Osteoporotic Fracture-Mortality Association And The Effect Of Anti-osteoporosis Treatment: A Multinational Study
Funder
National Health and Medical Research Council
Funding Amount
$84,800.00
Summary
Osteoporosis burden is due primarily to osteoporotic fractures resulting in economic and public health burden, increased disability, further fracture risk and more importantly early death. However, it remains under-treated although treatment reduces the number of fractures and may reduce early death. This study aims to understand which types of fractures result in early death and for which age groups and whether osteoporosis treatment does or does not reduce early death.
Atypical femoral fractures (AFF) are uncommon, but catastrophic, complications of the anti-osteoporosis medications, bisphosphonates. We aim to identify patients either protected from, or at risk of, AFF by identifying changes in their bone geometry, structure and quality, and genes increasing risk of these fractures. In this way, these cheap and effective anti-osteoporosis treatments can be targeted to patients at the lowest risk of AFF and alternative treatments to those at highest risk.
Prediction Of Adverse Outcomes Following A Fragility Fracture
Funder
National Health and Medical Research Council
Funding Amount
$148,426.00
Summary
Individuals with an existing fracture are at increased risk of adverse outcomes such as re-fracture and premature mortality, but it is not clear why. We propose to evaluate risk factors, and prognostic models, for predicting the risk of adverse outcomes. We also propose to develop a quantitative risk-benefit framework for evaluating the clinical utility of such prognostic models and help ensure that therapies appropriately address real-life experience of osteoporotic patients.
Osteoporosis is a major and increasing public health problem. Fracture, the ultimate consequence of osteoporosis is associated with significant morbidity, mortality and economic costs. The Dubbo Osteoporosis Epidemiology Study, starting in 1989, with over 2000 women and men, is one of the longest running epidemiological studies in osteoporosis worldwide. It has been at the forefront of epidemiological advances in osteoporosis. It has identified osteoporotic fracture risks including low bone dens ....Osteoporosis is a major and increasing public health problem. Fracture, the ultimate consequence of osteoporosis is associated with significant morbidity, mortality and economic costs. The Dubbo Osteoporosis Epidemiology Study, starting in 1989, with over 2000 women and men, is one of the longest running epidemiological studies in osteoporosis worldwide. It has been at the forefront of epidemiological advances in osteoporosis. It has identified osteoporotic fracture risks including low bone density and bone loss, muscle weakness and postural instability, as well as the extent of the problem in men, and the significant costs, ill-heath and mortality associated with fracture. Despite the clarification of risk factors over the past decade, there are significant gaps in knowledge about osteoporosis, particularly in the accurate prediction of fracture risk and in identification of factors related to fracture-associated mortality and survival post fracture. Although bone density is one of the best predictors of fracture risk, it incompletely discriminates between those who will fracture from those who will not. Although a number of clinical risk factors, and other measures of bone strength, such as quantitative ultrasound and geometry, have been shown to be independent predictors of fracture risk, it is not clear that these measures can be integrated with BMD to improve fracture prediction. The aim of the current study, is to develop and validate models using bone density, other measures of bone strength and clinical parameters that will more accurately predict fracture risk and mortality following fracture in older men and women. The more precise identification of those at high risk of fracture and at risk for poor outcomes following fracture will provide a rational basis for the development of more cost effective interventions for prevention of fracture and its associated morbidity and mortality.Read moreRead less
Fractures And Bisphosphonates: Reviving Osteoporosis Treatment Uptake By Identifying The Genetic, Material, And Microstructural Risk Factors Of Atypical Femur Fractures.
Funder
National Health and Medical Research Council
Funding Amount
$1,053,094.00
Summary
Atypical femoral fractures (AFF) are uncommon, but catastrophic, complications of antiresorptive osteoporosis treatments including bisphosphonates. We will identify patients at risk of AFF by determining changes in their bone structure and quality, and identifying genes that increase the risk of these fractures. In this way, cheap and effective antiresorptive treatments can be targeted to patients at the lowest risk of AFF and alternative treatments to those at highest risk.
The ASPREE-fracture Sub-study: Does Daily Low-dose Aspirin Reduce Fracture Risk In Healthy Older Adults?
Funder
National Health and Medical Research Council
Funding Amount
$1,351,150.00
Summary
Disability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. This is despite decades of clinical research, best practice guidelines and advances in therapies that aim to reduce fracture risk. The World Health Organization has identified fracture prevention as a public health priority. This study will determine whether a widely available, simple and inexpensive health intervention—aspirin—can reduce the incidence of fracture and associated disability ....Disability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. This is despite decades of clinical research, best practice guidelines and advances in therapies that aim to reduce fracture risk. The World Health Organization has identified fracture prevention as a public health priority. This study will determine whether a widely available, simple and inexpensive health intervention—aspirin—can reduce the incidence of fracture and associated disability amongst older Australians.Read moreRead less
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
Geelong Osteoporosis Study: Fracture Risk Prediction Based On Twenty Years Of Prospective Data.
Funder
National Health and Medical Research Council
Funding Amount
$1,107,758.00
Summary
In this population-based study we will generate evidence, both environmental and genetic, for defining fracture risk in Australian men and women. This will help identify individuals likely to sustain fragility fractures so that suitable therapies can be recommended. The data will be useful for developing prognostic models in both a clinical setting and for genetic screening programmes.
Economic Evaluation And Optimisation Of Services For The Preoperative Assessment And Management Of High Risk Surgical Patients
Funder
National Health and Medical Research Council
Funding Amount
$399,406.00
Summary
Medical co-morbidities in surgical patients affect post-surgical recovery, resulting in higher health service costs and poorer patient outcomes. Preliminary data indicate reduced post-surgical length of stay for patients with modifiable risk factors who attended a specialist preoperative clinic. This project will analyse existing data to identify patient sub-groups with the greatest capacity to benefit from specialist preoperative assessment, and evaluate new service pathways for these patients.