Exploring practical and translational methods to prevent bone fractures in older adults

Every three seconds, an older adult suffers a fragility fracture. About half of older women and a quarter of older men are going to sustain an age-related fragility fracture as they age. The loss of bone and muscle mass and strength with aging (respectively known as osteoporosis and sarcopenia) leads to increased risk for falls and fractures. This often leads to disability, fear of falling, social isolation, and ultimately, loss of the ability to live independently. Tackling these set of difficulties are Drs. Neil Binkley, an M.D. and Professor, and Bjoern Buehring, an M.D. and Assistant Professor, at University of Wisconsin-Madison (UW). They are exploring practical and translational ways to address bone and muscle weakness to reduce the risk in older adults. Many older adults with osteoporosis and sarcopenia go from being active members with their families and in their community, to requiring daily aid from a caretaker and many require moving from their homes to nursing facilities. Therefore, measures to enhance the clinical identification of older adults at risk for falls and fractures—combined with measures to improve bone and muscle strength—have significant personal and societal benefit. 

As investigators at the UW Osteoporosis Clinical Research Program, Drs. Binkley and Buehring have a unique understanding of the current research and the potential—or lack thereof—to translate these findings to clinical medicine and patient care. They’ve observed that their patients often do not want to take medication, yet, understandably, prefer maintained quality of life and independence. Therefore, their pragmatic approach explores non-pharmacological interventions to reduce fracture risks; namely exercise, nutrition, and supplementation when indicated. The overarching goal of their research is to promote maintenance of independence among older adults by mitigating bone and muscle loss with advancing age. Drs. Binkley and Buehring are developing, evaluating, and enhancing clinical tools to evaluate muscle mass and function, as current approaches are either flawed or prohibitively expensive. Additionally, they are evaluating traditional vs. computerized approaches for determining physical and muscle function. These computer-based methods hold promise to enhance sensitivity to detect muscle change resulting from various interventions in older adults. 

Drs. Binkley and Buehring—as well as other investigators on their team—bring a novel clinical perspective to clinical/translational research. They have extensive collaborations with diverse faculty at UW, including specialists in Chemistry, Kinesiology, and Population Health. Together, they are exploring genetic and mechanistic pathways that affect vitamin D metabolism, muscle maintenance and performance. They also have close collaborations with researchers around the world; these interdisciplinary collaborators specialize in study design, publications, clinical trials, laboratory research, and data analysis, among other fields. The team ultimately aims to improve people’s mobility and independence, seeking out methods that not only make the bones stronger, but make the entire human being more resistant to fracture; this includes making sure the individual doesn’t fall, increasing muscle strength, and maintaining their independence. 

Current Projects Include: 

Evaluating Traditional vs. Computerized Approaches to Determining Physical and Muscle Function – Current measures to test bone and muscle function are often simplistic and not ideally reproducible. Though the traditional assessment of osteoporosis by bone density measurement is largely a good predictor of fracture risk, it has limitations. This is also true for current clinical tools that assess muscle health. To prove an intervention is effective, it must be tested. This can be done through surrogate parameters, such as bone density, gait speed, and measures of muscle mass and function. Drs. Binkley and Buehring’s research explores novel computerized tests and newer methods that will enable them to identify the necessary parameters to monitor muscle mass, function, and bone quality. These parameters must be validated before they can test their interventions; therefore, a long term goal of their research is to create the necessary tests to trial the effectiveness of their interventions.

Vibration Exercise Trials – Less than 10 percent of people 65 and older get the recommended 150 minutes of weekly activity. One of the most intuitive non-pharmaceutical solutions for improved bone and muscle help is exercise. However, typical exercise programs are too difficult for older adults with physical or cognitive impairments. Drs. Binkley and Buehring have been exploring new exercise methods—called “vibration exercise”—that may well be more time efficient, easier to do, and less complex than traditional exercise regimens. Together with collaborators, they are performing exercise studies with older adults using vibration equipment. Their goal is to identify whether or not whole body vibration exercises are feasible—both safe and effective—for older frail adults with impairments that limit them from going to the gym or joining an exercise class on a regular basis. The vibration exercise device allows users to sit, so they can potentially obtain exercise benefits. Drs. Binkley and Buehring currently have a small-scale pilot test in which they recruited volunteers in an assisted living facility to use the seated vibration equipment. After the last wave of participants performs the testing, they will analyze these data and from there, they aim to adapt those findings into a larger trial to see if this method can improve individual’s mobility and independence.

