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Lifelong prevention of fractures and loss of muscle strength in later life

We have led new approaches to preventing weakening of bones (osteoporosis) and muscles (sarcopenia), changing UK and global health policy.

Key facts

  • Systematic risk screening was found to reduce hip fractures by 28% in older women

  • Southampton BRC expertise has fostered the growth of Fracture Liaison Services that are now based in 46 countries

  • We were first to show a link between pregnant mothers’ vitamin D status and their babies’ bone mass, informing new pregnancy guidelines

  • Our research describing the human and economic costs of these conditions has informed guidelines and policy globally. These include the UK National Osteoporosis Guideline Group recommendations, 2019 Europe-wide guidelines (ESCEO-IOF), World Health Organisation (WHO) 2016 Report on Ageing and Health, and WHO Minsk Declaration on the lifecourse approach.


Better risk management

In the MRC-SCOOP trial we addressed those health burdens through better risk management. It demonstrated a 28% reduction in hip fractures through systematic fracture risk screening (published here).

Those results drove major shifts in recommendations, supported by our role in developing the second generation FRAX tool. FRAX is the global standard for fracture risk assessment. It is central to 120 guidelines worldwide.

International impact

We have led demonstration of the clinical- and cost-effectiveness of Fracture Liaison Services (FLS). This includes establishing the global standard of care through the International Osteoporosis Foundation Capture the Fracture initiative. It has led to over 400 registered FLS across 46 countries. It is also a key part of the 2020 global Consensus on Secondary Fracture Prevention.

In the UK, NHS-wide audit shows that over half of the population currently has access to the global FLS standard of care. We are now tackling universal access through our implementation science.

Importance of vitamin D

Complementing this, our vitamin D research takes fracture prevention back to the womb. We were first to show a link between pregnant mothers’ vitamin D status and their babies’ bone mass. This informed 2014 Royal College of Obstetricians and Gynaecologists vitamin D in pregnancy guidelines.

Our MAVIDOS trial went on to show greater bone mass in winter babies born to mothers receiving vitamin D supplements (published here). Those results informed recommendations by the UK Scientific Advisory Committee on Nutrition. This is now reflected in Public Health England maternal vitamin D guidance.

Building on our international work to define sarcopenia (SDOC, EWGSOP), we used human muscle samples to provide the first complete picture of molecular changes in sarcopenia across ethnicities. This revealed that impaired energy metabolism is of central importance in sarcopenia (published here), enabling us to target efforts in finding treatments.

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