For the past 20 years, Professor Cyrus Cooper has led the University’s Medical Research Council Lifecourse Epidemiology Unit (MRC LEU). He has been at the forefront of pioneering research that has changed the way in which we view conditions such as osteoporosis and osteoarthritis; and changed the amount of vitamin D women take during pregnancy. He is constantly one of the country’s most cited researchers.
In April, he will step down as Director and continue as a senior scientist at the Unit. Medically Speaking takes a look at Professor Cooper’s distinguished and influential contribution to the epidemiology field.
40 years of research
Even though Professor Cooper has been leading the MRC LEU for the past two decades, he joined the University of Southampton 20 years prior, in 1983, as a research registrar under Professor David Barker, before he succeeded Professor Donald Acheson, then Director of the MRC Environmental Epidemiology Unit.
Professor Barker pioneered the “Barker hypothesis”, sometimes known as the “foetal origins of disease hypothesis”, which proposed that the development of heart and circulatory diseases, type 2 diabetes and even obesity in adulthood might be triggered by nutrition and other environmental characteristics during development in our mother’s womb.
This theory was controversial at the time but has now been confirmed by studies around the world. It was through Barker’s expertise that Professor Cooper developed his interests in epidemiology and osteoporosis.
“Professor Barker was instrumental in my enthusiasm to pursue population-based research,” Professor Cooper said. “He was and will always be my principal epidemiological mentor, and inspired a career in clinical research since I was a junior doctor.”
“My first studies were to establish whether there was any link between osteoporosis and hip fractures in older people. At the time, falls were thought the principle cause, with bone density a confounding factors. In our main study in the BMJ, the answer was clearly yes.
“The second was investigating whether dietary calcium intake and physical activity have important roles in prevention of hip fracture in older people. We ran large case control studies in the UK and Hong Kong, again published in the BMJ, which showed the unequivocal impact of physical activity and muscle strength. Finally, we went on to look at the geography of hip fracture throughout the UK and showed remarkably similar distribution between hip fracture and cardiovascular disease, both linked to infant mortality many years earlier.”
The prominent link between early development and risk of disease in later life was starting to be able to be applied to osteoporosis and other musculoskeletal conditions.
Today, Southampton is known the world over for this pioneering research, which has gone even further to show how the environment before conception, as well as during pregnancy and in the early years of life, including nutrition, exposure to toxic stress and environmental chemicals, impacts lifelong risk of disease.
But back in the 1980s and early 1990s, conditions like osteoporosis were not the well-known condition we know about today.
It was Professor Cooper’s research that paved the way for it to be recognised as the commonest metabolic bone disorder worldwide, a condition affecting millions of people, and a major economic burden to healthcare systems – osteoporosis is estimated to cost the NHS up to £4 billion a year.
“I was part of the World Health Organisation Working Party set up to define osteoporosis in 1994, and several key milestones in the development of bone densitometry and treatment modalities. And at that point, our small research profile into early life influences was purely Southampton but it has grown hugely and it added to a really exciting and interesting, next generation approach to prevention. I feel privileged to be a part of that.”
Changing healthcare and policy
Since the 1990s, Professor Cooper has developed and led the Unit’s osteoporosis programme including three key research studies assessing the developmental origins of osteoporotic fracture. These were the Hertfordshire Cohort Study, Southampton Women’s Survey and MAVIDOS; all have led to changes in the way we prevent osteoporosis in future generations. The MAVIDOS trial also informed new recommendations in 2016 to incorporate seasonal stratification into supplementation advice for vitamin D during pregnancy.
In addition, we have dramatically influenced the management of osteoporosis in later life also. For example, our research has supported the implementation of Fracture Liaison Services (FLSs), which identify older patients presenting, typically to A&E, with a fracture, and ensure that they receive appropriate assessment and treatment for osteoporosis, to minimise the risk of sustaining a further fracture event.
“I’ve been fortunate to work with some great people,” Professor Cooper said. “And it is incredibly rewarding to see our research, which has taken place over many years, have an important impact on clinical care today.”
“At the time we started, osteoporosis wasn’t the well-known condition, we know today. I feel really satisfied to have had the career in research that I have. The disorder that I happened to be studying turned out to be frequent and tractable; that shows the importance of good fortune! That having been said, I was lucky to be part of just 300 people around the world who were researching the disorder collectively. Together, a universal accompaniment of ageing has become a treatable medical condition.”
The future
Despite stepping down as Director after so long Professor Cooper knows the Unit is in good hands.
“The Unit has just gone on from strength to strength,” he explained. “30 years ago, we were a group of under 30 people and at our peak over the years, we’ve had 100 researchers working together on projects, many of which have had international collaborators.
“I’m very proud to pass the baton to Professor Nick Harvey, who is an extremely valued colleague and a truly leading clinical academic in our field.
“The Unit will move to be more focused on musculoskeletal frailty in older people, in particular conditions such as sarcopenia and osteoarthritis. The aim will be to evaluate musculoskeletal frailty at the levels of molecule, cell, system, organism and population to understand how we become frail, and to develop better interventions. I very much look forward to the future scientific achievements.”
On Thursday 30 March, Professor Cooper will discuss his four decades of research at a special event entitled A Journey Into The Epidemiology, Prevention & Treatment of Osteoporosis. The event at Avenue Campus will take place from 16:30. Register your place here.