Latest / 'Bone Up' / Boosting bone health and preventing falls

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Boosting bone health and preventing falls · 'Bone Up'

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Hello and welcome to Bone Up, the podcast all
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about bones, how we make them, why we break them
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and if we fully understand them. I'm David Armstrong.
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Hi and I'm Richie Abel and over this series we're
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going to be exploring osteoporosis, bones, what
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we know and what we're yet to discover and we
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hope you will join us on the journey. So for
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anyone keen to learn more about our infrastructure
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of calcified collagen, this is Bone up. Hello
0:55
and welcome back to Bone Up. We've made it back
0:59
from Marseille from the European meeting in one
1:01
piece and we hope you have enjoyed listening
1:05
to our take on what went on at the CTS conference.
1:10
Do you feel invigorated, Richie? Relaxed? Inspired?
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I do. I always feel inspired after coming back
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from a conference. It's hard sometimes in science.
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You have to write grants and write papers that
1:23
get rejected a lot, and you have to keep trying.
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Whenever I go to a conference, I always get a
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big boost, and I think, come on, keep going,
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keep going. It's really important. How did you
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find the conference? Yeah, I thought it was great.
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Again, it's inspiring. It's nice to meet people
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around the world. It's nice to hear science.
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It's nice for me to be able to go back to patients
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and say, you know, the questions that patients
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ask me, saying, well, I've actually been speaking
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to some of the world's leading researchers who
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have been actually trying to answer. the specific
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questions you you ask me and yeah it's nice to
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get away for a few days unfortunately the work
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builds up you know there's no one does my work
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while i'm away but but yeah it's good it gives
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you a bit of a bit of a refresh Today we're going
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to have a guest speaking to us about the importance
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of exercise in bone health and I was just wondering
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David what kind of questions do your patients
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have for you about exercise and its role in their
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treatment if you like for osteoporosis? Yeah
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it's I mean people we've mentioned this before
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I would say for every one question you get about
2:28
how bones work at some basic level or about drugs.
2:32
You probably get about 10 questions about diet
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and exercise. Those are the things people are
2:37
interested in. And I think some of that is because
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it's something that is very much patient -centered
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and they can go away and do themselves. And of
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course, sometimes research on exercise can be
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a little more difficult because it's not just
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as clean and dry as doing either basic research
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on cells or animals. or research just using drugs.
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But I suppose one of the questions, rather than
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just the basic questions about exercise, because
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I think most people realise exercise now is good
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for them and good for their muscles and bones,
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is the combination of exercise with drugs. Because
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usually when people come to see me at the clinic...
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I don't get to see everyone with osteoporosis
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in the trust where I work. People who come to
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see me at the clinic usually have quite severe
3:28
or unusual osteoporosis. Often now they've broken
3:32
vertebrae, broken bones in their back. So they're
3:36
in pain. They're often quite frightened about
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having further fractures. They know they're coming
3:42
to see me about some new drugs. And they ask
3:45
questions about should they exercise? What sort
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of exercise should they do? And then when I tell
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them they're about to start some new powerful
3:54
drug, some people might assume that they don't
3:58
need to exercise then because they're now getting
4:01
a wonder drug, getting some really... powerful
4:05
treatment or they may worry that exercising may
4:08
interfere with the function of the drug in the
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way you might have been told if you're taking
4:13
an antibiotic you shouldn't go to the gym or
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go running because you're on an antibiotic so
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I shouldn't exercise if I'm injecting myself
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with an anabolic and until fairly recently we
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didn't have a lot of evidence to advise people
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on that connection between exercise and the new
4:35
medication and some of the older medication we
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give people but as you know then at last year's
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ECTS we met a researcher who was just starting
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to do some really interesting work looking at
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what happens if you add mechanical loading resistance
4:53
training to treatment with drugs and indeed looking
4:57
at different drugs to see the effect that has
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on the bone. So listeners, if you're living with
5:03
osteoporosis or you're living with somebody who's
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living with osteoporosis and you have questions
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about exercise and how exercise interacts with
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the medicines for osteoporosis, we've got a great
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interview for you today. Yeah. We managed to
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get Frederica Schulte. We spoke to her briefly
5:23
last year. She agreed then at some point to give
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us a... a bigger interview today. We managed
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to catch up with her when we were in Marseille
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and ask her all the questions I hope that my
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patients ask me and that will be relevant to
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listeners. We're delighted to have with us today
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Friederike Schulte from ZTH Zurich. Welcome.
