Hormone replacement therapy could help kidney dialysis patients

Dr Jasna Aleksova

Men undergoing kidney dialysis may have lower testosterone and reproductive hormone levels, providing evidence as to why this group are more prone to bone fractures, a new Monash research study has shown.

The study, by Clinical Associate Professor Frances Milat and first author Dr Jasna Aleksova, suggests hormone replacement therapy could be used in clinical trials for people undergoing kidney dialysis.

The findings of the study, a collaboration between Hudson Institute, Monash Health, Monash University and Professor Grahame Elder from Westmead Hospital, have been published in Kidney International.

Sex hormone-binding globulin is a biomarker associated with nonvertebral fracture in men on dialysis therapy

Jasna Aleksova et al. published in Kidney International.

Aortic vascular calcification is inversely associated with the trabecular bone score in patients receiving dialysis

Jasna Aleksova et al. published in Bone.

Monash PhD students recognised at the Australia New Zealand Bone and Mineral Society’s annual meeting

Alexander Rodriguez, Dr Jasna Aleksova and
Prof Peter Ebeling at the AMZBMS scientific meeting

School of Clinical Sciences at Monash Health PhD students Alexander Rodriguez and Dr Jasna Aleksova received prestigious awards from the Australia New Zealand Bone and Mineral Society (ANZBMS) in Brisbane last week.

Alexander received the 2017 Christine & T. Jack Martin Research Travel Grant, an award in memory of Christine Martin that also honours the outstanding and major scientific contributions of Professor T. Jack Martin to bone and mineral research.

Alexander will use the $15,000 grant to travel to Odense, Denmark to work with Professor Bo Abrahamsen from the University of Southern Denmark.

“My current research investigates how bone and muscle loss can effect cardiovascular risk in old age, and I plan to collaborate with Professor Abrahamsen to examine how anti-osteoporosis therapies, which we think are helping us by making our bones healthier, may actually have harmful cardiovascular side-effects,” Alexander said.

“I hope that this research will enable us to identify who is at least cardiovascular risk from these medications and thus avoid potential adverse events whilst still remaining on osteoporosis treatment.”

Alexander’s supervisor and Head, Department of Medicine Professor Peter Ebeling AO said this research comes at a critical time, as two anti-osteoporosis drugs, strontium ranelate and odanacatib, have recently been withdrawn from the market because of cardiovascular safety concerns.

“Alexander’s research will help us understand who may be better suited to the many different treatment options available and by targeting therapy to increase benefit and to reduce potential harm,” Professor Ebeling said.

Fellow PhD student in the Bone and Muscle Research Group and Monash Health Endocrinologist, Dr Jasna Aleksova, won the Professor Philip Sambrook Young Investigator Travel Award which is awarded to an outstanding early career scientist or clinical researcher.

Dr Aleksova’s research evaluates novel risk factors associated with fractures in patients with chronic kidney disease (CKD) and those with kidney transplants.

“These patients have a high burden of fractures and associated mortality, however, the current diagnostic tools used to evaluate patients with osteoporosis are less useful in patients with CKD,” Dr Aleksova said.

“CKD now affects one in ten Australians so urgent strategies are needed to identify and treat those at highest risk of fracture.”

“My research focuses on the role of hypogonadism in CKD and post-transplantation and the validation of novel imaging techniques, including the trabecular bone score and structural hip analyses, to better predict patients who are at the greatest risk of fracture,” she said.

Dr. Aleksova will use this grant to present some of her work at the American Society for Bone and Mineral Research annual meeting in Denver later this year where she will also be meeting with potential collaborators from Columbia University.

Senior Research Fellow Dr David Scott also from the Bone and Muscle Research Group had his abstract ‘Sarcopenic obesity is associated with lower tibial cortical area and thickness and poor physical function in community-dwelling older adults’ selected for an oral presentation at the ANZBMS scientific meeting last week.

Dr Scott said his study demonstrates that important indicators of bone quality, which are usually improved in obese individuals, may be compromised if muscle quality is also poor.

“The findings highlight the need for specific assessments and interventions to target bone health in obese older adults,” Dr Scott said.

Serum phosphorus levels and fracture following renal transplantation

Jasna Aleksova et al. published in Clinical Endocrinology.

Read article here.

Monash research team gives hope to patients with spinal factures

Alexander Rodriguez and Dr Jasna Aleksova
at the ASBMR annual scientific meeting

Monash researchers made significant contributions towards improving pain management associated with spinal fractures at the American Society for Bone and Mineral Research (ASBMR) annual scientific meeting last month in Atlanta.

Chair of Medicine at Monash Health and Head, Department of Medicine at Monash University Professor Peter Ebeling led the ASBMR Taskforce reporting on vertebral augmentation and was joined by his PhD students Dr Jasna Aleksova and Mr Alexander Rodriguez at the Georgia World Congress Centre in Atlanta.

“1.5 million vertebral compression fractures (fracture in the spine) occur every year in the USA and there is a similar high prevalence in Australia,” said Alexander. 

“Current therapies are inadequate as they only treat the pain rather than the
underlying fracture causing the pain.”

Alexander said their research showed that kyphoplasty (a type of surgery that restores cracked vertebrae in the spine by inflating a balloon and then injecting cement into the vertebral body) is effective at relieving pain and disability compared to standard therapy of pain medications and physical therapy.  However, kyphoplasty was not more effective than other types of surgical interventions for painful vertebral fractures.

“These findings are significant because clinicians will now have an evidence base in which to discuss treatment options with their patients,” said Alexander.

The research team’s findings form part of the ASBMR Taskforce on Vertebral Augmentation, which is being compiled as the Society’s clinical guideline for clinicians and patients.

First year PhD student and Monash Health endocrinologist, Dr Aleksova, was selected from a highly competitive international cohort of researchers to attend the Endocrine Fellows Forum on Metabolic Bone Disorders prior to the ASBMR annual scientific meeting.

“Participating at the conference was an incredible opportunity to learn from international experts as well as meet and discuss research ideas and aspirations on an individual level,” said Dr Aleksova.

Fellow member of the ASBMR Taskforce and PhD student Alexander has co-authored a meta-analysis on outcomes of kyphoplasty to treat back pain from compression fractures in the spine. His study formed the bulk of the Taskforce report on kyphoplasty presented at the meeting.

“I’m very proud of both Jasna and Alex,” said Professor Ebeling.

“They both acquitted themselves with great professionalism and were not daunted by the size of the ASBMR meeting and rose to new challenges—they both have bright futures ahead in clinical practice and research, with growing international networks.”