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Not Just Bone Density Anymore: Genetics, Aging and Osteoporosis

New ways of studying osteoporosis may help better predict fracture
New ways of studying osteoporosis may help better predict fracture

One of the defining moments of my work in aging research was learning how dramatically age affects the deterioration of the skeleton. This realization motivated me to perform research focused on understanding age effects on the skeleton. Thus I have spent my career studying the impact of low bone density and working to characterize the contributors to age-related bone loss (osteoporosis). This is an area of research with the potential to help many individuals as the National Osteoporosis Foundation reports that low bone density and osteoporosis affects 54 million Americans. 

But, what exactly happens to our bones as we age? Osteoporosis—meaning ‘porous bone’—causes a deterioration of the bones that leads to fractures. Fractures from osteoporosis occur in the spine, wrists, hips and other bones. Hip fractures cause the most significant loss in the ability to care for oneself. In fact, the World Health Organization reports that hip fractures almost always require hospitalization and permanently disables half of those injured, with only 30% fully recovering from their injury. 

Part of our work at the Institute for Aging Research (IFAR) involves the study of lifestyle factors that contribute to loss of bone, falls and fractures, with the goal of finding ways to prevent falls and fractures with drug and non-drug treatments. One such area with great promise is the IFAR “geriOMICS” program, where we investigate genetic factors that lead to bone loss and fractures, and how future treatment might be tailored to the individual depending on one’s genetic profile. This emerging field of research, known as precision medicine, offers much potential for older adults who are at greatest risk of falls and fractures. 

Another area of our research at IFAR focuses on high resolution scanning of the skeleton to determine if bone microarchitecture can predict fracture. This technology goes beyond measuring bone density—the current standard of measure to identify those at risk of osteoporosis—to analyze bones at the micro level.  This research project will help us understand bone strength in more detail than results from bone density tests now available in the doctor’s office, and ultimately will help to understand how we can prevent fractures in individuals at high risk.

Novel technologies and research such as this will help to revolutionize the area of bone health, especially for older adults. It’s not just about measuring one’s bone density each year, but rather understanding all the factors that affect bone strength and the tendency to fracture. A collaboration with Elizabeth (Lisa) Samelson, PhD, Associate Scientist in the IFAR Musculoskeletal Research Center, focuses on the use of high resolution scanning of the skeleton to investigate why older adults with type 2 diabetes have increased risk of fracture.

Bone density testing does not work well to identify diabetic patients with high risk of fracture. In fact, people with diabetes tend to have better bone density than those who do not have diabetes. As a result, health care providers are unable to identify the diabetic patients who would benefit from treatments or other interventions to prevent fracture. High resolution scanning allows us to examine whether older adults with diabetes have weakness in the micro-architecture of their bones that cannot be measured by standard bone density testing. Studies such as this aim to enhance the quality of life for older adults by preventing bone loss and fracture-related falls

The Institute for Aging Research team recently contributed to a study published on September 14th in Nature detailing the discovery of the EN1 genome variant as a determinant for bone density and fracture. Understanding the genomics underlying skeletal fragility (osteoporosis) may lead to preventative interventions that ultimately reduce fractures as we age.

About Hebrew SeniorLife Outpatient Health Clinic
The health clinics within Outpatient Services at Hebrew SeniorLife offer high-quality, specialized care for Boston-area seniors. We offer a wide-range of therapies and medical services, including treatment for conditions such as hearing loss, memory disorders, osteoporosis, difficulty with speech and language, chronic illness, rehabilitation and wound care. When you visit Outpatient Services, you'll be treated by experts who understand the unique health needs of older adults, working to improve each patient’s health and quality of life.

Douglas P. Kiel, M.D., M.P.H.'s picture

About the Blogger

Director of Medical Research, Senior Scientist

My primary research interests are in the area of osteoporosis and related fractures, including falls, nutritional factors, genetics, and frailty. Much of my work has been carried out in association with the Framingham Study, which includes an ancillary study called the Framingham Osteoporosis Study. In addition, I am interested in clinical trials of pharmacologic and non-pharmacologic interventions to preserve bone mass and prevent fractures.

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