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Thank you. I'm glad to be here. Welcome. If you're
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a big fan of the podcast, you may remember Friederike
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speaking to us. briefly last year at the ECTS
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meeting telling us about her research and we
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were so excited. We asked her if she'd come back
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and speak to us for a proper episode and here
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she is. And listeners, today we're recording
6:05
this from the ECTS conference. This is a face
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-to -face meeting which is really nice. We don't
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often get to see our guests' faces and talk to
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them for so long. So thank you for joining us
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today. Sure, I also appreciate that. So we were
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really excited last year to hear about your research
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into how bone medicines and physical activity
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and loading might combine and how a combination
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of those might improve treatments for patients.
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And you've got a really amazing paper in preprint,
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which will hopefully come out in publication
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soon. So listeners, you're getting the first
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here today. We brought it to you first. Would
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you tell us about your really interesting project?
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Yes, sure. We work in the preclinical field and
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in our laboratory we work with a mechanical loading
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model of in mice and we are interested in investigating
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how mechanical loading that is to say in translated
7:04
physical exercise than in humans, how this mechanical
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loading affects trabecular bone mass, especially
7:13
in the case of osteoporosis. So the mice that
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we use are rectomized in order to let the bone
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loss occur. There, for mechanical loading, we
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see increases in the bone mass, in the bone volume
7:32
fraction. And we were then lately very much interested
7:37
in the effects of several osteoporosis treatments.
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That is to say, bisphosphonate treatment, being
7:46
anti -catabolic or PTH treatment. an anabolic
7:50
treatment or sclerostin antibodies. And we were
7:55
then particularly interested in whether mechanical
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loading combined with one of those treatments
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would lead to even enhanced effects. That's what
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we were investigating. What a wonderful research
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question. How does physical activity affect the
8:12
effect of a drug on osteoporotic bone? Absolutely.
8:15
And I think of all the... of all the sort of
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more basic science papers that I saw in the last
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year, I think yours is the one that I've ended
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up discussing most with patients because it comes
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up most relevantly where patients say to me,
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I've been doing a bit of resistance training
8:32
exercise for my bones and now you want to give
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me a drug. Is the resistance training better
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than the drug? Will the drug interfere with the
8:40
exercise? Do I get benefits together? And obviously
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you could design a trial involving thousands
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of human beings taking different drugs following
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for many years, but you can do this in mice,
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and in mice that are sort of designed to have
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osteoporosis, and you can get the results obviously
8:56
more quickly and give us a clue about humans.
9:00
So I suppose the big question is then, what did
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you find the exercise the loading mechanical
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loading it was good for bones and how did that
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compare with the different drugs as well yeah
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i'm sure the mechanical so the first parameter
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that we looked at was the trabecular bone volume
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fraction and in all treatments considering the
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mechanical loading also a mono treatment we found
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after four weeks of mechanical loading this is
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a cyclic mechanical loading protocol three times
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a week uh three thousand cycles at ten hertz
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and eight newton and we found after four weeks
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of mechanical loading um an increase in tropical
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volume fraction of about 20%. Okay and the trabecular
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bone volume is sort of thickness strength of
9:47
bone essentially? For the listeners it's bone
9:50
strength and you were sort of sending the mice
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to the gym? Three times a day? Yes. And it supports
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the core, the strength of the whole bone of the
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vertebra. And it has the trabecular network itself.
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With the single trabecular, it adapts very responsively
10:08
to mechanical loads. That's what we know from
10:11
research, because individual trabecular have
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the freedom to move and adapt themselves in order
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to align best with the incoming load. loading
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demands yeah the stress you're putting on them
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yeah this is um that's yeah that's why the the
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trabecular compartment is like more responsive
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to the mechanical demands and this is why we
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also expected um more results or more changes
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in the in this compartment you sent the mice
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to the gym four weeks later their their vertebrae
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the trabecular bone was was stronger was thicker
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was better so that's good yeah what happened
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then when you gave them the different types of
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drugs and our listeners will know there's bisphosphonates
10:52
which generally reduce bone turnover, denosumab
10:55
which reduces bone turnover and then there's
10:57
the other type of drugs which promotes bone building
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like teriparatide and anti -sclerostin antibodies.
