Key Discoveries

Programme 1 – Musculoskeletal health in later life

  1. Characterization of osteoporotic fracture epidemiology systematically assessing secular trends in hip fracture incidence by age, gender, ethnicity and time.1-3
  2. Efficacy of screening for fracture prevention in primary care using innovative intervention strategies to reduce hip fracture incidence; in secondary care leading a global benchmarking tool for quality assessment of secondary fracture prevention services worldwide; refining and developing FRAX-based risk assessment tool.4-12
  3. Novel risk factors, comorbidities and body composition and associations with adverse BMD and bone microarchitecture. Novel assessments of musculoskeletal phenotype for fracture discrimination and better understanding of fracture etiology for intervention design.13-23
  4. Global assessment of sarcopenia and risk factors for sarcopenia, epigenetic mechanisms of sarcopenia, muscle and bone interactions and the role of muscle in fracture risk prediction.24-31

Programme 2 – Determinants of musculoskeletal health in the mid-lifecourse

  1. Using data from our HEAF study we have shown that pre-frailty and frailty are relatively common amongst adults aged 50-64 years, and importantly associated with being unable to work to older ages (10-fold and 30-fold).
  2. Using data from the Hertfordshire cohort study we have shown that men who have undertaken heavy manual work throughout their working life are no better off, in terms of muscle strength, at retirement age, and in fact have poorer grip strength than men who have done office-based work.
  3. The CUPID study has shown that most people (95%) at work who report low back pain do not ONLY have low back pain but usually also report pain at other anatomical sites.  The 5% with localised back pain had a different risk factor profile to this group. This suggests that the ergonomic-focussed interventions for low back pain will be suitable for prevention of localised low back pain but that they are unlikely to make a major impact on non-localised low back pain (that is in 95% of cases) in whom attention to mental health and psychosocial risk factors is likely to be more effective.
  4. In a multicentre RCT which allowed for comparison of different types of advice and early vs delayed physiotherapy, we have shown that advice to remain active, as opposed to usual advice to rest, leads to improved outcomes in terms of function at 6 months amongst people referred to physiotherapy with pain in the elbow, forearm, wrist and hand.
  5. Job satisfaction is known to be important in retaining older workers.  Using data from our HEAF study we showed that job dissatisfaction was associated with feeling unappreciated or lacking a sense of achievement and also with poorer self-rated health, mental health and lower wellbeing. We identified factors that employers could influence or change to maximise satisfaction and retain workers include relationships in the workplace, fairness, job security and instilling a sense of achievement.

Programme 3 – Early development and risk of adult musculoskeletal disease

  1. Confirmation that low maternal 25(OH)-vitamin D concentration during pregnancy is associated with reduced bone mass in the offspring Demonstration that maternal vitamin D supplementation during pregnancy improves offspring bone mass amongst winter births
  2. Characterisation of 25(OH)D across pregnancy and determinants of response to treatment
  3. Elucidation of aetiological factors underlying these epidemiological observations, such as the relationship between placental calcium transporters and offspring bone mass and epigenetic regulation of genes in umbilical cord
  4. Description of relationships between growth in utero, measured using gestational ultrasound scanning, and skeletal development in childhood


†open access at 1st March 2019

1) Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19-26.†

2) Moon RJ, Harvey NC, Curtis EM, de Vries F, van Staa T, Cooper C. Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom. Bone. 2016;85:9-14.†

3) van der Velde RY, Wyers CE, Curtis EM, Geusens PP, van den Bergh JP, de Vries F, Cooper C, van Staa TP, Harvey NC. Secular trends in fracture incidence in the UK between 1990 and 2012. Osteoporos Int. 2016;27(11):3197-206.

4) Gale CR, Deary IJ, Wardle J, Zaninotto P, Batty GD. Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing. J Epidemiol Community Health. 2015;69(6):530-5.†

5) Harvey  NC,  Kanis  JA,  Oden  A,  Nakamura  T,  Shiraki  M,  Sugimoto  T,  Kuroda  T,  Johansson  H, McCloskey  EV.  Efficacy  of  weekly  teriparatide  does  not  vary  by  baseline  fracture  probability calculated using FRAX. Osteoporos Int. 2015;26(9):2347-53.†

6) McCloskey EV, Oden A, Harvey NC, Leslie WD, Hans D, Johansson H, Kanis JA. Adjusting fracture probability by trabecular bone score. Calcif Tissue Int. 2015;96(6):500-9.

