Michael Kleerekoper, MD, MACE | Endocrinology Blogs

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<span>›</span> <a href="/web/20130502145603/http://www.healio.com/endocrinology/blogs"> Blogs</a> </p>   <div class="blog-content">  <div class="blog-tab-group"> <ul class="blog-tabs"> <li> <a class="current" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace">Michael Kleerekoper, MD, MACE</a> </li> <li> <a href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/thomas-b-repas-do-facp-face-cde">Thomas B Repas, DO, FACP, FACE, CDE</a> </li> </ul>  <div class="blog-panes"> <div class="eviblog-header"> <a id="layout_0_maincontent_0_blogcontent_0_HyperlinkBlog" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace">Michael Kleerekoper, MD, MACE</a> </div> <div>  <ul class="blog-bio"> <li class="img"> <img src="/web/20130502145603im_/http://www.healio.com/~/media/Images/Blog Authors/Endocrinology/Kleerekoper.jpg" alt="Michael Kleerekoper, MD, MACE" width="71" height="90"/></li> <li> Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for<em> Endocrine Today</em>, <em>Endocrine Practice</em>,<em> Journal of Clinical Densitometry</em>, <em>Journal of Women's Health</em>, <em>Osteoporosis International</em> and <em>Calcified Tissue International</em>. Dr. Kleerekoper is also a founding board member of the newly formed <em>Academy of Women’s Health</em>.</li> </ul>  <div class="blog-post"> <p class="meta-info"> Tuesday, April 16, 2013 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_0" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/why-dont-patients-care-about-their-diabetes-care">Why don't patients care about their diabetes care?</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p class="BodyCxSpFirst">It’s no secret that most of my clinical and research activities involve in bone and mineral metabolism, both in the lab and the clinic. In my new position I am faced with most of my patients coming to clinic for management of diabetes. </p> <p class="BodyCxSpMiddle">In my role as a clinician, I view myself as a teacher to my patients with diabetes, but for the most part, it is an uphill battle. More than 30% of my new patients with type 2 diabetes turn up at the clinic without a glucose meter and/or a blood glucose diary. If they do bring a meter, it is immediately obvious that they do not look at serial blood glucose data and do not know that they should have been taught how to adjust their insulin dosing, or preferably their eating habits, to maintain a more stable capillary blood glucose. When they are concerned about a high fasting glucose (ie, >300mg) they tend to overdose with insulin. Most often they elect to inject glargine twice a day.</p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_0" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/why-dont-patients-care-about-their-diabetes-care">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Thursday, March 7, 2013 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_1" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/how-does-your-thyroid-grow">How does your thyroid grow?</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>In September 2011, I presented the case of a 16-year-old girl who developed substantial thyroid gland growth after she had been treated with radioactive iodine therapy for initial management of severe hyperthyroidism. Every colleague from whom I solicited advice about this uncommon occurrence, as well as anything I could find in the published literature, pointed to marked elevations in thyroid antibodies as the primary cause for this sequence of events. </p> <p>I am now caring for a 30-year-old woman who is 3 months into her therapy for Graves’ disease. She had been taking 20 mg of methimazole daily and also 20 mg of propranolol, but she did not think she was getting better and requested a referral to a surgeon. Some unrelated gynecologic issues developed and she put off her possible surgery while continuing to take her anti-thyroid medication. When I first saw her as a patient it was quickly apparent that her gland had enlarged in size quite substantially despite continued “appropriate” therapy. </p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_1" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/how-does-your-thyroid-grow">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Thursday, February 14, 2013 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_2" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/time-for-a-change">Time for a change</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>The recent decreases in reimbursement for DXA studies seem to have affected and possibly decreased the quality of the studies, particularly at centers where the operator or the person reporting the data may not have undergone formal training in this important technology.</p> <p>However, considering both the past and the future, I am not yet convinced that is the only problem facing DXA. </p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_2" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/time-for-a-change">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Wednesday, December 19, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_3" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/very-overweight-with-very-different-stories">Very overweight with very different stories</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>Marcy is a 22-year-old woman has had type 1 diabetes since age 6 years. During the past year or so, she has been chasing hypoglycemia and has ballooned to a BMI of 44.6. As she has gained the weight, she has clearly developed some insulin resistance. To her credit, she is seeing a dietitian regularly and has an appointment set up to consider bariatric surgery.</p> <p>Jody, on the other hand, is also 22 years old, but her story is quite different. Almost 12 months before she was referred to my clinic, she was diagnosed as having type 2 diabetes. Her clinician could not have been more incorrect! She has ballooned to a BMI of 60.8 — not a typographical error — as she struggled to avoid the symptoms of hypoglycemia. Because her blood glucose values were more often low than high, she was not placed on any therapy to control “diabetes.” Be thankful for small mercies.