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So what did you see in those different groups?
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Yes regarding the bone volume fraction we kind
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of also designed the study like that that we
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would see similar extents in the bone volume
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fraction so what we can say is that all three
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drugs that we investigated ended with about 20
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percent increase in this trabecular bone volume
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fraction and that we used as a as a baseline
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of course if you then look closer into trabecular
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thickness the other morphometric parameters or
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also bone formation rates and bone resorption
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rates then you see differences between the treatments
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and then this fact that you mentioned that anti
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-catabolic bisphosphonates would reduce resorption
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rates this can then be seen in the in the remodeling
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rates in the bone formation and resorption rates
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so you're seeing then that exercise and the medicines
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they change increase bone volume by changing
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the activity of the cells so you can see the
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mechanism by which exercise and medicines affect
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bone strength yes yeah and when you combined
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the exercise with the bone medicines what did
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you find did you get bigger better bone growth
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in so shortly speaking yes we did and there were
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differences in the effects After combination
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treatments, if you start with bisphosphonates,
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there was a slight increase that the mechanical
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loading brought in addition to the bisphosphonate
12:43
treatment. So I would say it's still recommendable,
12:46
although slightly. It's a slight decrease that
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you can achieve with the mechanical loading on
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top of it. And then with the anabolic treatments,
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it was for the PTH. you received a synergistic
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effect in the bone volume fraction. We might
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come to this later because in other parameters
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it's additive. But in the bone volume fraction,
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you see a synergistic effect in the combination
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of PTH and mechanical loading. And in the sclerostin
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antibody group, we saw the even stronger synergistic
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effect of sclerostin antibody therapy plus mechanical
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loading. So how much more does the bone volume
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increase, the trabecular bone volume, when you
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combine exercise with a medicine? Yeah, if you
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stick to the numbers, 20 % increase by monotreatments,
13:39
mechanical loading, and then 20 % increase by
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sclerostin antibody treatment alone. And then
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in the combination group, we had more than 50
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% increase in the combined group. That is an
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astonishing finding. So when you combine... the
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medicines and the exercise together you basically
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more than double the increase in bone volume
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fraction and i guess you know if we're thinking
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about people and patients if you're getting dexascans
14:07
measuring your bone mineral density if you greatly
14:09
increase the amount of trabecular bone in your
14:12
hip or your lumbar vertebrae then you're going
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to get a much better t -score and that tells
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you you're going to get a lower risk of fracture
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and so if i've got this right then giving giving
14:24
Anabolic, giving bone building agents, seems
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to work better with resistance training, mechanical
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loading, than giving anti -resorptive, anti -catabolic,
14:34
giving bisphosphonates. So what's your thinking
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behind that? Why do anabolic agents work better
14:41
with exercise than the bisphosphonates? These
14:46
phosphonates themselves also have advantages
14:49
from what we saw because these phosphonates were
14:53
the only pharmaceutical treatment that did not
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reduce the trabecular number from those morphometric
15:01
parameters that we investigated, meaning that
15:04
the trabecular network itself was maintained.
15:10
While in all other treatments, including the
15:12
physical loading treatment, we saw a decrease
15:16
in trabecular number, meaning that trabecular
15:19
that are lost during osteoporotic bone loss are
15:24
lost. That's a fact that also highlights that
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it's... Better to start early with the treatments.
15:32
But with bisphosphonates, this was the advantage
15:37
that we saw with bisphosphonates. Apart from
15:40
that, I think that increasing the bone formation
15:44
is the most straightforward way to increase what
15:50
we want to have, an increase in bone mass. So
15:55
thinking about the methodology of the study then.
