Current Projects
Current Research Studies
The Added Value of Bone Microstructure Assessment in the Management of Osteoporotic Bone(ADVANTAGE BONE study).
How we Treat and Diagnose Osteoporosis
Whilst DEXA is a valuable tool in diagnosing and treating osteoporosis, it has limitations in that it only gives information on the amount of bone (BMD) but not the quality of that bone. Assessment of bone microstructure, which is an important determinant of bone strength and fracture risk, can be carried out by imaging such as quantitative computed tomography (QCT) scan and more recently by using a software called trabecular bone score (TBS) which measures bone texture on already acquired DEXA imaging. Unlike QCT which is expensive and involves ionised radiation, TBS is a non-invasive, rotation-free, and cheap diagnostic tool. using images acquired on a DEXA scanner.
Measuring Bone Quality Aims:
- Usually, bone density is assessed in clinic. However, some patients, even with high bone density will still suffer multiple fractures.
- Assessment of the quality of bone, compared to its density will help us to learn more about why some patients fracture more than others
- We will study the microarchitecture of bone as a measure of bone health
- We will aim to use information on on bone quality to inform clinical risk scores for fracture
- To monitor the effects of current treatments on bone quality
This project will be done on data we already have. That is data already acquired as part of a patients standard of care. This collaborative research will lead to a better understanding of the value of assessing bone microstructure and bone quality in fracture assessment and management.
Real-World Long-Term Musculoskeletal and Extra-Skeletal Outcomes of Obesity, Diabetes, Ageing, Frailty, and Sarcopenia: The Oswestry Metabolic BONE Cohort
OsBONE study
In recent years, new comorbidities have emerged as important determinants of fragility fracture.
In this study we aim to look at some of these co-morbidities which are:
- Obesity
- Type II diabetes
- Sarcopenia (age related progressive loss of fat and muscle)
- Frailty
We have a considerable amount of data collected from patients attending the metabolic clinic and bone density unit over many years. We can use this data, anonymously, to enhance our knowledge of bone health and the risk factors of fracture to optimise treatment for our patients through well designed research studies. We have a track record of using patient data to; assess the use of bone markers for monitoring treatment, find relationships between levels of hormone therapy and bone density, levels of hormones on bone markers, serious side effects of bisphosphonate treatment. In addition to using data from patients who have attended clinic in the past we will also aim to recruit new patients to our study to collect data using:
- Blood, urine and stool samples
- MRI imaging
- CT imaging
It is widely known that different lifestyle factors can have a huge impact on health. Smoking, drinking alcohol, poor diet and lack of exercise increase the chances of developing a range of diseases, osteoporosis being one of them.
Real world data on how effective treatments are for patients with osteoporosis
Our clinics see a large number of patients who are started on treatments for their osteoporosis. These treatments can be divided into two categories: 1. Anabolic treatment and 2. Anti-resorptive treatment. Anabolic treatments involve the use of drugs such as romosozumab. This is a drug called a monoclonal antibody that targets a protein made by bone cells. Research shows the drug increases bone formation and decreases bone resorption in postmenopausal women with low bone density.
Anti-resorptive treatments use drugs called bisphosphonates such as alendronate. Our bones constantly renew themselves in a natural process. Our bodies break down older bone and removes it in a process called resorption. This is followed by new bone formation. Biphosphonates work by slowing down bone resorption or removal. This helps prevent future bone fractures by strengthening bones. Because our patients undergo different treatments, we can study how well these work in different patient groups as part of our research. The aim of this research is to be able to prescribe the right treatment at the right time to maximise the beneficial effects for patients. We are also very interested in precision medicine where a one size fits all approach isn’t always appropriate. In the future, we hope to be able to use individualised medicine, taking a holistic approach by reviewing a patients medical history, comorbidities (how many different diseases they have), age and fracture risk to give them the correct drug treatment for maximum beneficial effect. This will only be possible with effective research.