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The University of Southampton
Medicine

Reducing the risk of osteoporosis in later life

Research at the University of Southampton’s MRC Lifecourse Epidemiology Unit (LEU) focusses on the determinants, across the whole lifecourse, of chronic non-communicable disease development (such as osteoporosis) in later life, and identification of novel interventions in early life that might reduce the burden of these conditions. Recently, our research has led to the world’s first randomised controlled trial of vitamin D supplementation in pregnant women. This work will provide an answer to the question of whether an intervention during pregnancy (e.g. vitamin D supplementation) can lead to an improvement in offspring health (in this case, bone and muscle strength). Our work has shaped international guidance and attracted over £10 million in funding for further osteoporosis research.

Research Challenge

In the early 2000s expert opinion was suggesting that elderly people should be given calcium and vitamin D supplements to reduce their risk of bone fractures due to osteoporosis. But following two trials conducted by Southampton researchers, our team was able to conclude that recommended approaches to supplementation with calcium and vitamin D had no marked effect on fracture incidence.

Context

Osteoporosis is a major public health problem because it is associated with bone fractures - for example, broken hips - in older people. It is estimated to cost the UK economy almost £3 billion a year. We have attempted to quantify the human and economic costs of the disease, and have elucidated risk factors across the whole lifecourse for the development of osteoporosis. These findings have informed our investigation of potential public health interventions early in life, such as vitamin D supplementation in pregnancy.

Our Solution

Switching our research focus to younger life, we carried out research over the course of a decade which demonstrated that osteoporotic fracture risk in older age is affected by environmental conditions in the womb or in very early life after birth.

We undertook population-based studies which provided evidence that directly linked maternal vitamin D insufficiency during pregnancy with reduced bone mass in their children, a situation likely to lead to an increased risk of bone fracture in late adulthood.

These observations, confirmed in other cohorts, have led directly to the MAVIDOS Maternal Vitamin D Osteoporosis Study, in which over 1000 women have been randomised, in a double-blind placebo-controlled design, to either vitamin D or placebo daily, with offspring bone mass, measured by Dual Energy X-ray absorptiometry, as the primary outcome.

What was the impact?

This research has shaped national and international policy aimed at reducing the economic and social consequences of osteoporosis. It is actively contributing towards an estimated 20% decrease in fracture incidence.

In addition, it has informed and influenced both the World Health Organisation and NICE, and has helped save the NHS an estimated £1bn per year. Finally, it has informed government recommendations on maternal diet and vitamin D supplementation during pregnancy; results from the MAVIDOS study will definitively inform the optimal dose and efficacy of this approach in terms of offspring bone mass and body composition.

Our findings have been featured in national media, including ITV's ‘Daybreak', and the work of the unit as a whole has formed the basis for a recent documentary series on BBC Radio 4.

Tracking disease development across the generations
Disease dvmpt across generations

Key Publications

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