15:57
You're using mice in this study, and it makes
15:59
logical sense that we can extrapolate the findings
16:03
to humans, but it might be worth digging down
16:04
a little bit into the detail. How old were the
16:07
mice, and what kind of human stage of life do
16:12
they represent? Yeah, mice were 15 weeks old
16:16
when they were overectomized. That corresponds
16:19
to adult patients. but they were rather young
16:24
at age so they would correspond to rather I'm
16:32
now guessing 40 50 ages years of age that's the
16:35
range so rather in a younger age that is a limitation
16:43
of the study to have it in older mice would have
16:48
been closer to what we have usually in the clinical
16:52
everyday life yeah so uh you've got 15 week old
16:56
mice then equivalent to an adult human around
16:59
about 50 years old and you remove the ovaries
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and that creates post -menopausal osteoporosis
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if you like so you mean that's a good model right
17:08
you've got a post -menopausal mouse in effect
17:11
which you can then test the effect of exercise
17:14
and the medicines on Yes, that's right, because
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we wanted to reflect as much as possible the
17:21
situation that we have in patients. And how closely
17:25
does the mechanical loading of your mice and
17:29
the mouse vertebra reflect what a human being
17:32
might do? So I was joking and saying you send
17:34
the mice to the gym, but if my patient actually
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goes to the gym and does some weight training,
17:39
resistance training, does Pilates, How can you
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be sure that the mechanical loading you're giving
17:44
the mice relates to a human who's standing upright
17:48
for a start? Yeah, that's a very good question.
17:51
And there we also need clinical studies. I'm
17:55
aware of one. a study in that german researchers
18:00
just published last year in erlangen where they
18:03
found exercise different kinds of exercises decreased
18:08
fracture risk and these are the kind of studies
18:11
that we we need and also want to rely on from
18:17
the more methodological perspective what we have
18:23
or what we apply in the preclinical model are
18:27
cyclic high loads compared to everyday walking
18:31
or so and we are inspired from tennis players
18:36
where these increased bone mass and bone strength
18:40
is observed and if you consider what the impacts
18:44
that are the on the bone of tennis players for
18:47
example then these are short very high impacts
18:51
and they are repeated and repeated that's what
18:55
And that's also the kind of exercise that we
18:57
have done in mind that would be necessary, like
19:00
hopping or like walking. in the heels that's
19:08
these cyclic patients will often say to me well
19:11
i walk a lot is that good and i will encourage
19:13
people to walk and say yeah it's good for your
19:15
muscles good for your health you know it's certainly
19:18
not bad for your bones but probably the evidence
19:20
is that you need you need a bit shorter periods
19:24
of high impact rather than just long standing
19:27
periods of lesser impact that's definitely also
19:30
a question that is of interest for me as a basic
19:34
researcher and that's why i also like these meetings
19:37
where we have the interaction also between clinical
19:40
researchers and us. And especially last year,
19:44
I also asked this question. And the response
19:49
that I got was that physical exercise, really
19:52
strength training, using the muscles and going
19:56
to the gym is actually one really... method to
20:03
see also increases in bone mass. So there's sports.
20:09
I suppose there's a message here. If you are
20:11
a young clinical scientist listening to this
20:14
podcast now and you want a good idea for a project,
20:17
I think testing the effect of exercise in your
20:20
patients who are receiving these different medicines
20:22
would be really wonderful. I always wonder, is
20:26
there any evidence that or sorry, maybe to put
20:29
it another way around, do you just build bone
20:31
uniformly or is there any evidence that you will
20:34
build bone in particular parts of the body where
20:38
the density is low or where the trabeculae are
20:41
thin? Is there any evidence that the body particularly
20:44
heals the parts that are weak? Yeah, that's a
20:47
very good question that I'd love to elaborate
20:50
on because the methodology that we used in vivo
20:55
microcomputer tomography allowed time -lapse
20:59
imaging and thus also allowed to visualize the
21:02
sites of formation and sites of resorption within
21:06
the bone. And with microfinite element analysis,
21:11
we get the... mechanical environment and the
21:18
load distribution within this trabecula compartment
21:22
and we compared exactly the sites of high strains
21:28
and highly strained trabeculae whether those
21:31
would result in formed and thickening of those
21:35
trabeculae and visually we saw indeed such a
21:38
correlation between the High strains and subsequent
21:45
bone formation. And on the other side, low strains
21:49
in a lowly loaded area or trabecular. And that
21:54
particular trabecular was then oftentimes resorbed.
21:59
So there seems really on the tissue level where
22:02
the sites act, there seems to be this relationship.
