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A graduate of Columbia College (A.B. Liberal Arts: cum laude) and Harvard Medical School (M.D. cum laude), Bruce Ettinger completed his Internal Medicine residency at the II & IV (Harvard) Medical Service, Boston City Hospital. Following a fellowship in Endocrinology at the UCSF Metabolic Research Unit, Dr. Ettinger joined The Permanente Medical Group (TPMG) in 1972. He worked as a Senior Physician in Endocrinology and Medicine at Kaiser Permanente San Francisco Medical Center until he retired in 2003. Throughout this tenure, he served in multiple leadership positions: Chair of Patient Rights Committee, TPMG 1970s; Regional Chair of Chiefs of Endocrinology, TPMG 1980-2003; Medical Liaison for the Regional Laboratory Services, KPNC 1985-2003; and Regional Chief of Densitometry Services, KPNC 1992-2003. As founding Chair of Endocrinology for KPNC and to many “The Father of TPMG Endocrinology”, he mentored countless TPMG residents, physicians, and researchers during his nearly 50-year career. His expertise in providing clear explanations that reassured patients navigating an uncertain medical diagnosis was remarkable. He is especially remembered for his curiosity, clinical insights, kindness, collegiality, and generosity of time.
As a Senior Investigator at the KPNC Division of Research 1990-2003, Dr. Ettinger spearheaded highly impactful research in women’s health related to menopause, osteoporosis, and fractures. His primary areas of research focused on kidney stones, osteoporosis epidemiology, fracture risk prediction, menopause management, and prevention and treatment of osteoporotic fractures. In addition to “stones and bones,” he was most proud of his women’s health research portfolio, which focused on efficacy and safety studies. Collaborating with scientists both nationally and internationally, he designed, planned, and executed both epidemiologic studies and clinical trials to identify acceptable, effective treatments for women’s menopause management and osteoporosis prevention. In 1996-1997, Dr. Ettinger served as President of the North American Menopause Society (NAMS). In addition to several awards from NAMS for his work advancing postmenopausal health, the journal Menopause selected three of Dr. Ettinger’s papers [1996 (1,2), 1997 (3,4), 2012 (5,6)] for its 25th Anniversary Commemorative Issue highlighting the most impactful paper from each of its 25 years of publication.(7)
Between 2000-2008, Dr. Ettinger served on an advisory committee for the National Committee for Quality Assurance (NCQA) to develop quality measures for osteoporosis diagnosis and treatment. These became the HEDIS measures that continue to serve as a benchmark for healthcare delivery systems nationally. The U.S. Preventive Services Task Force invited Dr. Ettinger to review their guidelines for screening to prevent osteoporotic fractures. In 2008 with the approval of the National Osteoporosis Foundation, Dr. Ettinger initiated an important update of the U.S. fracture incidence rates; this data became the revised reference standard used by the U.S. FRAX tool.(8) In 2009, he served as an expert reviewer for the Agency for Healthcare Research and Quality (AHRQ) scientific statement on the comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. In his final decade as Senior Investigator Emeritus at the KPNC Division of Research, Dr. Ettinger advanced our understanding of atypical femur fractures and provided mentorship to the next generation of KPNC researchers, particularly Joan Lo, whom he entrusted to carry on his work in fracture risk assessment and with whom he partnered in new research examining ethnic differences in skeletal health.
