Aging

Knee osteoarthritis (OA), a leading contributor to physical disability and chronic pain, is associated with poor health outcomes and has a significant socio-economic impact. Bone marrow lesions (BMLs) often occur prior to irreversible cartilage degeneration, and earlier detection of them may allow identification of individuals at high risk of knee OA. The overall goal of the project is to develop accurate and fast machine methods to automatically quantify BMLs from magnetic resonance imaging (MRI) data.

In the United States, a culture where the elderly are often marginalized, the COVID-19 pandemic has left many older adults feeling further devalued.  The pandemic has heightened its risks not only physically but psychologically.  With quarantines in place, the elderly worry about how they will obtain medications, food, and other daily necessities.  Many older adults will not seek medical care for health concerns for fear of contracting COVID-19. Most people have not experienced a pandemic that caused us to have to stay at home and avoid human contact.  Therefore, we want to explore the impact of the pandemic on older adults to be prepared to intervene in case this should happen again in the future. The purpose of this study is to explore older adults’ experiences with the COVID-19 pandemic, including, psychosocial, behavioral responses to the pandemic, and older adult’s overall well-being. The aims of this project are to explore a diverse sample of older adult’s psychosocial responses to COVID-19, explore a diverse sample of older adult’s behavioral responses to the COVID-19 pandemic, and evaluate a diverse sample of older adult’s perceived well-being during the COVID-19 pandemic. 

The study started in 1993 to evaluate health outcomes in aging postmenopausal women and to identify factors associated with healthy aging. Between 1993 and 1998, more than 161,000 women between 50 and 79 years of age joined the WHI. Beginning in October 2004, participants were consented for sequential 5-year WHI Extension Studies (ES). The research team continues to collect self-reported as well as medical record adjudicated health and mortality data. A team of junior investigators are engaged with data analysis in an effort to advance the dissemination of WHI research findings. Arizona research team members have published over 45 manuscripts in the past 8 years using this well-characterized and robust phenotypic information.

This project was used to pilot an investigation on whether using physical activity and computer instruction could reduce social isolation in the elderly. This project received funding support through a mini grant within the Mel and Enid Zuckerman College of Public Health. 

Osteoporosis is a major public health problem. Women are at a particularly high risk for osteoporosis, and 50% of women age 50 or older may suffer from a fragility fracture in their remaining lifetime. Hip fractures are the most detrimental type of fractures. Research has been conducted to assess hip fracture risk so prevention methods could be used to reduce this risk in the growing number of older women. However, previous risk assessment approaches are limited to a few variables and linear combinations of these factors. Also, there is an increasing number of available measures, such as bone structures and skeletal muscle mass, and no reliable risk prediction model exists based on this wealth of information. The overall goal of this study is to develop a comprehensive and flexible model to assess the risk of hip fracture for a specific woman. There are three specific aims. The first aim is to generate a risk model, based on clinical data that accounts for the coupling effects of the factors involved in hip fracture. This research introduces a new approach in the field of hip fracture, Support Vector Machines (SVM), which explicitly identifies the configurations of factors that are likely to lead to hip fracture. The second aim is to refine the prediction/decision model from the first aim using both the SVM classifier and finite element modeling. A scheme has been developed to select, in a high dimensional space, data points that would improve the accuracy of the SVM-based risk prediction model. These data points would be evaluated (fracture or not) using a finite element model. The novelty of the proposed finite element model stems from its full parameterization so that the variability of the bone response can be studied with respect to variations (even small) of structural geometry and material parameters. The third aim is to validate and compare the SVM-based risk with and without the use of finite element analysis and develop a hip fracture risk calculator for the web. A cross-validation will be performed using data sets from the WHI as well as other cohorts. The flexibility of the SVM classification approach makes it easily deployable on the Internet. This study will be carried out using existing cohorts by an interdisciplinary team with experience in epidemiology of osteoporosis research, DXA measurements including hip structures and sarcopenia, fracture assessments, biostatistics approaches for large datasets, high dimensional analysis and finite element modeling, thus making this study highly feasible. The study results will have an extremely significant public health impact by providing an innovative tool for hip fracture risk assessments. This study will use innovative approaches, existing cohort resources, and interdisciplinary expertise to address a significant public health challenge: assessing the risk of hip fracture, the most detrimental type of fragility fractures. The study aims for a better risk assessment tool on the web that can be used by researchers and clinicians to assess an individual's hip fracture risk. This research will test new predictors and use the assumption free modeling approach to capture complex and non-linear relationships of predictors with fracture risk This study was funded by National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. 

