Prolia (denosumab) is an injectable medication for osteoporosis given as a subcutaneous injection every 6 months. It is one of the most effective treatments for reducing fracture risk — clinical trials show it reduces spine fractures by approximately 68% and hip fractures by 40% over 3 years.

Unlike oral bisphosphonates, Prolia works by blocking RANKL, a protein that activates bone-resorbing cells (osteoclasts). This makes it particularly effective for patients who cannot tolerate oral medications or have poor GI absorption.

Who Is Prolia For?

• Postmenopausal women with osteoporosis at high fracture risk
• Men with osteoporosis receiving androgen deprivation therapy for prostate cancer
• Women receiving aromatase inhibitor therapy for breast cancer
• Patients who have failed or cannot tolerate oral bisphosphonate therapy
• Patients with chronic kidney disease (CKD stage 3–4) where bisphosphonates are not appropriate

What to Expect

The injection is administered subcutaneously (just under the skin) in the upper arm, upper thigh, or abdomen. The procedure takes under 10 minutes. Most patients experience no pain beyond a brief sting. You will need lab work (calcium, vitamin D, kidney function) before each injection to ensure safety.

Prior to Your Injection

• Labs are required within approximately 3 months of each injection (calcium, vitamin D 25-OH, creatinine)
• Ensure you are taking adequate calcium (1,200 mg/day) and vitamin D (at least 1,000 IU/day)
• Notify your doctor of any recent dental work or upcoming dental procedures

Thyroid ultrasound uses high-frequency sound waves to produce detailed images of the thyroid gland, allowing us to precisely measure the size of the gland and evaluate any nodules (growths) within it. The procedure is performed in our office by our physicians and produces no radiation.

Thyroid nodules are extremely common — detected in over 50% of adults when ultrasound is used. Having ultrasound performed in the same office as your endocrinology visit means your physician personally reviews and interprets the images in the context of your full clinical picture, and can discuss results with you immediately.

When Is Thyroid Ultrasound Ordered?

• Evaluation of a palpable (felt on exam) nodule or neck mass
• Abnormal TSH or thyroid hormone levels requiring anatomical evaluation
• Monitoring known nodules over time
• Evaluation of goiter (enlarged thyroid gland)
• Guidance planning for fine needle aspiration biopsy
• Follow-up after thyroid cancer surgery
• Family history of thyroid cancer

What to Expect

You lie on your back with your neck slightly extended. A small amount of gel is applied to the neck. The ultrasound probe (a handheld device) is moved gently across the skin — there is no discomfort. The procedure typically takes 15–20 minutes. Results and recommendations are discussed with you the same day.

ACR TI-RADS System

We use the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) to systematically categorize nodule risk. TI-RADS scores range from TR1 (benign) to TR5 (highly suspicious), guiding decisions about whether biopsy is warranted and how often monitoring is needed.

Fine needle aspiration (FNA) biopsy is a minimally invasive procedure used to sample cells from a thyroid nodule to determine whether it is benign (non-cancerous) or malignant (cancerous). It is performed in our office with ultrasound guidance to ensure precise needle placement — no hospital stay or general anesthesia is required.

FNA is the most accurate non-surgical method for evaluating thyroid nodules. It is recommended when a nodule meets specific size and ultrasound criteria suggesting a higher risk of malignancy.

Who Performs FNA at Our Clinic?

Dr. Chhavi Chadha specializes in ultrasound-guided thyroid FNA biopsy and has extensive experience performing this procedure. The procedure is performed with real-time ultrasound visualization, ensuring the needle is precisely placed within the target nodule.

What to Expect

• You will lie on your back with your neck slightly extended
• The skin is cleaned; local anesthetic may be used if desired
• A very thin needle is passed into the nodule under ultrasound guidance — this typically takes 3–5 passes, each lasting only seconds
• The collected cells are sent to a pathology lab for analysis (Bethesda classification system)
• Most patients describe mild pressure or a brief sting — the procedure is generally well tolerated
• The entire procedure takes approximately 20–30 minutes
• You may return to normal activity immediately after

After the Procedure

• Mild soreness at the biopsy site is normal for 1–2 days
• Apply ice as needed for comfort
• Avoid aspirin or blood thinners for 24 hours if possible
• Results are typically available within 5–7 business days

Continuous glucose monitors (CGMs) measure blood sugar every 1–5 minutes, 24 hours a day, without fingersticks. They have transformed diabetes management by revealing patterns that fingerstick testing simply cannot capture — such as overnight lows, post-meal spikes, and the effects of exercise, stress, or specific foods on glucose.

We prescribe, set up, and provide hands-on training for all major CGM platforms at our office. Our team ensures you leave confident in using your device and understanding the data it provides.

CGM Devices We Support

• Dexcom G7 / G6 — worn on the abdomen or arm; real-time readings on your phone; excellent accuracy; integrates with insulin pumps
• FreeStyle Libre 3 — smallest wearable sensor; worn on the back of the upper arm; real-time streaming; often preferred for its small profile
• Medtronic Guardian / Simplera — integrates directly with Medtronic insulin pumps for closed-loop ("artificial pancreas") systems

Who Can Benefit from a CGM?

• All patients with Type 1 diabetes
• Type 2 diabetes patients on insulin therapy
• Type 2 patients not on insulin who want to understand how food and activity affect their glucose
• Patients with frequent hypoglycemia or hypoglycemia unawareness
• Patients with gestational diabetes requiring tight glucose control
• Patients considering or already using insulin pumps

What Happens at Your CGM Setup Visit

• Review of CGM options and selection of the best device for your needs
• Prescription and insurance verification (most CGMs are covered under Part B for insulin-using patients)
• In-office sensor application and app pairing
• Review of your glucose targets and alarm settings
• Review of what patterns to watch for and when to call us

Both clinic locations have Quest Diagnostics on-site — no separate lab visit required. Having labs drawn at the same location as your endocrinology visit is one of our most appreciated conveniences. We strongly recommend completing labs at least one week before your appointment so results are ready for your doctor to review and discuss with you at the visit.

Sugar Land Location

Quest Diagnostics is inside our clinic at 1441 Hwy 6, Ste 100. No separate suite number — walk in through our office. Open Mondays, Wednesdays, and Thursdays only. No appointment needed.

Memorial City Location

Quest Diagnostics is located at Suite 480, 915 Gessner Rd., in the same Medical Office Building 3. Open Monday through Friday. No appointment needed.

Common Endocrine Labs Ordered

• TSH, Free T4, Free T3, thyroid antibodies
• Hemoglobin A1c, fasting glucose, fasting insulin
• Complete metabolic panel (kidney function, liver function, electrolytes)
• Lipid panel (cholesterol)
• Vitamin D (25-OH), PTH, calcium
• Testosterone (total and free), LH, FSH
• Cortisol, ACTH, DHEAS
• 24-hour urine collections (see our patient handouts for instructions)