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Richard H. Lee

Associate Professor of Medicine
Medicine, Endocrinology, Metabolism, and Nutrition
Box 3470, Durham, NC 27710
Dept of Medicine, Durham, NC 27710

Selected Publications


Association of prior treatment with nitrogen-containing bisphosphonates on outcomes of COVID-19 positive patients.

Journal Article Osteoporos Int · January 2024 UNLABELLED: COVID-19 infection has resulted in significant morbidity and mortality globally, especially among older adults. Repurposed drugs have demonstrated activity in respiratory illnesses, including nitrogen-containing bisphosphonates. In this retrosp ... Full text Link to item Cite

Metabolic factors associated with incident fracture among older adults with type 2 diabetes mellitus: a nested case-control study.

Journal Article Osteoporos Int · July 2023 UNLABELLED: Older adults with type 2 diabetes mellitus have an increased risk of fracture despite a paradoxically higher average bone mineral density. This study identified additional markers of fracture risk in this at-risk population. Non-esterified fatt ... Full text Open Access Link to item Cite

Protocol for the models of primary osteoporosis screening in men (MOPS) cluster randomized trial.

Journal Article Contemp Clin Trials · January 2022 Current guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, analyses in a national Veterans Health Administration cohort of over 4,000,000 men dem ... Full text Link to item Cite

Diabetes is associated with a lower minimum moment of inertia among older women: An analysis of 3D reconstructions of clinical CT scans.

Journal Article J Biomech · November 9, 2021 Hip fractures are a significant burden on the aging population, often resulting in reduced mobility, loss of independence, and elevated risk of mortality. While fracture risk is generally inversely related to bone mineral density (BMD), people with diabete ... Full text Link to item Cite

Factors Associated With Adherence to Osteoporosis Medications Among Male Veterans.

Conference JBMR Plus · August 2021 Risk factors for nonadherence to osteoporosis medication have been well described for cohorts of women with osteoporosis, but little is known about predictors or mediators of nonadherence in men. We conducted a secondary analysis of a national cohort of ma ... Full text Link to item Cite

FRAX without BMD can be used to risk-stratify Veterans who recently sustained a low trauma non-vertebral/non-hip fracture.

Journal Article Osteoporos Int · March 2021 UNLABELLED: We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and speci ... Full text Link to item Cite

Extent of and reasons for osteoporosis medication non-adherence among veterans and feasibility of a pilot text message reminder intervention.

Conference Arch Osteoporos · February 2, 2021 UNLABELLED: We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be ... Full text Link to item Cite

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia.

Journal Article J Bone Miner Res · March 2020 Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fr ... Full text Link to item Cite

Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus.

Journal Article J Bone Miner Res · November 2019 Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes-associated comorbidities, the relative ef ... Full text Link to item Cite

Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications.

Journal Article J Clin Endocrinol Metab · January 1, 2018 INTRODUCTION: Type 2 diabetes mellitus among older women has been associated with increased bone mineral density, but paradoxically with increased fracture risk. Findings among older men have varied, and potential mechanisms have not been fully elucidated. ... Full text Link to item Cite

Geographic scope and accessibility of a centralized, electronic consult program for patients with recent fracture.

Journal Article Rural Remote Health · 2016 INTRODUCTON: Low-trauma, osteoporotic fractures among older men are associated with a significant increase in morbidity and mortality. Despite effective therapies for osteoporosis, several studies have demonstrated that management and treatment after a low ... Link to item Cite

Functional Impairments Mediate Association Between Clinical Fracture Risk and Type 2 Diabetes Mellitus in Older Women.

Journal Article J Am Geriatr Soc · August 2015 OBJECTIVES: To examine the effect of functional impairments in older women with diabetes mellitus (DM) on incident clinical fractures. DESIGN: Secondary analysis of two large prospective cohort studies. SETTING: North Carolina Established Populations for E ... Full text Link to item Cite

Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.

Journal Article Calcif Tissue Int · June 2014 Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identif ... Full text Link to item Cite

Comparison of cost-effectiveness of vitamin D screening with that of universal supplementation in preventing falls in community-dwelling older adults.

Journal Article J Am Geriatr Soc · May 2013 OBJECTIVES: To compare the cost-effectiveness of population screening for vitamin D insufficiency with that of universal vitamin D supplementation in community-dwelling older adults. DESIGN: A Markov decision model simulating follow-up over a 36-month peri ... Full text Link to item Cite

Effectiveness of osteoporosis therapy among frail, older adults: Should we carry out more trials?

Journal Article Aging Health · October 1, 2012 Despite the increasing number of treatment options for osteoporosis, healthcare providers continue to face clinical conundrums when deciding if and how to treat frail, older adults. The under-representation of this population in randomized controlled trial ... Full text Cite

Association of prior treatment with nitrogen-containing bisphosphonates on outcomes of COVID-19 positive patients.

Journal Article Osteoporos Int · January 2024 UNLABELLED: COVID-19 infection has resulted in significant morbidity and mortality globally, especially among older adults. Repurposed drugs have demonstrated activity in respiratory illnesses, including nitrogen-containing bisphosphonates. In this retrosp ... Full text Link to item Cite

Metabolic factors associated with incident fracture among older adults with type 2 diabetes mellitus: a nested case-control study.