</p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_3" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/very-overweight-with-very-different-stories">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Friday, November 30, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_4" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-skinny-on-diabetes">The 'skinny' on diabetes</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>Necrobiosis Lipoidica (diabeticorum), mainly described and discussed in the dermatology literature<sup>1</sup>, is strongly linked to diabetes. As far as I can gather from extensive literature searching, the etiology is uncertain, but the most common suggested etiology is microvascular necrosis of subcutaneous blood vessels. </p> <p>The photos shown below are of a patient seen in clinic recently. While I went searching for a colleague in dermatology, my very astute resident had the foresight to pull out her iPhone and capture the lesions on film. Thank you. </p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_4" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-skinny-on-diabetes">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Monday, November 12, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_5" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/off-the-chart-tsh-and-heterophilic-antibodies">Off-the-chart TSH and heterophilic antibodies</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>A 40-year-old woman, several years post-thyroidectomy for management of thyroid cancer with concomitant parathyroidectomy, had been doing very well until about 2 years before I saw her as a patient.</p> <p>A few days before her clinic visit, her primary care provider sent me the most comprehensive clinical encounter report that I have seen in a long time, and several items caught my attention immediately.</p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_5" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/off-the-chart-tsh-and-heterophilic-antibodies">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Wednesday, October 17, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_6" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/overcoming-the-vitamin-d-hype">Overcoming the vitamin D hype</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>The United States Preventive Services Task Force has released a draft recommendation that 400 IU of vitamin D and 1,000 mg of calcium has not been shown to prevent fractures in postmenopausal women.</p> <p>I try and keep up with the literature, and I cannot recall any data that suggest otherwise. </p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_6" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/overcoming-the-vitamin-d-hype">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Friday, September 7, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_7" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hashitoxicosis-revisited">'Hashitoxicosis' revisited</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>In September 2011, I posted a <a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hashitoxicosis" target="_new">blog</a> about a 17-year-old girl in whom the thyroid gland increased in size a few months after radioactive iodine therapy for Graves’ disease. The gland decreased in size on steroid therapy, and by January 2012, she was clinically and biochemically euthyroid and the gland had returned to normal size. However, 2 months later, the gland began to enlarge again.</p> <p>An MRI with and without contrast revealed “heterogeneous in intensity and multiple small nodules.” There was also a 1.2x1.4x1.5 cm nodule at the thyroid isthmus. This larger nodule was subsequently biopsied but the pathology report was, to put it mildly, inconclusive. </p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_7" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hashitoxicosis-revisited">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Monday, August 13, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_8" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/bone-is-a-plastic-tissue">Bone is a plastic tissue</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>Decades ago, medical school final exams took the form of essays rather than the current multiple choice questions. For the histology finals, I selected the topic “Bone is a plastic tissue.” I knew absolutely nothing about the skeleton other than it was brittle and broken. It turns out that not only was I wrong but I knew as little about it as the professors: for the one and only time in medical school, I topped the class.</p> <p>Bone is clearly a plastic tissue subject to modeling during growth and development and remodeling shortly after epiphyseal closure. The most common skeletal disease resulting from altered remodeling is osteoporosis in which resorption outstrips formation. Monitoring resorption and formation — measures of total skeletal metabolism — is overlooked in favor of monitoring bone mineral density — measures of regional, not total, skeletal status.</p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_8" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/bone-is-a-plastic-tissue">Read more...</a> </div> </div> <div class="blog-post"> <p class="meta-info"> Tuesday, July 3, 2012 </p> <h2> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_lnkBlogPostTitle_9" class="postTitle" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/where-does-the-fault-lie">Where does the fault lie?</a> </h2> <p class="meta-info"> Michael Kleerekoper, MD, MACE </p> <div class="blog-intro"> <p>I recently saw three new patients with type 2 diabetes, two referred by their PCPs and one came on the recommendation of an existing patient who had brought his HbA1c down from 9.7% to 6.4% in the past 15 months.</p> </div> <div class="readmore"> <a id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_ListView1_BlogPostLink_9" href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/where-does-the-fault-lie">Read more...