As a Senior Investigator at the KPNC Division of Research 1990-2003, Dr. Ettinger spearheaded highly impactful research in women’s health related to menopause, osteoporosis, and fractures. His primary areas of research focused on kidney stones, osteoporosis epidemiology, fracture risk prediction, menopause management, and prevention and treatment of osteoporotic fractures. In addition to “stones and bones,” he was most proud of his women’s health research portfolio, which focused on efficacy and safety studies. Collaborating with scientists both nationally and internationally, he designed, planned, and executed both epidemiologic studies and clinical trials to identify acceptable, effective treatments for women’s menopause management and osteoporosis prevention. In 1996-1997, Dr. Ettinger served as President of the North American Menopause Society (NAMS). In addition to several awards from NAMS for his work advancing postmenopausal health, the journal Menopause selected three of Dr. Ettinger’s papers [1996 (1,2), 1997 (3,4), 2012 (5,6)] for its 25th Anniversary Commemorative Issue highlighting the most impactful paper from each of its 25 years of publication.(7)
Between 2000-2008, Dr. Ettinger served on an advisory committee for the National Committee for Quality Assurance (NCQA) to develop quality measures for osteoporosis diagnosis and treatment. These became the HEDIS measures that continue to serve as a benchmark for healthcare delivery systems nationally. The U.S. Preventive Services Task Force invited Dr. Ettinger to review their guidelines for screening to prevent osteoporotic fractures. In 2008 with the approval of the National Osteoporosis Foundation, Dr. Ettinger initiated an important update of the U.S. fracture incidence rates; this data became the revised reference standard used by the U.S. FRAX tool.(8) In 2009, he served as an expert reviewer for the Agency for Healthcare Research and Quality (AHRQ) scientific statement on the comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. In his final decade as Senior Investigator Emeritus at the KPNC Division of Research, Dr. Ettinger advanced our understanding of atypical femur fractures and provided mentorship to the next generation of KPNC researchers, particularly Joan Lo, whom he entrusted to carry on his work in fracture risk assessment and with whom he partnered in new research examining ethnic differences in skeletal health.
1. Kidney Stones: Characterization of triamterene nephrolithiasis, recurrence, and prevention
As a metabolic endocrinologist, Dr. Ettinger’s early work focused on kidney stones (nephrolithiasis), including crystal formation in cystinuria, cystinuric calculi, (9,10) and outcomes following inorganic phosphate treatment of patients with calcium nephrolithiasis.(11) As a Kaiser Permanente physician, he was the first to identify triamterene renal calculi in treated patients (12) and conducted the first epidemiologic study of triamterene nephrolithiasis in the U.S.(13) Over 20 years, Dr. Ettinger built upon these early investigations to develop a larger body of accomplished work that advanced the field of kidney stones and their prevention. These include numerous double-blind placebo-controlled studies of phosphate,(14,15) allopurinol,(16) chlorthalidone(17) and K-Mg citrate(18) therapy for the prevention of recurrent nephrolithiasis that he led within Kaiser Permanente during the first two decades of his Permanente career.
2. Measurement of bone mineral density (BMD)
Together with Dr. Harry Genant and colleagues, Dr. Ettinger organized a clinical trial of women following oophorectomy which showed high rates of vertebral trabecular bone loss measured by quantitative computed tomography (QCT)(19-21) As bone densitometry became the clinical standard for osteoporosis screening, Dr. Ettinger implemented a large KPNC BMD surveillance program for older women. He set up 15 bone densitometry imaging centers across Northern California performing ongoing quality monitoring and leadership for the program.
3. Women’s Health: Menopause Management and Osteoporosis Prevention
Following findings from the BMD-QCT research that administration of estrogen minimized bone loss, (21-23) Dr. Ettinger initiated several epidemiologic studies that demonstrated fracture risk reductions among women using hormone therapy. (24,25) At this time, the American College of Physicians commissioned a statement and guidelines for hormone therapy.(26) Lingering concerns about these positive conclusions arise from observational studies prompted Drs. Ettinger, Grady, and Cummings to pursue further research with randomized control trials (RCT) to advance more robust understanding of the risks and benefits of hormone therapy. In his curiosity-driven pursuit to identify the lowest dose needed to treat, Dr. Ettinger led several RCTs that demonstrated lower than standard dosages of estrogen could adequately maintain bone density after menopause.(22,27) Designing research from his clinical practice, Dr. Ettinger initiated several studies to examine how to improve menopause management; these studies evaluated the gynecologic consequences of cyclic estrogen and progestin (28,29) and unopposed estrogen therapy,(30) the risk of breast cancer with long-term estrogen use,(3,4) and the challenges relating to estrogen discontinuation.(31,32) After he and other clinicians began to encounter patients who reported that their “TCM prescribed dong quai for menopause,” he designed studies to determine whether the Chinese herb “dong quai” had estrogenic properties(33) and to assess diagnostic consistency among Traditional Chinese Medicine (TCM) practitioners.(34) Dr. Ettinger’s research advanced the quality of care and choices available to menopausal women.