Journal Article Osteoporos Int · July 2023 UNLABELLED: Older adults with type 2 diabetes mellitus have an increased risk of fracture despite a paradoxically higher average bone mineral density. This study identified additional markers of fracture risk in this at-risk population. Non-esterified fatt ... Full text Open Access Link to item Cite

Protocol for the models of primary osteoporosis screening in men (MOPS) cluster randomized trial.

Journal Article Contemp Clin Trials · January 2022 Current guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, analyses in a national Veterans Health Administration cohort of over 4,000,000 men dem ... Full text Link to item Cite

Diabetes is associated with a lower minimum moment of inertia among older women: An analysis of 3D reconstructions of clinical CT scans.

Journal Article J Biomech · November 9, 2021 Hip fractures are a significant burden on the aging population, often resulting in reduced mobility, loss of independence, and elevated risk of mortality. While fracture risk is generally inversely related to bone mineral density (BMD), people with diabete ... Full text Link to item Cite

Factors Associated With Adherence to Osteoporosis Medications Among Male Veterans.

Conference JBMR Plus · August 2021 Risk factors for nonadherence to osteoporosis medication have been well described for cohorts of women with osteoporosis, but little is known about predictors or mediators of nonadherence in men. We conducted a secondary analysis of a national cohort of ma ... Full text Link to item Cite

FRAX without BMD can be used to risk-stratify Veterans who recently sustained a low trauma non-vertebral/non-hip fracture.

Journal Article Osteoporos Int · March 2021 UNLABELLED: We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and speci ... Full text Link to item Cite

Extent of and reasons for osteoporosis medication non-adherence among veterans and feasibility of a pilot text message reminder intervention.

Conference Arch Osteoporos · February 2, 2021 UNLABELLED: We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be ... Full text Link to item Cite

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia.

Journal Article J Bone Miner Res · March 2020 Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fr ... Full text Link to item Cite

Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus.

Journal Article J Bone Miner Res · November 2019 Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes-associated comorbidities, the relative ef ... Full text Link to item Cite

Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications.

Journal Article J Clin Endocrinol Metab · January 1, 2018 INTRODUCTION: Type 2 diabetes mellitus among older women has been associated with increased bone mineral density, but paradoxically with increased fracture risk. Findings among older men have varied, and potential mechanisms have not been fully elucidated. ... Full text Link to item Cite

Geographic scope and accessibility of a centralized, electronic consult program for patients with recent fracture.

Journal Article Rural Remote Health · 2016 INTRODUCTON: Low-trauma, osteoporotic fractures among older men are associated with a significant increase in morbidity and mortality. Despite effective therapies for osteoporosis, several studies have demonstrated that management and treatment after a low ... Link to item Cite

Functional Impairments Mediate Association Between Clinical Fracture Risk and Type 2 Diabetes Mellitus in Older Women.

Journal Article J Am Geriatr Soc · August 2015 OBJECTIVES: To examine the effect of functional impairments in older women with diabetes mellitus (DM) on incident clinical fractures. DESIGN: Secondary analysis of two large prospective cohort studies. SETTING: North Carolina Established Populations for E ... Full text Link to item Cite

Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.

Journal Article Calcif Tissue Int · June 2014 Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identif ... Full text Link to item Cite

Comparison of cost-effectiveness of vitamin D screening with that of universal supplementation in preventing falls in community-dwelling older adults.

Journal Article J Am Geriatr Soc · May 2013 OBJECTIVES: To compare the cost-effectiveness of population screening for vitamin D insufficiency with that of universal vitamin D supplementation in community-dwelling older adults. DESIGN: A Markov decision model simulating follow-up over a 36-month peri ... Full text Link to item Cite

Effectiveness of osteoporosis therapy among frail, older adults: Should we carry out more trials?

Journal Article Aging Health · October 1, 2012 Despite the increasing number of treatment options for osteoporosis, healthcare providers continue to face clinical conundrums when deciding if and how to treat frail, older adults. The under-representation of this population in randomized controlled trial ... Full text Cite

The association of newer anticonvulsant medications and bone mineral density.

Journal Article Endocr Pract · September 14, 2012 OBJECTIVE: Previous studies have shown an association between the use of traditional anticonvulsants (e.g. phenytoin, carbamazepine, valproate) and decreased bone mineral density (BMD). However, there are limited data regarding the effects of newer anticon ... Full text Link to item Cite

Disorders of phosphorus homeostasis.

Journal Article Curr Opin Endocrinol Diabetes Obes · December 2010 PURPOSE OF REVIEW: The study of phosphorus physiology and investigations into clinical disorders of phosphorus metabolism has blossomed over the past decade. Recent work has confirmed and further extended our knowledge of basic mechanisms of phosphorus met ... Full text Link to item Cite

A review of the effect of anticonvulsant medications on bone mineral density and fracture risk.

Journal Article Am J Geriatr Pharmacother · February 2010 BACKGROUND: Osteoporosis and seizure disorders are common diagnoses in older adults and often occur concomitantly. OBJECTIVE: The goal of this review was to discuss the current hypothesis for the pathogenesis of anticonvulsant-induced bone density loss and ... Full text Link to item Cite