BONE SIZE AND BONE TURNOVER: RELATIONSHIP TO FRACTURE RISK OVER TEN YEARS
Funder
National Health and Medical Research Council
Funding Amount
$428,225.00
Summary
The occurrence of fracture in the ageing population is a major public health problem because these fractures are responsible for considerable morbidity and mortality. Of women reaching 90 years of age, one third will fracture their hip and overall, one in every six women will sustain an osteoporotic fracture in her lifetime. The direct cost to the community is unknown but estimated, conservatively, at 175 million dollars annually. Most of this is likely to be the result of hip fractures which oc ....The occurrence of fracture in the ageing population is a major public health problem because these fractures are responsible for considerable morbidity and mortality. Of women reaching 90 years of age, one third will fracture their hip and overall, one in every six women will sustain an osteoporotic fracture in her lifetime. The direct cost to the community is unknown but estimated, conservatively, at 175 million dollars annually. Most of this is likely to be the result of hip fractures which occupy an estimated 400,000 bed-days annually. This bed occupancy is fourth next to mental illness, cardiac disease and cancer. The Geelong Osteoporosis Study is a large population-based epidemiological study currently under way to evaluate the major risk factors for fracture in women . This present study which will be an extension of the study to date, will provide in total, 8-10 years of data concerning the processes that result in increased bone fragility and fracture.Read moreRead less
Functional Effects Of Polymorphic Variation Of The Aromatase (CYP19) Gene On Enzyme Activity:relationship To Disease
Funder
National Health and Medical Research Council
Funding Amount
$237,708.00
Summary
After menopause, oestrogen synthesis changes from an ovarian to an adipose source by concersion of androgens to estrogens, a process catalyzed by aromatase, the product of the CYP19 gene. We will generate mutants of the CYP19 gene that we have previously found in humans by site-directed mutagenesis and observe the effects of these mutants on aromatase function. This research will help with diagnosis and treatment of breast and other cancers and osteoporosis in humans .
MALE OSTEOPOROSIS: A POPULATION-BASED STUDY IN GEELONG
Funder
National Health and Medical Research Council
Funding Amount
$432,645.00
Summary
Osteoporosis is a term used to indicate that bones have become thin and fragile. During the ageing process bone fragility increases and fractures occur more easily and more often. Fractures may also occur during normal daily activities, with fractures of the spine, forearm and hip being common. However, many other sites may fracture. This is a serious problem because fractures cause pain, disability and, sometimes, death. Although previously overshadowed by its effect in women, osteoporosis is i ....Osteoporosis is a term used to indicate that bones have become thin and fragile. During the ageing process bone fragility increases and fractures occur more easily and more often. Fractures may also occur during normal daily activities, with fractures of the spine, forearm and hip being common. However, many other sites may fracture. This is a serious problem because fractures cause pain, disability and, sometimes, death. Although previously overshadowed by its effect in women, osteoporosis is increasingly being recognised in men. In Australia, 39% of all fractures occur in men and prognosis for fracture in men is worse than in women. A consequence of increasing male longevity is that osteoporosis will affect a growing number of Australian men. It is anticipated that between 1996 and 2051, the number of men with fracture will double, with a 4-fold increase in the number of male hip fractures. Unless the problem of osteoporosis in men is addressed and effective interventions are implemented, the substantial health burden imposed by age-related fractures will continue to escalate. In this case-control study of fracture risk in men, men with fractures (cases) will be identified prospectively for 3 years from radiological reports. Controls will be selected concurrently, at random from electoral rolls. Anticipated number of cases and controls are 800 and 1400, respectively. Cases and controls will be characterised for risk factors for fracture: bone density and bone geometry will be measured, serum samples collected, and diet, lifestyle and medical history documented by questionnaire. The advantage of this type of data is that information from patients with fracture will be used to tell us about the risk of fracture in healthy, unaffected men and about the characteristics of the Australian male population at risk for fracture. The information can be used in decision making for the individual and in policy making for the whole population.Read moreRead less
Apportioning Deficits In Bone Size And Density In Women With Fractures To Growth Or Ageing By Studies In Their Daughters
Funder
National Health and Medical Research Council
Funding Amount
$196,018.00
Summary
Women fracture their bones because the bones are small and break easily and because the bones are thin or low in denseness (very porous like a honey comb). This study is aimed at identifying why women with fractures have small bones and why the bones are so porous. They may have these problems because they lost a lot of bone as they get older or because growth was abnormal so the size of the bone didn't reach its potential size or because the denseness of the bones didn't develop properly. The s ....Women fracture their bones because the bones are small and break easily and because the bones are thin or low in denseness (very porous like a honey comb). This study is aimed at identifying why women with fractures have small bones and why the bones are so porous. They may have these problems because they lost a lot of bone as they get older or because growth was abnormal so the size of the bone didn't reach its potential size or because the denseness of the bones didn't develop properly. The study will be carried out in women with spine or hip fractures and their daughters. All participants will have bone densitometry, provide a 24 hour urine sample and a fasting blood sample of 20 ml whole blood. Informed consent will be obtained from all participants. The bone density scan is associated with radiation exposure of about 4 mSv, about one tenth of a chest x ray, temporary bruising may follow taking blood. If we can understand the different ways osteoporosis can occur we can then start to devise specific treatments tailored to the individual. Also if we can identify the causes of small bones and bone thinness during growth it may be possible to correct some of these causes before the reduced growth and reduced building of bone occurs. We might also prevent the thinning of bone by identifying and removing causes of bone thinning.Read moreRead less
Is Periosteal Bone Formation Responsible For Sexual Dimorphism In Bone Fragility