4. Clinical trial design and execution to examine osteoporosis prevention and treatment
KPNC Division of Research’s mission is research to improve the health of its members; over three decades, Dr. Ettinger played a key role in designing, executing, and monitoring numerous randomized controlled trials of novel therapies that were subsequently shown to prevent bone loss and/or reduce the risk of osteoporotic fractures. As well, he served as chair of bone endpoints committees in multiple trials. Dr. Ettinger was the lead author in the JAMA publication of the pivotal Multiple Outcomes of Raloxifene Evaluation (MORE) study,(35) a multicenter, double-blinded placebo-controlled randomized trial of two doses of raloxifene in 7705 post-menopausal women with osteoporosis. The MORE study showed that the risk of vertebral fracture was reduced for both doses of raloxifene, with greater efficacy at the higher dose, but it did not significantly reduce nonvertebral fracture risk.(35) He subsequently led a trial of parathyroid hormone in older women previously treated with alendronate or raloxifene within KPNC which found that parathyroid hormone stimulates bone turnover regardless of the type of prior therapy but increases bone mineral density only in those previously treated with raloxifene.(36) In collaboration with Dr. Steve Cummings and Dr. Deborah Grady at UCSF, Dr. Ettinger led the Ultra-Low-dose Transdermal estRogen Assessment (ULTRA) study, a multicenter randomized, double-blind, placebo-controlled trial which found that low-dose, unopposed estradiol increased bone mineral density and reduced bone turnover among post-menopausal women without leading to endometrial hyperplasia—all the benefits with none of the risks of hormone therapy.(27,37)
5. Clinically useful fracture risk prediction models
With the rise of widespread bone density testing and promotion of osteoporosis pharmacotherapy in the 1990s, the need for evidence-based fracture risk assessment and counseling about osteoporosis emerged. Practitioners found it difficult to provide women with an accurate estimate of their fracture risk based on bone density results and other risk factors. Beginning around 2000, Dr. Ettinger began to develop a simple computerized fracture risk model using information on bone density and clinical risk factors for osteoporosis to calculate the five-year risk of fracture for postmenopausal women.(38) He tested the impact of this risk assessment model on provider understanding and prescribing practice; he demonstrated the utility of estimating absolute fracture risk in younger postmenopausal women with osteopenia who might not otherwise require or benefit from pharmacotherapy.(38) In 2008, when the web-based FRAX® Fracture Risk Assessment Tool was introduced by the World Health Organization Collaborating Center for Metabolic Bone Disease (University of Sheffield, England) and the International Osteoporosis Foundation, Dr. Ettinger collaborated with other scientists to update the rates of hip fracture and of major osteoporotic fractures for the U.S.(8); these data became the reference standard for the U.S. FRAX® tool upon its 2009 revision. He also developed, refined, and tested a web-based Fracture Risk Calculator (FRC) tool that communicated fracture risk in an accessible manner for patients.(39,40) Dr. Ettinger led several studies to validate the FORE FRC tool and the U.S. FRAX® tool. Early studies focused on validating the FORE FRC(41) and examining the performance of FRAX® in women(42) with Kaiser Permanente’s population data. In collaboration with the Osteoporotic Fractures in Men study (MrOS), Dr. Ettinger also validated the FORE FRC in men(43) and assessed the performance of FRAX® in this population.(44)
6. Atypical femur fractures in association with bisphosphonate therapy
During the past decade, Dr. Ettinger partnered with Dr. Joan Lo at the Kaiser Permanente Northern California Division of Research to study the epidemiology of atypical femur fractures associated in women with bisphosphonate exposure.(45,46) After characterizing recent trends and ethnic differences in proximal and diaphyseal femur fractures,(47) they conducted population-based studies of atypical femur fracture among older women.(45,46) Dr. Ettinger also worked with a team of bone biologists to summarize the mechanism(s) contributing to the pathogenesis of atypical femur fracture.(48) These findings supported data from others that collectively convinced the medical and scientific community that atypical femur fractures were not osteoporotic fractures, but rather an uncommon adverse effect of bisphosphonate drugs on bone. In an evolving field lacking evidence-based consensus at that time, he published an important physician perspective that not only addressed a recent Task Force report on atypical femur fracture, but also provided practical treatment guidance and considerations for the practicing clinician.(49)
7. Ethnic differences in skeletal health
Throughout his career, Dr. Ettinger’s work has advanced our understanding of ethnicity and skeletal health. In an early Coronary Artery Risk Development in Young Adults (CARDIA) Ancillary Study, he examined differences in bone density among young adults of black and white race, not attributable to anthropometric, lifestyle and biochemical differences.(50) Recent studies with Dr. Joan Lo have focused on Asian skeletal health,(51) where they observed that Asian women had a lower incidence of hip fracture about half that of white women,(47) but a higher risk of atypical femur fracture with bisphosphonate exposure.(46)
References
1. Ettinger B, Li DK, Klein R. Continuation of postmenopausal hormone replacement therapy: comparison of cyclic versus continuous combined schedules. Menopause. 2018;25(11):1187-1190.
