Programme 1: Musculoskeletal health in later life

The aim of this programme is to reduce the burden of chronic non-communicable musculoskeletal disorders such as osteoporosis, osteoarthritis and sarcopenia (the commonest disorders worldwide of bone, joint and muscle respectively). Our approach integrates observational epidemiology and mechanistic understanding to develop novel interventions in later life aimed at optimising musculoskeletal health. Our work has already informed strategies developed by the WHO and IOF. Complemented by investigation of underlying mechanisms, we are evaluating interventions that might be widely delivered in older age, in order to successfully implement potential novel public health strategies which will reduce the health burden resulting from these disorders.

Summary: This programme integrates observational epidemiology and mechanistic understanding to develop novel interventions in later life aimed at optimising musculoskeletal health, in order to reduce the burden of chronic non-communicable musculoskeletal disorders, principally osteoporosis, osteoarthritis and sarcopenia.
Objectives: To (a) understand better the risk factors for, and mechanisms which underlie the development of osteoporosis, sarcopenia and osteoarthritis; and (b) develop intervention studies aimed at modifying later disease risk.
Research plan: Our future work will therefore focus on four key areas: (a) The Hertfordshire Cohort Study (HCS) and a novel musculoskeletal ageing cohort in Southampton, will form the basis for investigations across the lifecourse (complementing work in the Southampton Women’s Survey [SWS] with Programme 3). These will include novel intergenerational analyses as well as behaviour-focused diet and activity interventions to reduce falls and fracture risk; trajectories of musculoskeletal health in the oldest old will be characterized, with linkage to incident events via NHS Digital; (b) We will elucidate the environmental and genetic risk factors for musculoskeletal disorders such as osteoporosis, osteoarthritis and sarcopenia, accounting for multimorbidity, in cohorts including MrOS, WHI, Health ABC and UK Biobank. These findings will inform the development of the next version of the FRAX fracture risk assessment tool, as well as optimisation of primary and secondary risk assessment strategies (SCOOP and CTF); (c) We will use similar approaches to characterise the most effective integration of muscle mass, strength and physical performance, to predict falls, fractures, hospitalisation and death, in a new harmonised cohort collection (collaborator: MRC Versus Arthritis CIMA, Sheffield), in order to derive a novel outcome-based consensus definition of sarcopenia, and related risk assessment tool; and (d) We will carry out epidemiological studies to identify individuals at highest risk of requiring joint arthroplasty for osteoarthritis, and characterise outcomes of these surgeries.
Impact: We will continue to link closely with Programmes 2 and 3 in the MRC LEC, to characterise relevant aetiologic factors across the lifecourse from development, through working life, into senescence. We will thereby identify novel public health approaches and evidence-based integrated care pathways, to optimise musculoskeletal health and ameliorate the burden imposed by osteoporosis, osteoarthritis and sarcopenia in late adulthood.