7) Harvey NC, Gluer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, Kendler D, Lamy O, Laslop A,  Camargos  BM,  Reginster  JY,  Rizzoli  R,  et  al.  Trabecular  bone  score  (TBS)  as  a  new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015;78:216-24.†

8) McCloskey EV, Oden A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJ, Fujita Y, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. 2016;31(5):940-8.†

9) Harvey  NC,  Oden  A,  Orwoll  E,  Lapidus  J,  Kwok  T,  Karlsson  MK,  Rosengren  BE,  Ljunggren  O, Cooper C, McCloskey E, Kanis JA, Ohlsson C, et al. Falls predict fractures independently of FRAX probability: A meta-analysis of the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2018;33(3):510-6.†

10) Harvey NC, Oden A, Orwoll E, Lapidus J, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cooper C, Cawthon PM, Kanis JA, Ohlsson C, et al. Measures of physical performance and muscle strength as  predictors  of  fracture  risk  independent  of  FRAX,  falls,  and  aBMD:  A  meta-analysis  of  the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2018;33(12):2150-7.†

11) McCloskey E, Johansson H, Harvey NC, Shepstone L, Lenaghan E, Fordham R, Harvey I, Howe A, Cooper C, Clarke S, Gittoes N, Heawood A, et al. Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures – A post hoc analysis of the SCOOP study. J Bone Miner Res. 2018;33(6):1020-6.†

12) Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes N, Harvey I, Harvey N, Heawood A, Holland R, Howe A, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391(10122):741-7.

13) Compston JE, Flahive J, Hooven FH, Anderson FA, Jr., Adachi JD, Boonen S, Chapurlat RD, Cooper C, Diez-Perez A, Greenspan SL, LaCroix AZ, Lindsay R, et al. Obesity, health-care utilization, and health-related quality of life after fracture in postmenopausal women: Global Longitudinal Study of Osteoporosis in Women (GLOW). Calcif Tissue Int. 2014;94(2):223-31.

14) Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, Saag KG, Roux C, Rossini M, Pfeilschifter J, Nieves JW, Netelenbos JC, et al. including  Cooper C. Relationship of weight, height,  and  body  mass  index  with  fracture  risk  at  different  sites  in  postmenopausal  women:  the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res. 2014;29(2):487-93.†

15) Gregson  CL,  Dennison  EM,  Compston  JE,  Adami  S,  Adachi  JD,  Anderson  FA,  Jr.,  Boonen  S, Chapurlat  R,  Diez-Perez  A,  Greenspan  SL, Hooven  FH,  LaCroix  AZ,  et  al.  including  Cooper  C. Disease-specific  perception  of  fracture  risk  and  incident  fracture  rates:  GLOW  cohort  study. Osteoporos Int. 2014;25(1):85-95.†

16) Reyes C, Estrada P, Nogues X, Orozco P, Cooper C, Diez-Perez A, Formiga F, Gonzalez-Macias J, Prieto-Alhambra D. The impact of common co-morbidities (as measured using the Charlson index) on  hip  fracture  risk  in  elderly  men:  a  population-based  cohort  study.  Osteoporos  Int.
2014;25(6):1751-8.

17) Paccou J, Edwards MH, Ward KA, Jameson KA, Moss CL, Harvey NC, Dennison EM, Cooper C. Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius. Osteoporos Int. 2015;26(7):1893-901.

18) Kuh D, Muthuri SG, Moore A, Cole TJ, Adams JE, Cooper C, Hardy R, Ward KA. Pubertal timing and bone phenotype in early old age: findings from a British birth cohort study. Int J Epidemiol. 2016;45(4):1113-24.

19) Paccou J, Edwards MH, Patsch JM, Jameson KA, Ward KA, Moss C, Dennison  EM, Cooper C. Lower  leg  arterial  calcification  assessed  by  high-resolution  peripheral  quantitative  computed tomography  is  associated  with  bone  microstructure  abnormalities  in  women.  Osteoporos  Int. 2016;27(11):3279-87.