2. Ettinger B, Li DK, Klein R. Continuation of postmenopausal hormone replacement therapy: Comparison of cyclic versus continuous combined schedules. Menopause. 1996;3(4):185-189.
3. Ettinger B, Quesenberry C, Schroeder DA, Friedman G. Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: A cohort study. Menopause. 2018;25(11):1191-1194.
4. Ettinger B, Quesenberry C, Schroeder DA, Friedman G. Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: A cohort study. Menopause. 1997;4(3):125-129.
5. Ettinger B, Wang SM, Leslie RS, Patel BV, Boulware MJ, Mann ME, McBride M. Evolution of postmenopausal hormone therapy between 2002 and 2009. Menopause. 2012;19(6):610-615.
6. Ettinger B, Wang SM, Leslie RS, Patel BV, Boulware MJ, Mann ME, McBride M. Evolution of postmenopausal hormone therapy between 2002 and 2009. Menopause. 2018;25(11):1306-1312.
7. Menopause 25th Anniversary Commemorative Issue. Menopause. 2018;25(11):1171.
8. Ettinger B, Black DM, Dawson-Hughes B, Pressman AR, Melton LJ, 3rd. Updated fracture incidence rates for the US version of FRAX. Osteoporos Int. 2010;21(1):25-33.
9. Ettinger B, Kolb FO. Chlordiazepoxide and cystinuric calculus. JAMA. 1970;212(4):627.
10. Ettinger B, Kolb FO. Factors involved in crystal formation in cystinuria. In vivo and in vitro crystallization dynamics and a simple, quantitative colorimetic assay for cystine. J Urol. 1971;106(1):106-110.
11. Ettinger B, Kolb FO. Inorganic phosphate treatment of nephrolithiasis. Am J Med. 1973;55(1):32-37.
12. Ettinger B, Weil E, Mandel NS, Darling S. Triamterene-induced nephrolithiasis. Ann Intern Med. 1979;91(5):745-746.
13. Ettinger B, Oldroyd NO, Sorgel F. Triamterene nephrolithiasis. JAMA. 1980;244(21):2443-2445.
14. Ettinger B. Recurrent nephrolithiasis: natural history and effect of phosphate therapy. A double-blind controlled study. Am J Med. 1976;61(2):200-206.
15. Ettinger B. Recurrence of nephrolithiasis. A six-year prospective study. Am J Med. 1979;67(2):245-248.
16. Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med. 1986;315(22):1386-1389.
17. Ettinger B, Citron JT, Livermore B, Dolman LI. Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not. J Urol. 1988;139(4):679-684.
18. Ettinger B, Pak CY, Citron JT, Thomas C, Adams-Huet B, Vangessel A. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol. 1997;158(6):2069-2073.
19. Cann CE, Genant HK, Ettinger B, Gordan GS. Spinal mineral loss in oophorectomized women. Determination by quantitative computed tomography. JAMA. 1980;244(18):2056-2059.
20. Ettinger B, Genant HK, Cann CE. Assessment of vertebral and peripheral bone mineral loss in women after oophorectomy. In: Menczel K, Robin GC, Makin R, Steinberg R, eds. Osteoporosis. Chicester: John Wiley and Sons; 1982:436-440.
21. Genant HK, Cann CE, Ettinger B, Gordan GS. Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 1982;97(5):699-705.
22. Ettinger B, Genant HK, Cann CE. Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med. 1987;106(1):40-45.
23. Ettinger B, Genant HK, Steiger P, Madvig P. Low-dosage micronized 17 beta-estradiol prevents bone loss in postmenopausal women. Am J Obstet Gynecol. 1992;166(2):479-488.
24. Maxim P, Ettinger B, Spitalny GM. Fracture protection provided by long-term estrogen treatment. Osteoporos Int. 1995;5(1):23-29.
25. Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med. 1985;102(3):319-324.
26. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, Ernster VL, Cummings SR. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117(12):1016-1037.
