 95% confidence interval [CI], 1.49, 3.62) or >2 years of TZD use (HR = 2.01; 95% CI, 1.35, 2.98), compared with no use. The fracture rate was reduced in women who had discontinued TZD use for 1-2 years (HR = 0.57; 95% CI, 0.35, 0.92) or > 2 years (HR = 0.42; 95% CI, 0.24, 0.74) compared with current users. TZD use and discontinuation were not associated with non-spine fractures in men. CONCLUSIONS TZD use was associated with increased non-spine fractures in women, but not men, with type 2 diabetes. When women discontinued TZD use, the fracture effects were attenuated.
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Affiliation(s)
- Ann V Schwartz
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Haiying Chen
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Walter T Ambrosius
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Ajay Sood
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Robert G Josse
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Denise E Bonds
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Adrian M Schnall
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Eric Vittinghoff
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Douglas C Bauer
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Mary Ann Banerji
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Robert M Cohen
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Bruce P Hamilton
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Tamara Isakova
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Deborah E Sellmeyer
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Debra L Simmons
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Amal Shibli-Rahhal
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Jeff D Williamson
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
| | - Karen L Margolis
- University of California (A.V.S., E.V., D.C.B.), San Francisco, California 94143; Wake Forest School of Medicine (H.C., W.T.A., J.D.W.), Winston-Salem, North Carolina 27157; Louis Stokes VA Medical Center and Case Western Reserve University (A.S.), Cleveland, Ohio 44106; St. Michael's Hospital (R.G.J.), Toronto, ON M5B 1W8, Canada; National Heart Lung and Blood Institute (D.E.B.), National Institute of Health, Bethesda, Maryland 20892; Case Western Reserve University (A.M.S.), Cleveland, Ohio 44106; SUNY Downstate Medical Center and Kings County Hospital (M.A.B.), Brooklyn, New York 11203; University of Cincinnati College of Medicine (R.M.C.), Cincinnati, Ohio 45267; VA Medical Center and University of Maryland School of Medicine (B.P.H.), Baltimore, Maryland 21201; University of Miami (T.I.), Miami, Florida 33124; Division of Endocrinology (D.E.S.), Johns Hopkins School of Medicine, Baltimore, Maryland 21205; University of Utah and Salt Lake City Veterans Hospital (D.L.S.), Salt Lake City, Utah 84148; University of Iowa Carver College of Medicine (A.S.-R.), Iowa City, Iowa 52242; and Health Partners Institute for Education and Research (K.M.), Minneapolis, Minnesota 55425
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