Atypical tibial fracture in a 63-Year-old woman with intermittent use of bisphosphonate unmasking hypophosphatasia

We report an unusual case of atypical proximal tibial stress fracture (APTF) associated with intermittent use of bisphosphonates (BPs) and persistently low serum alkaline phosphatase (ALP) levels. We describe the case of a 63-year-old white woman who had experienced an APTF after 4 years of intermittent exposure to alendronate given for recurrent metatarsal stress fractures. BP administration was stopped after the diagnosis of the APTF. A review of her previous serum ALP levels revealed they had been consistently low. Adult hypophosphatasia (HPP) was diagnosed by the low serum ALP activity and elevated urine phosphoethanolamine levels. She was treated conservatively with analgesics. Adult HPP is an underrecognized condition associated with atypical insufficiency fractures, and BP use compounds this risk. To the best of our knowledge, we report the first case of intermittent BP exposure preceding an APTF in an adult patient with HPP, highlighting the uncommon site of the proximal tibia for BP-associated atypical insufficiency fractures, the need to screen for HPP in those with persistently low ALP levels before they begin BP therapy, and the importance of avoiding BP use in those with HPP

From protest to progress through partnership with students: Being human in STEM (HSTEM)

In Fall 2015, Amherst College students held a four-day sit-in in unity with student protests occurring all over the United States highlighting barriers to inclusion of underrepresented and marginalized students.Following appeals for action, students partnered with faculty and staff in science, technology, engineering, and mathematics (STEM) to develop the Being Human in STEM (HSTEM) Initiative. HSTEM involves exploring past diversity and inclusion efforts in STEM, sharing one’s own experiences in STEM with others, and developing student-driven projects to improve belonging in STEM. In this student, faculty, and staff co-authored paper, we describe the origin of HSTEM; share student, faculty and staff reflections on our experiences with HSTEM; and present two inquiry projects examining HSTEM impact. We discuss lessons learned and recommendations for diversity and inclusion efforts in higher education, both in and beyond STEM, emphasizing the power of an initiative that was originated by and remains driven by student partners