27. Ettinger B, Ensrud KE, Wallace R, Johnson KC, Cummings SR, Yankov V, Vittinghoff E, Grady D. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial. Obstet Gynecol. 2004;104(3):443-451.
28. Ettinger B, Selby JV, Citron JT, Ettinger VM, Zhang D. Gynecologic complications of cyclic estrogen progestin therapy. Maturitas. 1993;17(3):197-204.
29. Ettinger B, Selby J, Citron JT, Vangessel A, Ettinger VM, Hendrickson MR. Cyclic hormone replacement therapy using quarterly progestin. Obstet Gynecol. 1994;83(5 Pt 1):693-700.
30. Ettinger B, Golditch IM, Friedman G. Gynecologic consequences of long-term, unopposed estrogen replacement therapy. Maturitas. 1988;10(4):271-282.
31. Ettinger B, Grady D, Tosteson AN, Pressman A, Macer JL. Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol. 2003;102(6):1225-1232.
32. Grady D, Ettinger B, Tosteson AN, Pressman A, Macer JL. Predictors of difficulty when discontinuing postmenopausal hormone therapy. Obstet Gynecol. 2003;102(6):1233-1239.
33. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68(6):981-986.
34. Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause. 2000;7(2):129-134.
35. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282(7):637-645.
36. Ettinger B, San Martin J, Crans G, Pavo I. Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res. 2004;19(5):745-751.
37. Johnson SR, Ettinger B, Macer JL, Ensrud KE, Quan J, Grady D. Uterine and vaginal effects of unopposed ultralow-dose transdermal estradiol. Obstet Gynecol. 2005;105(4):779-787.
38. Ettinger B, Hillier TA, Pressman A, Che M, Hanley DA. Simple computer model for calculating and reporting 5-year osteoporotic fracture risk in postmenopausal women. J Womens Health (Larchmt). 2005;14(2):159-171.
39. FORE 10-Year Fracture Risk Calcuator for Health Care Professionals. http://riskcalculator.fore.org/. Accessed July 18, 2010.
40. Ettinger B. A personal perspective on fracture risk assessment tools. Menopause. 2008;15(5):1023-1026.
41. Lo JC, Pressman AR, Chandra M, Ettinger B. Fracture risk tool validation in an integrated healthcare delivery system. Am J Manag Care. 2011;17(3):188-194.
42. Pressman AR, Lo JC, Chandra M, Ettinger B. Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system. J Clin Densitom. 2011;14(4):407-415.
43. Ettinger B, Liu H, Blackwell T, Hoffman AR, Ensrud KE, Orwoll ES. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: the Osteoporotic Fractures in Men (MrOS) Study. J Clin Densitom. 2012;15(3):334-342.
44. Ettinger B, Ensrud KE, Blackwell T, Curtis JR, Lapidus JA, Orwoll ES, Osteoporotic Fracture in Men Study Research G. Performance of FRAX in a cohort of community-dwelling, ambulatory older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int. 2013;24(4):1185-1193.
45. Lo JC, Grimsrud CD, Ott SM, Chandra M, Hui RL, Ettinger B. Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure. Osteoporos Int. 2019;30(12):2515-2520.
46. Lo JC, Hui RL, Grimsrud CD, Chandra M, Neugebauer RS, Gonzalez JR, Budayr A, Lau G, Ettinger B. The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone. 2016;85:142-147.
47. Lo JC, Zheng P, Grimsrud CD, Chandra M, Ettinger B, Budayr A, Lau G, Baur MM, Hui RL, Neugebauer R. Racial/ethnic differences in hip and diaphyseal femur fractures. Osteoporos Int. 2014;25(9):2313-2318.
48. Ettinger B, Burr DB, Ritchie RO. Proposed pathogenesis for atypical femoral fractures: Lessons from material research. Bone. 2013;55(2):495-500.
49. Ettinger B, Stuenkel CA, Schnatz PF. Menopause practitioner perspective on the American Society of Bone and Mineral Research Task Force report on atypical femoral fracture. Menopause. 2013;20(10):1092-1097.
50. Ettinger B, Sidney S, Cummings SR, Libanati C, Bikle DD, Tekawa IS, Tolan K, Steiger P. Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle, and biochemical differences. J Clin Endocrinol Metab. 1997;82(2):429-434.
51. Lo JC, Kim S, Chandra M, Ettinger B. Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA. Osteoporos Int. 2016;27(12):3477-3484.