Anemia is a common health problem in US older populations. It increases the risk for disability, a decline in physical performance, low muscle strength, and premature death in the elderly. A recent study reported the prevalence of anemia being larger than 10% in the US population over age 65, and the prevalence of anemia varied by ethnicity, suggesting significant health disparities in minorities, especially in the African American population. In this study, a large (N >160,000) multiethnic (non-Hispanic white, Hispanic, African American, Native American, Asian/Pacific Islander) cohort from the nationwide Women's Health Initiative (WHI) study will be used to investigate the relationships of aging with anemia epidemiology, pathology and prognosis. Specifically, we will: Evaluate the frequency of and risk factors for anemia overall and according to race-ethnicity and co-morbidity Determine the association between anemia and risk of death over 10 years of follow-up in the WHI overall and by race-ethnicity Determine associations between anemia and changes in physical function over 9 years of follow-up in the WHI cohort overall and by race-ethnicity Examine associations of anemia with muscle loss (sarcopenia) among those with baseline and prospective measurements of body composition from dual-energy x-ray absorptiometry, and  Study the association of anemia with bone loss and risk for osteoporotic fractures in older women. In addition, the frequency of anemia subtypes by morphologic categories and optimal cutoff points of hemoglobin concentrations for anemia in older women will be evaluated. This study will use archived observational and clinical trial data from 40 WHI clinical centers. Additional data entering for blood analysis from existing reports, and data merging (body composition measurements) will be conducted in the WHI DXA cohort from Arizona, Birmingham and Pittsburgh. Multivariate data analyses will be conducted for the specific aims. The WHI provides a unique and invaluable resource for answering the research questions proposed above, as the WHI is the only study in the nation that has prospective co-morbidities and body composition data as well as hemoglobin values in multiethnic groups of older women. This study has a great potential to provide new and critical evidence that is needed for preventing and managing anemia in older women from different health, age, and ethnic backgrounds.  This study was funded by the National Institutes of Health. 

Low relative skeletal muscle mass (SMM) or sarcopenia significantly contributes to the decline in physical functioning among the elderly. Very little is known about genetic risk factors and their interactions with environmental factors in aging-related SMM loss. There are some indications that inflammatory factors and reduced levels of anabolic hormones are associated with lower muscle mass. These associations need to be confirmed in larger prospective studies and the exact role of each identified biomarker in the development of sarcopenia remains to be investigated. Since physical function impairment and disability are more prevalent in women than in men during later life, it is especially important to understand the mechanisms of muscle loss and to prevent sarcopenia among older women. The primary objective of this study is to identify genetic factors and biomarkers that are relevant to low SMM and high rates of SMM loss in older women. We will achieve two specific aims: Assess the association of cytokines and hormonal factors with low SMM and the rate of SMM loss, and Evaluate the role of genetic variation in catabolic inflammatory cytokines (IL-6, IL-1, TNF-alpha) as well as in anabolic growth factors (IGF1, Growth Hormone) related to SMM and the rate of SMM loss in a large cohort of Hispanic and non-Hispanic White postmenopausal women. Study participants will come from the Women's Health Initiative Observational Study. All of these women have had repeat body composition measurements by using Dual-energy X-ray Absorptiometry (DXA) during the nine- year follow-up. Their SMM will be assessed using a DXA-derived method developed by this research team. Genetic variations in selected catabolic (e.g.IL-1, IL6, TNF-a) as well as anabolic (e.g. IGF-1, and GH) factors will be assessed for the entire sample (n = 2800). Analyses of biomarkers, including IL-6, TNF-a, adiponectin, C-reactive protein, IL-1ra, IL-6sR, TNF Rll, acid labile subunitJGF-1, and IGFBP-3, will be conducted among 50 percent of the participants in this study. Regression and mixed effects models will be used in the final data analysis. This study is unique and innovative in the study design, selection of bioassays, and the study population. Results of this study will have significant impacts on the prevention and reduction of adverse health outcomes associated with sarcopenia of older women in the United States. This project was funded by National Institute on Aging of the National Institutes of Health.