22:06
So if you have a weak piece of tissue and you
22:08
take your drug. and you mechanically load, it's
22:12
almost as if the drug then will improve that
22:14
piece of tissue which is weak that you're mechanically
22:17
loading. It's like a signal almost. Come here
22:20
and build a bone here because this is the bit
22:22
that's weak. We also think it could be like a
22:24
map indicating. Yeah, like a map, yeah, where's
22:27
weak and where's strong. It's like getting your
22:30
builder in and saying, I want you to put bricks
22:31
into that piece of the wall there because that
22:33
piece is weak. Yeah. Yeah, that's really exciting.
22:37
While I have to say that the drugs themselves
22:39
do that as well, to a certain extent. So the
22:44
drugs as well, all of them follow this principle,
22:48
which is actually... exciting i think for the
22:51
um knowing that no bone will be um built in sites
22:55
that are actually not needed or the other way
22:58
around because that's something do patients do
23:00
want to know because they see a dexa scan and
23:02
i say it's particularly weak here particularly
23:04
low there it's not bad here they'll say well
23:06
how will the drug know that does my body know
23:09
that and i think i can reassure them say yes
23:11
if you do this exercise if you take the drug
23:13
you will actually increase bone density and bone
23:16
strength in the bits of the body that you need
23:18
yes People are excited when they hear that. Yeah.
23:20
And what we see also, what my colleague Julia
23:23
Griezbach investigated, was that whether the
23:27
mechanoregulation that we have, would that be
23:31
more tightly, would the bone be more tightly
23:36
regulated by mechanical stimuli or less tightly
23:40
regulated? And there we have a difference between
23:42
the anabolic and the anti -catabolic drugs. we
23:48
know is that about 80 % of the bone mass is regulated
23:54
by or controlled by the mechanics. And then 20
23:59
% are due to Like calcium. Hormones and nutrition
24:07
and other things. I'm sorry, does that just refer
24:09
to the vertebrae or the hips or all parts of
24:11
the body? So we only have knowledge about the
24:13
vertebrae. Only about the vertebrae. That's okay.
24:15
Sorry, I interrupted. Go ahead. No, it's important.
24:19
And this portion of untargeted remodeling is
24:22
about 20%. But what we saw that this... decreases
24:27
with the anabolic drugs, especially compared
24:30
or in addition to physical treatment. That means
24:35
a larger portion of the bone is then controlled
24:40
by mechanical stimuli in response to mechanical
24:44
loading. And in bisphosphonates, this is rather
24:49
increased, this amount of untargeted remodeling.
24:52
This is what we see. We have the impression that
24:54
because... osteoclast activity is reduced, we
24:58
have the impression that osteoblastic activity
25:01
is then more free, or osteoblasts are more free
25:07
to work. So it sounds like there's potentially
25:11
several overlapping mechanisms here for the...
25:16
potentiation of the effect of the drugs by exercise
25:19
I suppose what you're saying here is that the
25:21
drugs are making the bone more receptive to exercise
25:26
whilst also increasing the amount of bone themselves
25:29
I don't know if I or we could answer this with
25:37
our data it's a theory it could well be but We
25:44
don't know yet. That's a good, that's an honest
25:46
answer from a scientist, isn't it? You don't
25:48
want to extrapolate, that's good. But I think
25:50
that's almost what we're aiming for, isn't it?
25:53
It would be lovely to show that eventually. So
25:55
what's next then? If you could wave your magic
25:57
wand and have all the money and resources, maybe
25:59
from the IFMRS, what study would you like to
26:03
do next? Very good question. We are in the end
26:08
of bringing this all together. We are missing
26:13
denosumab in our overview. Of course, that's
26:16
a drug that I won't be particularly interested
26:18
in. yeah there are so many questions because
26:23
we have this uh the sclerostin bodies antibodies
26:26
uh themselves because they express now so much
26:29
potential um yeah i would like to further investigate
26:34
that how yeah what is the mechanism behind why
26:37
why do we have this synergy so uh we want to
26:41
know the on a biological the biological mechanisms
26:45
behind so this this is triggering yeah yeah that's
26:49
really good So, yeah, bringing the project to
26:53
a finish. The paper's in pre -print. Listeners,
26:56
it's freely available online. If you want to
26:58
go and read it on BioRocks, we'll put a link
27:00
in the podcast episode for you to follow. Hopefully
27:05
soon it'll be published as well. What's next
27:07
now you're finishing this project? Yeah, a lot
27:12
of ideas then. So we are in our lab also trying
27:18
to... understand these mechanisms and we are
27:21
using also next to the animal work also in silico
27:27
very where we try to reproduce the results that
27:31
we saw in silico and because there we have access
27:36
in silico also to like the proteins, sclerostin
27:41
itself. We can model those effects and then we
27:46
can study different hypothesis that we have.