2. Ettinger B, Li DK, Klein R. Continuation of postmenopausal hormone replacement therapy: Comparison of cyclic versus continuous combined schedules. Menopause. 1996;3(4):185-189.
3. Ettinger B, Quesenberry C, Schroeder DA, Friedman G. Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: A cohort study. Menopause. 2018;25(11):1191-1194.
4. Ettinger B, Quesenberry C, Schroeder DA, Friedman G. Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: A cohort study. Menopause. 1997;4(3):125-129.
5. Ettinger B, Wang SM, Leslie RS, Patel BV, Boulware MJ, Mann ME, McBride M. Evolution of postmenopausal hormone therapy between 2002 and 2009. Menopause. 2012;19(6):610-615.
6. Ettinger B, Wang SM, Leslie RS, Patel BV, Boulware MJ, Mann ME, McBride M. Evolution of postmenopausal hormone therapy between 2002 and 2009. Menopause. 2018;25(11):1306-1312.
7. Menopause 25th Anniversary Commemorative Issue. Menopause. 2018;25(11):1171.
8. Ettinger B, Black DM, Dawson-Hughes B, Pressman AR, Melton LJ, 3rd. Updated fracture incidence rates for the US version of FRAX. Osteoporos Int. 2010;21(1):25-33.
9. Ettinger B, Kolb FO. Chlordiazepoxide and cystinuric calculus. JAMA. 1970;212(4):627.
10. Ettinger B, Kolb FO. Factors involved in crystal formation in cystinuria. In vivo and in vitro crystallization dynamics and a simple, quantitative colorimetic assay for cystine. J Urol. 1971;106(1):106-110.
11. Ettinger B, Kolb FO. Inorganic phosphate treatment of nephrolithiasis. Am J Med. 1973;55(1):32-37.
12. Ettinger B, Weil E, Mandel NS, Darling S. Triamterene-induced nephrolithiasis. Ann Intern Med. 1979;91(5):745-746.
13. Ettinger B, Oldroyd NO, Sorgel F. Triamterene nephrolithiasis. JAMA. 1980;244(21):2443-2445.
14. Ettinger B. Recurrent nephrolithiasis: natural history and effect of phosphate therapy. A double-blind controlled study. Am J Med. 1976;61(2):200-206.
15. Ettinger B. Recurrence of nephrolithiasis. A six-year prospective study. Am J Med. 1979;67(2):245-248.
16. Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med. 1986;315(22):1386-1389.
17. Ettinger B, Citron JT, Livermore B, Dolman LI. Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not. J Urol. 1988;139(4):679-684.
18. Ettinger B, Pak CY, Citron JT, Thomas C, Adams-Huet B, Vangessel A. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol. 1997;158(6):2069-2073.
19. Cann CE, Genant HK, Ettinger B, Gordan GS. Spinal mineral loss in oophorectomized women. Determination by quantitative computed tomography. JAMA. 1980;244(18):2056-2059.
20. Ettinger B, Genant HK, Cann CE. Assessment of vertebral and peripheral bone mineral loss in women after oophorectomy. In: Menczel K, Robin GC, Makin R, Steinberg R, eds. Osteoporosis. Chicester: John Wiley and Sons; 1982:436-440.
21. Genant HK, Cann CE, Ettinger B, Gordan GS. Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 1982;97(5):699-705.
22. Ettinger B, Genant HK, Cann CE. Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med. 1987;106(1):40-45.
23. Ettinger B, Genant HK, Steiger P, Madvig P. Low-dosage micronized 17 beta-estradiol prevents bone loss in postmenopausal women. Am J Obstet Gynecol. 1992;166(2):479-488.
24. Maxim P, Ettinger B, Spitalny GM. Fracture protection provided by long-term estrogen treatment. Osteoporos Int. 1995;5(1):23-29.
25. Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med. 1985;102(3):319-324.
26. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, Ernster VL, Cummings SR. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117(12):1016-1037.
27. Ettinger B, Ensrud KE, Wallace R, Johnson KC, Cummings SR, Yankov V, Vittinghoff E, Grady D. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial. Obstet Gynecol. 2004;104(3):443-451.
28. Ettinger B, Selby JV, Citron JT, Ettinger VM, Zhang D. Gynecologic complications of cyclic estrogen progestin therapy. Maturitas. 1993;17(3):197-204.
