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Michael Kleerekoper (August 18, 1944 to May 10, 2018): In Relentless Pursuit of a Better Way

2018; Oxford University Press; Volume: 33; Issue: 9 Linguagem: Inglês

10.1002/jbmr.3548

1523-4681

Michael Kleerekoper,

Bone and Dental Protein Studies

Michael Kleerekoper On May 10, 2018, the bone and mineral community lost Michael Kleerekoper, one of its gems. Michael was born in Leeds, England, to Lilly (Biber) and Joseph Kleerekoper. When he was a toddler, the family moved to Sydney, Australia. Michael received his BSc with honors in 1967 and his MBBS (the MD equivalent but never so acknowledged; a prototypical Michaelism!) in 1970. His interest and curiosity in our field was catalyzed under the tutelage of another late giant of our field, Dr Sol Posen. Moving to St. Louis for his endocrinology and metabolism fellowship, Michael was then mentored by the late, great Lou Avioli, a founder of the ASBMR, as well as by John Haddad and Steve Teitelbaum. He also worked closely then with Roberto Civitelli and Roberto Pacifici. After his formative years at Washington University, Michael moved to Henry Ford Hospital, where he enjoyed a remarkably productive career working with Drs Boy Frame, A Michael Parfitt, and one of us (SDR). During his time at the Henry Ford Hospital, Michael trained a large number of future clinicians and basic scientists. With other luminaries there at the time, Michael's contributions, which spanned over 15 years, contributed significantly to our understanding of bone biology and mineral homeostasis. Examples include developing and applying assays for parathyroid hormone and 25-hydroxyvitamin D; reviving interest in skeletal histomorphometry as a clinical tool; and legendary contributions to our understanding of primary hyperparathyroidism and osteoporosis. In 1993, Michael moved to Wayne State University, where he served as director of research for bone and mineral metabolism and gerontology for the School of Medicine. Later, he became chief of the Endocrinology Division at University of Toledo Medical School. Michael was a clinician, an educator, a passionate investigator, and an outside-the-box thinker. He questioned the obvious, challenged long-standing traditions, and was never satisfied with conventional answers. He was an erudite reader, published prolifically, and served on editorial boards of several prestigious journals including this one. He was active in the American Association of Clinical Endocrinologists from its inception, and in 2006 he received its distinguished honor, Master of the American College of Endocrinology (MACE). Michael's contributions to basic research included the cellular origin of liver alkaline phosphatase activity demonstrating that it was not hepatocytes but rather biliary tract lining cells. His contributions to clinical conundrums included the question of whether all patients with primary hyperparathyroidism needed surgery, a question that paved the way for a randomized clinical trial of parathyroidectomy versus no surgery. He was an important contributor to the first clinical trials of sodium fluoride in osteoporosis. His contributions to translational science were also noteworthy, highlighted by helping to establish microarchitectural deterioration as a feature of the osteoporotic state and subsequently as a key element in the definition of osteoporosis. Michael was always forthright, direct, and spoke his mind, qualities that were not always endearing but that always provoked respect. Below are personal reflections of Dorothy Nelson, his wife, as well as professional colleagues and his close friends who knew the man up close. I am grateful to Michael for introducing me to clinical research and having taught me how both basic and clinical research can be pursued at the same time. He was always supportive and yet always critically relevant. He was a meticulous researcher, an avid thinker, and a dear friend. Our friendship bonded more tightly during a trip to India in 1991 as a part of a nationwide Endocrinology Symposia tour. He was eager to educate medical students, postgraduates, and endocrinology fellows in India. Of course, Michael always liked attention and wanted to have the last word, but again who doesn't! Michael and I spent long hours (the jet lag helped!) discussing and, yes, arguing at times how our field should move forward. As one who “grew up” with Michael for more than four decades, I sorely miss his wit, grit, and grace. With the previous passing of Boy Frame, Harold Frost, and Michael Parfitt and now with the loss of Michael, I feel a keen sense of profound loss. We have lost a friend who was as engaging as he was beneficially provocative, pushing us always to be clear, to be rigorous, and to be passionate about our work. With self-confidence that bolstered the rest of us, Mike never shied away from a knotty issue and made us, in kind, reach for knowledge above the low-hanging fruit. Years ago, Mike wanted to create a specialty that would be recognized as “osteology,” thinking correctly that the discipline of metabolic bone diseases was broad and deep enough to require the kinds of standards accorded other recognized specialties in internal medicine. While that effort did not succeed officially, it did succeed in real terms. Mike's proposal made us think of ourselves as true specialists dealing with diseases that matter. He helped us to think of ourselves in ways that defined us more realistically and, yes, in a much more relevant manner. Mike was a true iconoclast. We loved him for a refreshing view of virtually anything that was put before his keen intellect. Always filled with opinions that he freely expressed, he was also careful to distinguish them from facts, a standard to which he held us all. His contributions to new knowledge in our field are legendary; placing that new knowledge into the proper clinical context was his special gift. We will miss you, Mike, but remember what you taught over and over again: Be passionate about our field; teach our next generation with the same passion as our mentors did; don't settle for incomplete insight; and love life as we love our field. Although some thought Michael was from South Africa, those with a keen ear for accents would know that Michael (born in England) was really from Australia, where he graduated with honors from the University of Sydney and received his medical education and internal medicine training. He moved to St. Louis for an endocrinology fellowship at Washington University, then to Detroit, where he lived for almost half a century. A consummate academic