27:49
For example, why do we have the synergism in
27:52
order to gain a better understanding of what's
27:55
really happening in the bone. And in the wider
27:58
world, what's next for you? I did a bit of a
28:00
Google stalk on you. I understand you've got
28:02
a spin -out about falls prevention. That sounds
28:05
really interesting. That's right. That's another
28:06
baby of mine. So, yes, sure. I think what we
28:11
all as a community want is to reduce fractures
28:15
in the elderly population. And this is during
28:20
my time in research when I did my PhD. So I knew
28:25
there were a lot of... fall prevention approaches
28:28
around. And the principle is simple. If no fall
28:32
occurs, then probably also no fracture occurs.
28:35
We know that 90 % of the fractures in the elderly
28:39
population occur due to a severe fall. When I
28:48
was in research, there were all possibilities,
28:51
and we had access to all newest information and
28:55
international false research. So we thought there
29:00
is a lot of potential for false prevention. But
29:03
then when really speaking to the elderly population,
29:06
to elderly people, my grandfather, for example,
29:10
or my neighbor, and then we noticed that there
29:14
is not that knowledge that we think. that is
29:17
available in research really in the in the population
29:20
but there is a huge need for that people are
29:24
asking what could I do because I fear I would
29:27
fracture and many of those are also not diagnosed
29:32
with them so those that are at risk of fracture
29:37
so it but still they know it's a a situation
29:41
that could occur. And because of this need that
29:45
we felt, we initiated this, it's called Swiss
29:50
Falls Center, in order to bring this knowledge
29:56
that is available in research on a more direct
29:59
way to the people. And we did that via giving
30:03
expert lectures in senior resident homes. um
30:08
and uh and senior organizations and so do you
30:11
go around and educate in in senior senior homes
30:16
uh do you show people exercises is it a hands
30:20
-on thing or is it more educational advice how
30:22
does it work and it works on um just by uh knowledge
30:26
transfer yeah um highlighting the kind of exercise
30:30
that is in fall research uh important those are
30:34
the the three kinds of exercise strength training
30:37
of course which also helps for um to not fracture
30:41
of course and balance training in order to keep
30:43
balance and then in recent years also the um
30:47
the mental uh training brain training has been
30:51
um like highlighted or um this uh motor cognitive
30:55
training um because because reaction is also
30:58
one important factor yes steady steady straight
31:01
and strong as they say your research is fascinating
31:06
Friederike how you can go from really fundamental
31:11
science all the way through to clinical translational
31:15
science you know it's amazing that's such a wonderful
31:19
breadth and also depth of research. I'm really
31:22
impressed. Thank you for coming to talk to us
31:24
today. Thank you as well for the interview. I
31:27
really enjoyed that. Yeah, it's been really nice
31:29
to talk to you. Thank you. And I'm sure we're
31:32
going to have you back in the future again. Absolutely.
31:34
And keep sending your mice to the gym. I will.
31:40
David, I really enjoyed that interview. Fascinating.
