Type 1 Diabetes and Skeletal Fragility

Adults with type 1 diabetes (T1D) have an increased risk of fractures, particularly at the hip. This clinically important problem is further compounded by the fact that patients with T1D experience poorer outcomes following a fracture. However, little is currently known about the effect of T1D on bone composition and bone quality, particularly in older adults. Our goal is to investigate biomechanical mechanisms of skeletal fragility in postmenopausal women and men age > or = to 50 years with T1D.  Using state-of-the-art methods with in vivo imaging and ex vivo examinations, our study will provide novel insights about the alterations in bone structure and quality that contribute to skeletal fragility in older adults with T1D. In addition, our findings will clarify the impact of diabetic history and accumulation of advanced glycation end-products on skeletal fragility in T1D. Addressing these critical gaps in knowledge will ultimately allow clinicians to develop rational approaches to prevent fractures in patients with T1D. 

Effects of Obesity and Bariatric Surgery on Bone Health

Bariatric (weight loss) surgery is a highly effective treatment for severe obesity, but may have negative longterm consequences for the skeleton. We have previously demonstrated that the first year of gastric bypass typically leads to bone loss of 3-6% at the lumbar spine and 5-10% at the hip.  We are utilizing state-of-the art research techniques to provide a comprehensive evaluation of bone health, including metabolic bone labs, bone mineral density, bone microarchitecture, and bone marrow adiposity. Our aim is to evaluate long-term skeletal strength as evidenced by bone density and microarchitecture in adults after Roux-en-Y gastric bypass or adjustable gastric banding. We hypothesize that skeletal effects may differ based on the type of bariatric surgery. We are interested in recruiting former bariatric surgery subjects as well as non-surgical weight-matched controls. 

Prevention of Bone Loss after Bariatric Surgery

We are exploring the use of osteoporosis medications to augment the treatment of adults undergoing either Roux-en-Y gastric bypass or sleeve gastrectomy surgery.  We are recruiting men and women aged 50 years or older who are planning bariatric surgery to participate in a randomized controlled trial.  We are studying whether using an FDA-approved osteoporosis treatment can prevent clinically relevant bone loss after bariatric surgery.  

Health Disparities in Osteoporosis Care

There are large disparities in the diagnosis, treatment and consequences of osteoporosis among different racial/ethnic groups within the United States. Further compounding these inequities is a notable lack of epidemiologic and clinical trial data among communities of color. It is important to ascertain health outcomes among diverse populations as the first step to defining clinically important socioeconomic, cultural, environmental and/or biologic factors that influence individual differences in fracture risk and treatment. My research group is leveraging existing large datasets to investigate disparities in osteoporosis management by race/ethnicity, detailing how race/ethnicity impacts the complex relationship between bone density and fracture, understand the implications of race/ethnicity adjustments in fracture risk calculators, and study the efficacy of pharmacologic osteoporosis treatments among diverse populations. Ultimately, better understanding of these important issues will provide better clinical guidance for osteoporosis treatment that are validated and applicable to all populations.