physician, Michael had numerous teaching positions, served as reviewer and editorial board member for a number of journals, was active in all the right professional societies (including the American Association of Clinical Chemistry and the American College of Endocrinology, which honored him as a MACE [Master]). He authored almost 300 articles, editorials, letters, books and chapters, proceedings and abstracts, always bringing forth with these publications keen insights and original thinking. I drew close to Michael Kleerekoper early in my career as he was unmistakably noticeable at our national and international bone meetings. As he frequently went to the microphone, and thus even more noticeable, I observed a man whose tone was sometimes strident, whose opinions were always strong, and whose bearing was frankly a bit intimidating (actually more than just a bit). Waiting to go to the airport after one or another meeting, not knowing each other very well, he invited me to join him for a beer. The ensuing wonderful conversation began a lengthy friendship that included our spouses (his wife, Dorothy Nelson, greets me with “hello, Nelson” and I say the same back to her). Michael was one of a kind. His passing leaves a void, professionally and personally, that I doubt can be filled. Michael was my friend as well as my close professional colleague. From his early days at Henry Ford Hospital, where he was a key member of the large group of metabolic bone disease giants that made Henry Ford an internationally respected institution in “bone,” to his final years at the Medical College of Ohio, he molded young minds to think critically but respectfully. Complementing a great intellectual mind, Michael always gave a passionate and critical point of view to many of the things we did as our common interests evolved. He looked at much of what we did in the field with a singular purpose of making the field better and, by doing so, made us all better as well. His boundless energy kept us always “on our toes” to do better. He will be missed, but we are better people ourselves for having Michael in our lives. With the passing of Michael Kleerekoper, we have lost one of the exceptional members of our bone community. My first important interaction with Michael was in the early 1990s when he invited me to lead a discussion of clinical cases at a Henry Ford Metabolic Bone Disease symposium. This was a huge challenge, for Michael was a knowledgeable and passionate clinician who relished in dissecting the nuances of both complex and even routine cases. That weekend was the beginning of many pleasurable discussions of clinical cases over the succeeding years at scientific meetings, advisory boards, guideline committees, and vacations on the Oregon coast. Discussing cases with Michael was akin to watching an accomplished musician “play” music. Clinical scenarios seemed to dance in his head. By intertwining his insight, gleaned from his extensive clinical experience, with the pathophysiology of bone diseases, Michael often saw or sensed clinical issues in unique ways. He loved to challenge the simple clinical explanation, looking for and wanting more. It was always clear, however, that his “playing” with clinical scenarios was not just an intellectual game; its purpose was to make things better for the patient. He made thinking about and caring for patients fun for all of us who had these discussions with him, and he helped us all remember how fortunate we were to be physicians and teachers. On top of all that, Michael enjoyed life and living. He knew he was fortunate to have partnered with Dorothy, and the two of them together added both intellect and splashes of silliness and mirth to many evenings. As a dear friend and special colleague, he will be genuinely missed, but his special spirit still dances in our heads. I met Michael at Henry Ford Hospital in 1985, when the late Dr Michael Parfitt hired me to oversee the clinical bone density program. This was a fairly unusual appointment, given that I had just received my PhD in physical anthropology, not in a clinical discipline. I met Michael Kleerekoper on my first day at work, whereupon he remarked, “I don't know what an anthropologist is doing in the bone and mineral clinic!” A few months later, he asked me if I would be interested in evaluating vertebral deformities on over 700 spine films from participants in his federally funded clinical trial of fluoride treatment for osteoporosis. I agreed, and as we worked together on this project, we “bonded over people's vertebrae” (a phrase that the rabbi included in his eulogy for Michael). That was the beginning of a beautiful friendship and our eventual marriage of 27 years. I have never met someone with Michael's intellect and insight into complicated issues. He never forgot any article that he had ever read—and he read many journals each week. He never shied away from a controversial opinion, and he was often, if not usually, correct. I am proud of his contributions to the bone and mineral literature as well as of his clinical endocrinology expertise and passion for patient care. I learned so much from him, and he occasionally said that I had taught him something new (I would use a smile emoji here if I could). On a personal note, Michael was generous, patient, supportive, and always ready to help family and friends. He raised two daughters, Emma and Sonya, who are both very accomplished in their fields. He also embraced his role as stepfather to my two daughters, Gurianna and Kira. Altogether, he was a grandfather to eight: Francesca, Ian, Leah, Lily, Luca, Maria, Mia, and Zachary. We will all miss this amazing man whose voice and presence filled a room and brought us all joy and inspiration. So long, Michael, we all miss you, but memories of our times together will always remain in our hearts. To paraphrase his own words: “…we all will miss Michael but will never forget the paths he has shown us and led us through.” Sudhaker D Rao, MD Endocrinology, Diabetes, and Bone and Mineral Disorders, and Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, MI, USA John P Bilezikian, MD College of Physicians and Surgeons, Columbia University, New York, NY, USA Nelson B Watts, MD Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA Paul D Miller, MD University of Colorado Health Sciences Center and Colorado Center for Bone Research, Golden, CO, USA Michael R McClung, MD Oregon Osteoporosis Center, Portland, OR, USA Dorothy A Nelson, PhD Professor of Anthropology and Chair, Department of Sociology, Anthropology, Social Work, and Criminal Justice, Oakland University, Rochester, MI, USA