31:43
What are your takeaways? Yeah, isn't it always
31:45
so good to hear what is very very fundamental
31:48
science research, but yet which has such a direct
31:53
application to what we do in the clinic. You
31:56
know, there's such a short pathway between Frederica's
31:59
laboratory and my clinic room, which always excites
32:02
me. I think obviously one takeaway is that exercise
32:06
is good. Exercise, you know, mechanical loading
32:09
of the mice she was looking at, it's beneficial
32:11
to their bones. We can't hear that enough. the
32:18
bones respond differently to different types
32:21
of treatment. We sort of knew that but it's interesting
32:24
to hear how if you add exercise to those different
32:27
types of treatment then the bones do respond
32:29
slightly differently. You could say, I suppose,
32:33
one of the bigger take -home messages is that
32:36
the anabolic, the bone building medication, seems
32:41
to work particularly well with exercise. Exercise
32:45
stimulates bone building, reduces bone loss,
32:49
and it seems that if you add an extra stimulant
32:51
to bone building, romosuzumab, teriparatide,
32:56
to that, then you get not just an additive effect,
33:00
not just the 20 % from exercise, 20 % from the
33:04
medication, but Frederica was saying 50%, so
33:09
you get like a synergistic effect, so I think
33:11
that's really interesting. She did point out,
33:14
of course, these things are complex, so the effects
33:17
of bisphosphonates are also positive in the bone,
33:19
but work differently. And I think it was nice
33:22
to hear her being honest when you ask some questions
33:25
and we were maybe overstepping, saying, well,
33:27
does this mean X and Y and Z? And she said, well,
33:30
I just don't have the data for that yet. And
33:32
that's always nice to hear someone. They still
33:34
got their science head on. She's just as excited
33:36
about all this as we are. But yet she's just
33:39
taking things one step at a time because we never
33:41
want to give people advice that's not. backed
33:46
up by science and backed up by evidence. So yeah,
33:49
I really enjoy talking to her and I have more
33:52
confidence to recommend exercise to patients
33:55
and particularly when they're starting some of
33:57
these new drugs. And what about you? I thought
34:04
the research project is amazing. The thing that
34:07
I most liked about it was that fundamentally
34:10
it was a really interesting question. How does
34:14
exercise affect bone when people are taking a
34:18
bone medicine? It's a really interesting and
34:22
important question. I was completely impressed
34:26
by the delivery of the research. I mean, that
34:30
is a very difficult project. Looking after mice,
34:34
loading their bones in vivo while the mice are
34:39
alive. repeatedly CT scanning the mice over time
34:43
to try and understand what's going on in the
34:46
bone. I know that analyzing CT scans is hard.
34:50
It takes a lot of time. I mean, there must have
34:54
been so much time dedicated in that project to
34:56
reconstructing the CT scans, studying the changes
34:59
in shape in bone over time. On top of that, Frederico
35:03
was also looking at the cells and looking at
35:06
how the... osteoblastic and osteoclastic activity
35:09
was changing over time so it was possible to
35:12
work out what the mechanism linking the exercise
35:16
or the medicine was to the ultimate outcomes
35:19
in bone. The outcome measures for the project,
35:23
looking at trabecular bone volume fraction was
35:25
a really important one. Obviously, the amount
35:27
of trabecular bone is really important in humans.
35:30
You know, when we collect a DEXA scan, that's
35:32
really what we're looking at. We're trying to
35:33
understand how much bone there is so we can understand
35:35
whether somebody needs a treatment. I thought
35:38
Friederike explains everything really well. Brilliantly
35:42
conceived project. amazingly well delivered and
35:47
then well explained. And it's a sort of research
35:50
that I really love. And ever since we spoke to
35:53
Friederike at ECTS 2023, I've really wanted to
35:57
get her back on the show and interview her again
36:00
to find out more about this. And I suppose the
36:02
last thing I would say is kind of reiterating
36:04
what you were talking about earlier on. Listeners,
36:07
this is just such a wonderful example of how
36:09
basic science can tell us something about...
36:14
us, you and your lives and how exercise is going
36:18
to benefit you. It's just amazing. I'm really
36:22
looking forward to seeing all this finished,
36:26
of her work finished. And I think in particular
36:28
that concept that the body almost knows which
36:32
parts of its skeleton are weakest and that's
36:35
the part of the skeleton that gets... particular
36:38
attention that's the part of the skeleton that
36:40
builds bone most when you combine exercise with
36:43
anabolic agents that's a that's amazing and i
36:45
i'm really excited to see that working its way
36:48
out as all the research is finished yeah it's
36:50
fascinating and it kind of all makes sense really
36:52
but we've got to do this research to demonstrate
36:55
the effects so that somebody like yourself can
36:59
really give good recommendations to patients
37:02
and have confidence in those recommendations
37:04
and be able to explain the scientific evidence
37:07
base that supports those recommendations. Absolutely.
37:12
Well, we'd better leave it there. Thank you for
37:15
joining us again, listeners. We hope you're having
37:16
a good day. Bye now.