</a> </div> </div>  <div id="layout_0_maincontent_0_blogcontent_0_phblogmain_0_pagination_divPagination" class="pagination"> <ul> <li> <a class="current page" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace?Filter=&startItem=0"> 1 </a> </li> <li> <a class="page" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace?Filter=&startItem=10"> 2 </a> </li> <li> <a class="page" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace?Filter=&startItem=20"> 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href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace?tag=thyroid">thyroid</a> <a class="weight1" href="/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace?tag=fine+needle+aspiration">fine needle aspiration</a> </li> </ul> </div> <ul class="archives"> <li class="header"> <h6> Archives</h6> </li> <li><a onclick="ToggleVisibility("month-2013")" class="year">2013</a></li><ul id="month-2013" class="month"><li><a onclick="ToggleVisibility("entries-20132")" class="month">February (1)</a><ul id="entries-20132" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/time-for-a-change">Time for a change</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20133")" class="month">March (1)</a><ul id="entries-20133" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/how-does-your-thyroid-grow">How does your thyroid grow?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20134")" class="month">April (1)</a><ul id="entries-20134" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/why-dont-patients-care-about-their-diabetes-care">Why don't patients care about their diabetes care?</a></li></ul></li></ul><li><a onclick="ToggleVisibility("month-2012")" class="year">2012</a></li><ul id="month-2012" class="month"><li><a onclick="ToggleVisibility("entries-20121")" class="month">January (1)</a><ul id="entries-20121" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/high-bone-mass">High bone mass</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20122")" class="month">February (1)</a><ul id="entries-20122" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-lesson-learned">A lesson learned?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20124")" class="month">April (1)</a><ul id="entries-20124" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/fna-or-surgery">FNA or surgery?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20125")" class="month">May (1)</a><ul id="entries-20125" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/cutting-dxa-reimbursement-won-t-improve-the-quality-of-the-testing">Cutting DXA reimbursement won't improve the quality of the testing</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20127")" class="month">July (1)</a><ul id="entries-20127" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/where-does-the-fault-lie">Where does the fault lie?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20128")" class="month">August (1)</a><ul id="entries-20128" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/bone-is-a-plastic-tissue">Bone is a plastic tissue</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20129")" class="month">September (1)</a><ul id="entries-20129" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hashitoxicosis-revisited">'Hashitoxicosis' revisited</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201210")" class="month">October (1)</a><ul id="entries-201210" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/overcoming-the-vitamin-d-hype">Overcoming the vitamin D hype</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201211")" class="month">November (2)</a><ul id="entries-201211" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-skinny-on-diabetes">The 'skinny' on diabetes</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/off-the-chart-tsh-and-heterophilic-antibodies">Off-the-chart TSH and heterophilic antibodies</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201212")" class="month">December (1)</a><ul id="entries-201212" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/very-overweight-with-very-different-stories">Very overweight with very different stories</a></li></ul></li></ul><li><a onclick="ToggleVisibility("month-2011")" class="year">2011</a></li><ul id="month-2011" class="month"><li><a onclick="ToggleVisibility("entries-20111")" class="month">January (2)</a><ul id="entries-20111" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/management-of-type-2-diabetes-in-older-married-couples">Management of type 2 diabetes in older married couples</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-bad-miss">A bad miss</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20112")" class="month">February (1)</a><ul id="entries-20112" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/work-up-for-calcium-containing-kidney-stones">Work-up for calcium-containing kidney stones</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20113")" class="month">March (3)</a><ul id="entries-20113" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hypoglycemia">Hypoglycemia</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hba1c-2b-or-not-2b">HbA1c — 2B or not 2B?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hair-loss-and-thyroid-disease">Hair loss and thyroid disease</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20115")" class="month">May (2)</a><ul id="entries-20115" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/biochemical-markers-of-bone-remodeling-do-the-guidelines-help">Biochemical markers of bone remodeling: Do the guidelines help?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/preventing-atypical-femur-fractures-in-patients-treated-with-bisphosphonates">Preventing atypical femur fractures in patients treated with bisphosphonates</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20116")" class="month">June (1)</a><ul id="entries-20116" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/clinical-judgment-is-paramount">Clinical judgment is paramount</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20117")" class="month">July (1)</a><ul id="entries-20117" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/low-t-without-elevated-gonadotropins">Low T without elevated gonadotropins</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20118")" class="month">August (2)</a><ul id="entries-20118" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/polypharmacy-at-its-worst">Polypharmacy at its worst</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/caveat-emptor">Caveat Emptor!