Funder
National Health and Medical Research Council
Funding Amount
$316,320.00
Summary
Men and women sustain fractures as they age because their bones become fragile. Women sustain fractures more often than men. Bone thinning occurs in both sexes but it is usually believed that this thinning or loss of bone is greater in women than men. We have evidence to suggest that this may not be correct. In fact, it is likely that men and women lose a similar amount of bone, about half what they started with, but during ageing, men lay down more bone on the outside surface of the bone than w ....Men and women sustain fractures as they age because their bones become fragile. Women sustain fractures more often than men. Bone thinning occurs in both sexes but it is usually believed that this thinning or loss of bone is greater in women than men. We have evidence to suggest that this may not be correct. In fact, it is likely that men and women lose a similar amount of bone, about half what they started with, but during ageing, men lay down more bone on the outside surface of the bone than women compensating for the similar amount lost on the inside of the bone. We also have evidence to suggest than men and women who get spine fractures do so because the process of laying down bone may fail to occur normally. We will study these processes of bone loss inside the bone and bone gain outside the bone to try to better understand why bones become weak. We will measure the bone size and its density in healthy men and women and patients with fractures to determine how the increasing size of the bone produced by laying down bone on its outside helps to keep it strong and to preserve the bone that would otherwise be lost if it didn't occur or if a disease developed that might reduce the compensatoryRead moreRead less
Efficacy And Safety Of Vertebroplasty For Treatment Of Painful Osteoporotic Spinal Fractures: A Randomised Trial
Funder
National Health and Medical Research Council
Funding Amount
$586,250.00
Summary
Painful spinal or vertebral fractures are a substantial and growing public health problem and are a burden on the health care system. In Australia, 20-25% of women and 15-20% of men over the age of 50 will develop one or more fractures of their spine in their lifetime. Up to a half of these fractures will result in severe pain and disability. While the fractures generally heal within weeks or a few months, some are so painful that they require narcotic pain control, hospitalisation, and-or long- ....Painful spinal or vertebral fractures are a substantial and growing public health problem and are a burden on the health care system. In Australia, 20-25% of women and 15-20% of men over the age of 50 will develop one or more fractures of their spine in their lifetime. Up to a half of these fractures will result in severe pain and disability. While the fractures generally heal within weeks or a few months, some are so painful that they require narcotic pain control, hospitalisation, and-or long-term nursing home care. Other problems include chronic pain, spinal deformities, loss of height and mobility and restricted breathing. Vertebroplasty is a new procedure consisting of injection of a type of 'bone cement' into the vertebrae to mend the break. It is an exciting treatment because for some people, this results in an immediate and sustained improvement in pain. Although rare, complications such as rib fracture, cement leakage and fractures in other vertebrae do occur. One particular concern is that the mechanical changes to the spine caused by the bone cement may cause long-term complications such as an increased risk of future fractures of treated or adjacent vertebrae. So far, there is very little evidence of the efficacy and safety of this new technology. Importantly, it has not been compared with usual medical care for fractures. In medical research it can be difficult to properly evaluate an exciting and 'apparently' effective treatment that doctors and patients demand. The main aim of this project is to determine whether vertebroplasty is an effective and safe treatment compared to usual medical care. We have a unique opportunity to evaluate vertebroplasty through a strong collaborative effort between the 3 centres currently offering this procedure in Melbourne. If vertebroplasty can be demonstrated to be an effective, safe and cost-effective treatment for painful osteoporotic spinal fractures this will be a valuable addition to current treatment options.Read moreRead less
Structural And Biomechanical Basis Of Differences In Bone Fragility In Asian And Caucasian Men And Women
Funder
National Health and Medical Research Council
Funding Amount
$188,500.00
Summary
Lay Summary Fractures occur less commonly in males than females because males have greater periosteal apposition than females during ageing. This increases bone size (reducing load per unit area - stress), and reduces net bone loss, more in males than females so that the increase in bone fragility with advancing age seen in both sexes is less in males than females. Few males than females have a fracture risk index for vertebral fractures (FRI or ratio of load-bone strength) above unity. The purp ....Lay Summary Fractures occur less commonly in males than females because males have greater periosteal apposition than females during ageing. This increases bone size (reducing load per unit area - stress), and reduces net bone loss, more in males than females so that the increase in bone fragility with advancing age seen in both sexes is less in males than females. Few males than females have a fracture risk index for vertebral fractures (FRI or ratio of load-bone strength) above unity. The purpose of this study is to define the structural and biomechanical basis responsible for the racial differences in fracture rates between Asians and Caucasians. Following the same biomechanical principles as published in Caucasian males and females, we hypothesise that racial differences in periosteal expansion during aging may contribute, in part, to the racial differences in bone fragility at the spine and hip. A cross-sectional study will be conducted in 500 healthy Chinese men and 500 Chinese women age ranged 18 to 90 years living in Melbourne, Australia. We have recruited larger numbers of Caucasian men and women in our Centre. BMD and bone size will be measured at the spine, hip and total body by using dual x-ray bone densitometer (DXA). Vertebral body width, depth, height, cross-sectional area (CSA), stress (load per unit CSA) and fracture risk index (load-strength) at the third lumbar vertebrae will be measured by PA and lateral scanning. Femoral neck periosteal-endocortical diameter, cortical thickness, cross-section moment of inertia (CSMI), section modulus buckling index will be measured by using hip structural analysis program. Just as insight into bone fragility in women has been obtained by studies in men, we believe that the results of this study will provide important insights into the pathogenesis of bone fragility in both racial groups.Read moreRead less