Statistics. All studies were performed with biological replicates as described in Supplemental Tables 1-11. The data were analyzed with GraphPad Prism v.7 software using 2-tailed Student's t test and 2-way ANOVA Sidak or Tukey's multiple comparison tests. The Sidak test was used when comparing means between WT and FOP, and the Tukey test was used when means of both WT and FOP were compared together with other groups. The software R was used for heatmaps and PCA. P < 0.05 were considered statistically significant. Study approvals. All of the human study and sample collection procedures were reviewed and approved by the UCSF Committee on Human Research. All subjects provided informed consent prior to their participation in the study.

Current osteoporosis medications reduce fractures significantly but have rare and serious adverse effects (osteonecrosis of the jaw, atypical femoral fractures) that may limit their safety for long-term use. Insights from basic bone biology and genetic disorders have led to recent advances in therapeutics for osteoporosis. New approaches now in clinical use include the antisclerostin monoclonal antibody romosozumab, as well as the parathyroid hormone–related peptide analog abaloparatide. Clinical trial data show significant antifracture benefits with recently approved romosozumab. Studies using abaloparatide build on our longstanding experience with teriparatide and the importance of consolidating the bone mineral density gains achieved from an anabolic agent by following it with an antiresorptive. Combination and sequential treatments using osteoporosis medications with different mechanisms of action have also been tested with promising results. On the horizon is the potential for cell-based therapies (e.g., mesenchymal stem cells) and drugs that target the elimination of senescent cells in the bone microenvironment.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease in which heterotopic bone forms in muscle and soft tissue, leading to joint dysfunction and significant disability. FOP is progressive and many patients are wheelchair‐bound by the 3rd decade of life. FOP is caused by an activating mutation in the ACVR1 gene, which encodes the activin A Type 1 receptor. Aberrant signalling through this receptor leads to abnormal activation of the pSMAD 1/5/8 pathway and triggers the formation of bone outside of the skeleton. There is no curative therapy for FOP; however, exciting advances in novel therapies have developed recently. Here, we review the clinical and translational pharmacology of three drugs that are currently in clinical trials (palovarotene, REGN 2477 and rapamycin) as well as other emerging treatment strategies for FOP.

BACKGROUND Hospitalists provide much of the clinical teaching in internal medicine, yet formative feedback to improve their teaching is rare. METHODS We developed a peer observation, assessment, and feedback program to improve attending hospitalist teaching. Participants were trained to identify 10 optimal teaching behaviors using a structured observation tool that was developed from the validated Stanford Faculty Development Program clinical teaching framework. Participants joined year‐long feedback dyads and engaged in peer observation and feedback on teaching. Pre‐ and post‐program surveys assessed confidence in teaching, performance of teaching behaviors, confidence in giving and receiving feedback, attitudes toward peer observation, and overall satisfaction with the program. RESULTS Twenty‐two attending hospitalists participated, averaging 2.2 years (± 2.1 years standard deviation [SD]) experience; 15 (68%) completed pre‐ and post‐program surveys. Confidence in giving feedback, receiving feedback, and teaching efficacy increased (1 = strongly disagree, 5 = strongly agree, mean ± SD): “I can accurately assess my colleagues' teaching skills,” (pre = 3.2 ± 0.9 vs post = 4.1 ± 0.6, P < 0.01), “I can give accurate feedback to my colleagues” (pre = 3.4 ± 0.6 vs post = 4.2 ± 0.6, P < 0.01), and “I am confident in my ability to teach students and residents” (pre = 3.2 ± 0.9 vs post = 3.7 ± 0.8, P = 0.026). CONCLUSIONS Peer observation and feedback of teaching increases hospitalist confidence in several domains that are essential for optimizing teaching. Further studies are needed to examine if educational outcomes are improved by this program. Journal of Hospital Medicine 2014;9:244–250. © 2014 Society of Hospital Medicine