29. Ettinger B, Selby J, Citron JT, Vangessel A, Ettinger VM, Hendrickson MR. Cyclic hormone replacement therapy using quarterly progestin. Obstet Gynecol. 1994;83(5 Pt 1):693-700.
30. Ettinger B, Golditch IM, Friedman G. Gynecologic consequences of long-term, unopposed estrogen replacement therapy. Maturitas. 1988;10(4):271-282.
31. Ettinger B, Grady D, Tosteson AN, Pressman A, Macer JL. Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol. 2003;102(6):1225-1232.
32. Grady D, Ettinger B, Tosteson AN, Pressman A, Macer JL. Predictors of difficulty when discontinuing postmenopausal hormone therapy. Obstet Gynecol. 2003;102(6):1233-1239.
33. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997;68(6):981-986.
34. Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause. 2000;7(2):129-134.
35. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282(7):637-645.
36. Ettinger B, San Martin J, Crans G, Pavo I. Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res. 2004;19(5):745-751.
37. Johnson SR, Ettinger B, Macer JL, Ensrud KE, Quan J, Grady D. Uterine and vaginal effects of unopposed ultralow-dose transdermal estradiol. Obstet Gynecol. 2005;105(4):779-787.
38. Ettinger B, Hillier TA, Pressman A, Che M, Hanley DA. Simple computer model for calculating and reporting 5-year osteoporotic fracture risk in postmenopausal women. J Womens Health (Larchmt). 2005;14(2):159-171.
39. FORE 10-Year Fracture Risk Calcuator for Health Care Professionals. http://riskcalculator.fore.org/. Accessed July 18, 2010.
40. Ettinger B. A personal perspective on fracture risk assessment tools. Menopause. 2008;15(5):1023-1026.
41. Lo JC, Pressman AR, Chandra M, Ettinger B. Fracture risk tool validation in an integrated healthcare delivery system. Am J Manag Care. 2011;17(3):188-194.
42. Pressman AR, Lo JC, Chandra M, Ettinger B. Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system. J Clin Densitom. 2011;14(4):407-415.
43. Ettinger B, Liu H, Blackwell T, Hoffman AR, Ensrud KE, Orwoll ES. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: the Osteoporotic Fractures in Men (MrOS) Study. J Clin Densitom. 2012;15(3):334-342.
44. Ettinger B, Ensrud KE, Blackwell T, Curtis JR, Lapidus JA, Orwoll ES, Osteoporotic Fracture in Men Study Research G. Performance of FRAX in a cohort of community-dwelling, ambulatory older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int. 2013;24(4):1185-1193.
45. Lo JC, Grimsrud CD, Ott SM, Chandra M, Hui RL, Ettinger B. Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure. Osteoporos Int. 2019;30(12):2515-2520.
46. Lo JC, Hui RL, Grimsrud CD, Chandra M, Neugebauer RS, Gonzalez JR, Budayr A, Lau G, Ettinger B. The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone. 2016;85:142-147.
47. Lo JC, Zheng P, Grimsrud CD, Chandra M, Ettinger B, Budayr A, Lau G, Baur MM, Hui RL, Neugebauer R. Racial/ethnic differences in hip and diaphyseal femur fractures. Osteoporos Int. 2014;25(9):2313-2318.
48. Ettinger B, Burr DB, Ritchie RO. Proposed pathogenesis for atypical femoral fractures: Lessons from material research. Bone. 2013;55(2):495-500.
49. Ettinger B, Stuenkel CA, Schnatz PF. Menopause practitioner perspective on the American Society of Bone and Mineral Research Task Force report on atypical femoral fracture. Menopause. 2013;20(10):1092-1097.
50. Ettinger B, Sidney S, Cummings SR, Libanati C, Bikle DD, Tekawa IS, Tolan K, Steiger P. Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle, and biochemical differences. J Clin Endocrinol Metab. 1997;82(2):429-434.
51. Lo JC, Kim S, Chandra M, Ettinger B. Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA. Osteoporos Int. 2016;27(12):3477-3484.
We would like to thank Joan Lo, MD for her extraordinary effort to help us prepare this summary of Bruce's contributions to science. This text was adapted from Bruce's own writing in a recent NIH grant. We would also like to acknowledge assistance in "remembering" by Bruce's colleagues: Steve Cummings, Harry K. Genant, Deborah Grady, Robert Marcus, and Wulf Utian.