</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20119")" class="month">September (1)</a><ul id="entries-20119" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/insulin-via-pump-for-type-2-diabetes">Insulin via pump for type 2 diabetes</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201110")" class="month">October (1)</a><ul id="entries-201110" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hashitoxicosis">'Hashitoxicosis'</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201111")" class="month">November (1)</a><ul id="entries-201111" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/stormin-norman">Stormin' Norman</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201112")" class="month">December (1)</a><ul id="entries-201112" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/it-seems-so-straightforward-why-can-t-i-get-it-right">It seems so straightforward - why can't I get it right?</a></li></ul></li></ul><li><a onclick="ToggleVisibility("month-2010")" class="year">2010</a></li><ul id="month-2010" class="month"><li><a onclick="ToggleVisibility("entries-20101")" class="month">January (3)</a><ul id="entries-20101" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/testosterone-for-older-men">Testosterone for older men</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/monitor-hba1c-but-be-careful">Monitor HbA1c, but be careful</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/type-2-diabetes-and-minimal-trauma-fractures">Type 2 diabetes and minimal trauma fractures</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20102")" class="month">February (3)</a><ul id="entries-20102" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-panoply-of-parathyroid-diseases">A panoply of parathyroid diseases</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/not-a-tall-tale">Not a tall tale</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-cream-rises-to-the-top-then-creates-problems">The cream rises to the top, then creates problems</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20103")" class="month">March (3)</a><ul id="entries-20103" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/drug-therapy-not-an-exact-science">Drug therapy — not an exact science</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/diabetes-care-in-a-down-economy-put-a-spring-in-your-step">Diabetes care in a down economy – put (a) spring in your step</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/too-much-to-handle-at-once">Too much to handle at once</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20104")" class="month">April (3)</a><ul id="entries-20104" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/dxa-scans">DXA scans</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-picture-is-worth-a-thousand-words-continuous-glucose-monitoring">A picture is worth a thousand words — continuous glucose monitoring</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-vitamin-d-hype-is-just-that-at-least-for-now">The vitamin D hype is just that — at least for now</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20105")" class="month">May (3)</a><ul id="entries-20105" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/some-do-s-and-don-ts-of-dxa-reporting">Some do’s and don’ts of DXA reporting</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/check-out-these-lab-reports">Check out these lab reports!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/bisphosphonates-are-both-effective-and-safe">Bisphosphonates are both effective and safe</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20106")" class="month">June (1)</a><ul id="entries-20106" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/steroid-therapy-and-osteoporosis-worth-repeating">Steroid therapy and osteoporosis — worth repeating</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20107")" class="month">July (2)</a><ul id="entries-20107" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-uspstf-is-hard-to-please">The USPSTF is hard to please</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/not-an-everyday-occurrence">Not an everyday occurrence</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20108")" class="month">August (1)</a><ul id="entries-20108" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/forearm-dxa">Forearm DXA</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20109")" class="month">September (1)</a><ul id="entries-20109" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/how-would-you-manage-these-patients">How would you manage these patients?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201010")" class="month">October (2)</a><ul id="entries-201010" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/guide-your-patients-through-the-fda-warning-concerning-bisphosphonates">Guide your patients through the FDA warning concerning bisphosphonates</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/parathyroidectomy-in-the-elderly">Parathyroidectomy in the elderly</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201011")" class="month">November (2)</a><ul id="entries-201011" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/two-ends-of-the-spectrum-part-2">Two ends of the spectrum: Part 2</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/two-ends-of-the-spectrum-part-1">Two ends of the spectrum: Part 1</a></li></ul></li><li><a onclick="ToggleVisibility("entries-201012")" class="month">December (1)</a><ul id="entries-201012" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-parathyroidectomy-was-not-successful">The parathyroidectomy was not successful</a></li></ul></li></ul><li><a onclick="ToggleVisibility("month-2009")" class="year">2009</a></li><ul id="month-2009" class="month"><li><a onclick="ToggleVisibility("entries-20091")" class="month">January (8)</a><ul id="entries-20091" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/i-am-going-to-keep-blogging-until-we-get-it-right">I am going to keep blogging until we get it right</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/self-induced-hypoglycemia">Self-induced hypoglycemia?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/severe-hypothyroidism-and-atrial-fibrillation-a-therapeutic-dilemma">Severe hypothyroidism and atrial fibrillation — a therapeutic dilemma</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/who-what-is-normal">Who/what is NORMAL?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/thyroid-hormone-therapy-and-the-skeleton">Thyroid hormone therapy and the skeleton</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/primary-hyperparathyroidism">Primary hyperparathyroidism</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/thiazides-and-magnesium">Thiazides and magnesium</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/what-is-the-cause-of-the-anorexia">What is the cause of the anorexia?