Vitamin D Status Assessment – Vitamin D has long been recognized as being important in bone health and calcium metabolism. More recent studies indicate that this nutrient is also important in muscle function. Drs. Binkley and Buehring’s research group is on the forefront of vitamin D status assessment to improve identification of those who are deficient. Current clinical and research approach to defining vitamin D inadequacy are flawed by treating vitamin D like a drug, providing a higher dose in hopes of increasing its effect. However, nutrients are ineffective beyond a certain threshold. Drs. Binkley and Buehring are continuing define a comprehensive vitamin D metabolic measurement approach coined a “vitamin D panel” (similar to the “lipid panels” being used to evaluate lipid/cholesterol status) and also have developed a ‘treat-to-target’ strategy to improve clinical trials of vitamin D supplementation. The goal is to enhance the ability of clinicians and researchers to better define in an individual what constitutes vitamin D inadequacy and subsequently to tailor personal supplementation approaches to maximize benefit. Rather than provide an ineffective one-size-fits-all dose, the individual’s vitamin D status is measured at baseline and the correct amount of vitamin D is supplemented to get them at the target blood level. Drs. Binkley and Buehring would eventually like to integrate this vitamin D strategy into a vibration exercise study. 

Neil Binkley

After earning his MD degree from the UW Medical School and completing his training in Internal Medicine at the Marshfield Clinic, Dr. Neil Binkley became a private practice primary care internal medicine doctor. The motivation for his research originated from the years working at a primary care practice and witnessing the negative impact osteoporotic fractures have on older adults and their families. In one particular case, Dr. Binkley was caring for a whole family, including a Grandpa and Grandma, and the next two generations of family members. The grandmother developed extremely severe osteoporosis and Dr. Binkley saw how it heavily affected her and entire extended family. As a result, he wanted to find a better way to tackle age-related bone and muscle problems.

When Dr. Binkley returned to academia to complete a Geriatric Fellowship at UW, his research career began; he realized he wanted to impact health care on a global level. He went on to establish the UW Osteoporosis Clinical Center and the Osteoporosis Clinical Research Program. His research largely focuses on osteoporosis diagnosis and the connection between muscle bone and fracture risk. It was at the osteoporosis clinical center that he and Dr. Buehring met and began their now 10+ research career together. They both share a strong motivation to pursue research that has a real-world impact.

Dr. Binkley is on the Scientific Advisory Board of the International Osteoporosis Foundation and Editorial Board for the Journal of Bone and Mineral Research. He is also the past president of the International Society for Clinical Densitometry.

http://www.uwosteoporosis.org/

Bjoern Buehring

Obtaining his medical degree from Charité-Universitätsmedizin Berlin, Germany, Dr. Buehring became fascinated with the musculoskeletal system early on in his academic career. While at his medical school, he joined a research group that was part of the European Space Agency performing a bedrest study. The researchers were looking at the musculoskeletal system, keeping young participants in a bed for 56 days and testing various interventions. One of the interventions was vibration exercises; this was the first time Dr. Buehring was exposed to this method.

Dr. Buehring completed a Rheumatology fellowship at the Cleveland Clinic and Geriatric fellowship at the UW. He then went into Internal Medicine at UW, focusing on Geriatrics and Rheumatology. He started working with Dr. Binkley in 2006 when he joined the Osteoporosis Clinical Research Program. He is now a faculty member at the UW Osteoporosis Clinical Center. Additionally, Dr. Buehring is a member of the University of Wisconsin Institute of Aging, the Scientific Advisory Board of the International Society for Clinical Densitometry, and the American Geriatrics Society Osteoporosis and Metabolic Bone Disease Special Interest Group. Throughout his work, Dr. Buehring has focused on bone, joint, and muscle function, while looking at the entire musculoskeletal system. His mission is to find interventions that keep that system functioning as we age. Together, he and Dr. Binkley have created a vision of preventing fragility fractures and increasing independence for older adults, thus improving their quality of life.  http://www.uwosteoporosis.org/

2016 Champions in Women's Health