20) Johansson  H,  Siggeirsdottir K, Harvey  NC, Oden A,  Gudnason  V,  McCloskey  E,  Sigurdsson G, Kanis JA. Imminent risk of fracture after fracture. Osteoporos Int. 2017;28(3):775-80.† 1026: Martinez-Laguna D, Tebe C, Nogues X, Javaid MK, Cooper C, Moreno V, Diez-Perez A, Collins GS, Prieto-Alhambra D. Fracture risk in type 2 diabetic patients: A clinical  prediction tool based on a large population-based cohort. PLoS One. 2018;13(9):e0203533.†

21) Kanis  JA,  Johansson  H,  Oden  A,  Harvey  NC,  Gudnason  V,  Sanders  KM,  Sigurdsson  G, Siggeirsdottir K, Fitzpatrick LA, Borgstrom F, McCloskey EV. Characteristics of recurrent fractures. Osteoporos Int. 2018;29(8):1747-57.

22) Robinson DE, van Staa TP, Dennison EM, Cooper C, Dixon WG. The limitations of using simple definitions of glucocorticoid exposure to predict fracture risk: A cohort study. Bone. 2018;117:83-90.

23) Robinson DE, van Staa TP, Dennison EM, Cooper C, Dixon WG. The limitations of using simple definitions of glucocorticoid exposure to predict fracture risk: A cohort study. Bone. 2018;117:83-90.

24) Patel HP, Al-Shanti N, Davies LC, Barton SJ, Grounds MD, Tellam RL, Stewart CE, Cooper C, Sayer AA. Lean mass, muscle strength and gene expression in community dwelling older men: findings from the Hertfordshire Sarcopenia Study (HSS). Calcif Tissue Int. 2014;95(4):308-16.

25) Patel  HP, White MC, Westbury  L,  Syddall  HE,  Stephens  PJ,  Clough  GF,  Cooper  C,  Sayer  AA. Skeletal muscle morphology in sarcopenia defined using the EWGSOP criteria: findings from the Hertfordshire Sarcopenia Study (HSS). BMC Geriatr. 2015;15:171.†

26) Baczynska AM, Shaw S, Roberts HC, Cooper C, Aihie Sayer A, Patel HP. Human Vastus Lateralis skeletal muscle biopsy using the Weil-Blakesley conchotome. J Vis Exp. 2016(109):e53075.†

27) Zengin A, Fulford AJ, Sawo Y, Jarjou LM, Schoenmakers I, Goldberg G, Prentice A, Ward KA. The Gambian bone and muscle ageing study: Baseline data from a prospective observational African sub-Saharan study. Front Endocrinol (Lausanne). 2017;8:219.†

28) Patel A, Edwards MH, Jameson KA, Ward KA, Fuggle N, Cooper C, Dennison EM. Longitudinal change  in  peripheral  quantitative  computed  tomography  assessment  in  older  adults:  The Hertfordshire cohort study. Calcif Tissue Int. 2018;103(5):476-82.†

29) Patel  HP,  Dawson  A,  Westbury  LD,  Hasnaoui  G,  Syddall  HE,  Shaw  S,  Sayer  AA,  Cooper  C, Dennison EM. Muscle mass, muscle morphology and bone health among community-dwelling older men: Findings from the Hertfordshire Sarcopenia Study (HSS). Calcif Tissue Int. 2018;103(1):35-43.†

30) Robinson SM, Westbury LD, Cooper R, Kuh D, Ward K, Syddall HE, Sayer AA, Cooper C. Adult lifetime diet quality and physical performance in older age: Findings from a British birth cohort. J Gerontol A Biol Sci Med Sci. 2018;73(11):1532-7.†

31) Zengin A, Jarjou LM, Prentice A, Cooper C, Ebeling PR, Ward KA. The prevalence of sarcopenia and relationships between muscle and bone in ageing West-African Gambian men and women. J Cachexia Sarcopenia Muscle. 2018;9(5):920-8.†