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20092")" class="month">February (4)</a><ul id="entries-20092" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/more-on-dxa">More on DXA</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/updated-guidelines-for-management-of-asymptomatic-primary-hyperparathyroidism">Updated guidelines for management of asymptomatic primary hyperparathyroidism</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/multivitamins-safe-but-not-beneficial-are-we-sure">Multivitamins — safe but not beneficial; are we sure?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/what-my-colleagues-are-asking-about-skeletal-health">What my colleagues are asking about skeletal health</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20093")" class="month">March (5)</a><ul id="entries-20093" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/cme-must-continue-but-is-becoming-increasingly-difficult-to-organize">CME must continue but is becoming increasingly difficult to organize</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/honest-my-hip-broke-before-i-fell">'Honest! My hip broke before I fell!'</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/testosterone-therapy-in-hypogonadal-men">Testosterone therapy in hypogonadal men</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/power-to-the-patient">Power to the patient!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/corticosteroid-therapy">Corticosteroid therapy</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20094")" class="month">April (5)</a><ul id="entries-20094" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/two-ends-of-the-spectrum">Two ends of the spectrum</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/another-use-for-the-frax-tool">Another use for the FRAX tool!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/does-the-patient-always-have-the-right-to-know-everything">Does the patient always have the right to know everything?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/what-s-new-in-osteoporosis-report-of-the-8th-international-symposium-on-osteoporosis">What’s new in osteoporosis: report of the 8th International Symposium on Osteoporosis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hypoglycemia-after-roux-en-y-surgery-for-weight-reduction">Hypoglycemia after Roux-en-Y surgery for weight reduction</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20095")" class="month">May (4)</a><ul id="entries-20095" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/don-t-practice-medicine-with-blinders-on">Don’t practice medicine with blinders on</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/what-s-in-a-name-does-the-patient-have-diabetes-or-is-the-patient-a-diabetic">What’s in a name: Does the patient have diabetes or is the patient 'a diabetic'?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/epidemiology-to-the-rescue">Epidemiology to the rescue?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/why-does-common-sense-go-out-the-window">Why does common sense go out the window?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20096")" class="month">June (4)</a><ul id="entries-20096" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/what-is-osteoporosis">What is osteoporosis?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/rogue-patients">Rogue patients</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/too-hot-to-handle">Too hot to handle</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/vitamin-d-further-down-the-road">Vitamin D further down the road</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20097")" class="month">July (6)</a><ul id="entries-20097" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/short-but-not-very-sweet">Short but not very sweet!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/common-sense-dxa-reporting">Common sense DXA reporting</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/not-as-sick-as-her-numbers">Not as sick as her numbers</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/osteoporosis-in-premenopausal-women">Osteoporosis in premenopausal women</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/severe-hypothyroidism-and-myocardial-ischemia">Severe hypothyroidism and myocardial ischemia</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/do-stress-fractures-indicate-underlying-bone-disease">Do stress fractures indicate underlying bone disease?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20098")" class="month">August (4)</a><ul id="entries-20098" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/how-to-determine-who-or-what-is-normal">How to determine who or what is normal</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/body-composition-assessed-by-dxa">Body composition assessed by DXA</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/weigh-out-on-a-limb">‘Weigh’ out on a limb!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/good-news-bad-news-for-osteoporosis">Good news, bad news for osteoporosis</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20099")" class="month">September (6)</a><ul id="entries-20099" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/testosterone-replacement-for-male-hypogonadism">Testosterone replacement for male hypogonadism</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/empower-the-patient">Empower the patient</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/lots-of-new-information-but-nothing-has-changed">Lots of new information, but nothing has changed!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/are-we-overtreating-osteoporosis">Are we overtreating osteoporosis?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/the-worst-headache-i-have-ever-had">'The worst headache I have ever had'</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/sex-ed-for-adults">'Sex Ed' for adults</a></li></ul></li><li><a onclick="ToggleVisibility("entries-200910")" class="month">October (5)</a><ul id="entries-200910" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/bioidentical-hormones">Bioidentical hormones</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/see-ya-lada-alligada">See ya LADA, alliGADa!