GENETIC PREDICTION OF FRACTURE IN A RISK-STRATIFIED POPULATION
Funder
National Health and Medical Research Council
Funding Amount
$363,000.00
Summary
Osteoporosis is a condition characterised by excessive bone loss and impaired bone quality, which ultimately results in fracture with minimal trauma. Osteoporosis affects 27% of women and 11% of men aged 60 years or above in the community, and costs Australia around $7 billion each year. Individuals with low bone mineral density (BMD) have a significantly higher risk of fracture than those with normal BMD. In the long-term (14-year) Dubbo Osteoporosis Epidemiology Study, more than half of indivi ....Osteoporosis is a condition characterised by excessive bone loss and impaired bone quality, which ultimately results in fracture with minimal trauma. Osteoporosis affects 27% of women and 11% of men aged 60 years or above in the community, and costs Australia around $7 billion each year. Individuals with low bone mineral density (BMD) have a significantly higher risk of fracture than those with normal BMD. In the long-term (14-year) Dubbo Osteoporosis Epidemiology Study, more than half of individuals with osteoporosis (e.g., low BMD) did not sustain a fracture, while approximately 60% of fracture cases had BMD above the high risk levels. Thus, BMD alone is not a good discriminant of fracture versus non-fracture cases. It is widely known that the liability to fracture is determined in part by genes. Previous studies, including from our group, have suggested a number of candidate genes that are associated with fracture risk. The fundamental issue that this study is concerned is that how and whether genetic markers could be used to facilitate case finding. It is proposed that common variations of certain genes are associated with fracture risk independent of BMD. That is, they can identify individuals at relatively high and low fracture risk after stratification for BMD. Hence, some markers may identify those individuals likely (and unlikely) to fracture even with low (osteoporotic) BMD. Similarly, some, possibly the same, markers may identify individuals at high risk of fracture despite relatively good (ie non-osteoporotic) BMD. It is further proposed that no single gene will achieve this outcome, but rather a small set of such gene polymorphisms will provide clinically useful risk information. This effect is entirely analogous to the use of clinical risk indicators (eg, age, weight, sex, family history, etc) to assess the risk of future fracture.Read moreRead less
This proposal is designed to test the protein leverage hypothesis (PLH) in humans: the idea that the level of food consumption in humans, like other animals, is adjusted to maintain a target protein intake. As the prevalence of overweight and obesity increases, with its attendant health problems, the need to identify which dietary components limit rather than exacerbate energy intake is imperative. According to the PLH, the consumption of a diet low in % protein and high in % fat and carbohydrat ....This proposal is designed to test the protein leverage hypothesis (PLH) in humans: the idea that the level of food consumption in humans, like other animals, is adjusted to maintain a target protein intake. As the prevalence of overweight and obesity increases, with its attendant health problems, the need to identify which dietary components limit rather than exacerbate energy intake is imperative. According to the PLH, the consumption of a diet low in % protein and high in % fat and carbohydrate, typical of many Western countries, inevitably requires the ingestion of additional energy to maintain protein intake constant, thus driving weight gain. Conversely, the consumption of a diet that is relatively high in % protein requires the ingestion of lower levels of energy, creating the potential for weight loss. Preliminary experimental and population-level nutritional survey data support the PLH, as does the finding that protein is more satiating than other macronutrients. If, as predicted, small changes in the proportion of protein in diets described in the current study are found to impact on total energy intake there will be significant implications for weight control strategies. Thus, if the PLH is confirmed, public health dietary recommendations and government policy settings for the food industry will need to change. Large-scale intervention studies aimed at demonstrating the longer term impact on body weight will also be required.Read moreRead less