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/dxa-under-threat-from-many-directions">DXA under threat from many directions</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-heavy-football-weekend">A heavy football weekend</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/dxa-and-scoliosis">DXA and scoliosis</a></li></ul></li><li><a onclick="ToggleVisibility("entries-200911")" class="month">November (4)</a><ul id="entries-200911" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/sight-unseen">Sight unseen</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/unnecessary-uncertainty-continues-to-plague-osteoporosis">Unnecessary uncertainty continues to plague osteoporosis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/amiodarone-induced-thyroiditis">Amiodarone-induced thyroiditis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/paget-s-disease">Paget’s disease</a></li></ul></li><li><a onclick="ToggleVisibility("entries-200912")" class="month">December (3)</a><ul id="entries-200912" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/just-hope-the-wires-don-t-get-crossed">Just hope the wires don’t get crossed</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-sliding-scale-is-good-for-fishing-but-is-it-good-for-managing-diabetes-in-outpatients">A sliding scale is good for fishing, but is it good for managing diabetes in outpatients?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/she-didn-t-follow-the-rules">She didn’t follow the rules</a></li></ul></li></ul><li><a onclick="ToggleVisibility("month-2008")" class="year">2008</a></li><ul id="month-2008" class="month"><li><a onclick="ToggleVisibility("entries-20081")" class="month">January (1)</a><ul id="entries-20081" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/does-this-woman-need-therapy-for-osteoporosis">Does this woman need therapy for osteoporosis?</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20082")" class="month">February (4)</a><ul id="entries-20082" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/be-on-the-look-out-for-osteoporosis">Be on the look-out for osteoporosis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/low-bone-density-leads-to-turner-s-syndrome-diagnosis">Low bone density leads to Turner’s syndrome diagnosis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/contributing-factors-may-alter-management-of-osteoporosis">Contributing factors may alter management of osteoporosis</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/calibrating-glucose-meters">Calibrating glucose meters</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20083")" class="month">March (9)</a><ul id="entries-20083" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/to-sleep-perchance-to-dream-and-to-make-some-growth-hormone">'To sleep, perchance to dream'* — and to make some growth hormone</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/some-quick-facts-about-vitamin-d">Some quick facts about vitamin D</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/when-expensive-medicine-is-worth-the-cost">When expensive medicine is worth the cost</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/diabetes-care-requires-full-patient-family-involvement">Diabetes care requires full patient, family involvement</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/it-s-hard-to-keep-up-with-osteoporosis-but-it-is-necessary">It’s hard to keep up with osteoporosis—but it is necessary</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/reference-intervals-normal-ranges-not-speed-limits">Reference intervals (normal ranges) not speed limits</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/attendees-of-endocrine-university-show-enthusiasm-for-the-field">Attendees of Endocrine University show enthusiasm for the field</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/do-not-rely-on-hba1c-measurement-alone">Do not rely on HbA1c measurement alone</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/consider-high-urine-oxalate-in-the-evaluation-of-kidney-stones">Consider high urine oxalate in the evaluation of kidney stones</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20084")" class="month">April (8)</a><ul id="entries-20084" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/eating-disorders-hard-to-treat">Eating disorders hard to treat</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/a-difference-of-opinion">A difference of opinion</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/being-too-overweight-is-not-good-for-you-being-too-underweight-isn-t-either">Being too overweight is not good for you — being too underweight isn’t either</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/share-control-with-the-patient">Share control with the patient!</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/spam">Spam</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/osteouria-the-link-between-osteoporosis-and-hypercalciuria">'Osteouria' the link between osteoporosis and hypercalciuria</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/where-did-my-bones-go">Where did my bones go?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/diagnosing-patients-referred-for-hypoglycemia">Diagnosing patients referred for hypoglycemia</a></li></ul></li><li><a onclick="ToggleVisibility("entries-20085")" class="month">May (8)</a><ul id="entries-20085" class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/more-on-home-glucose-monitoring">More on home glucose monitoring</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/whose-patient-is-it">Whose patient is it?</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/consider-the-evidence-carefully">Consider the evidence carefully</a></li><li><a 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class="entries" style="display:none;"><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hip-fracture-risk-after-discontinuing-bisphosphonate-use">Hip fracture risk after discontinuing bisphosphonate use</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/paget-s-disease-of-bone">Paget’s disease of bone</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/hormone-therapy-at-menopause-re-visited">Hormone therapy at menopause re-visited</a></li><li><a href="https://web.archive.org/web/20130502145603/http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/think-twice-before-ordering-thyroid-function-tests-in-hospitalized-patients">Think twice before ordering thyroid function tests in hospitalized patients</a></li><li><a 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Michael Kleerekoper, MD, MACE | Endocrinology Blogs