DiMeN Doctoral Training Partnership: Obesity, falls and fractures; determining the mechanism(s) and potential reversibility of falls risk by diet and physical activity.

Fragility fracture and obesity are huge and growing public health problems. One in two women and one in five men over age 50 will have an osteoporotic fracture and one in four adults in England is obese.

While evidence suggests that obesity is generally protective against fractures of proximal femur and vertebral bodies, compared to adults with a normal body mass index (BMI), the overall fracture burden in obesity is similar; 23% of all fractures in postmenopausal women occur in obese women. This reflects an increase in fracture risk at other skeletal sites in obesity, particularly in the proximal humerus, upper leg, and ankle. We have recently demonstrated higher bone mass and stronger bone microarchitecture in obese men and women, suggesting that fracture risk in obesity is not due to physical properties of bone, but possibly differences in falls risk and/or the reaction to falls.

In this PhD project, we will assess the fall characteristics, gait, muscle strength and power, reaction times and stability of obese older men and women with and without a history of recent fall (within the last 6-12 months). Those with falls will also be sub-divided into those with and without injurious falls (falls associated with fracture or other sequelae requiring medical attention). The measures will be compared also to a group of normal BMI subjects, again divided into those with and without a history of recent falls (injurious and non-injurious). The study will allow a better understanding of the factors contributing to falls risk in obesity compared to subjects with normal BMI as well as the development of interventional pathways to reduce the reversible aspects of falls risk in obesity.

The assessments will comprise currently used standard measures of muscle mass and function (e.g. appendicular lean mass by dual x-ray absorptiometry (DXA), grip strength, gait speed), combined with state-of the-art objective quantitative assessment of gait and balance control with wearable inertial sensors during standard clinical assessment protocols (e.g. 6-minutes walking and Timed Up and Go). Data collected by these techniques will be analysed to determine if quantitative assessment provides better characterisation of falls risk than simple observation and timing. All subjecst will also undergo assessments of skeletal strength and structure (DXA, HR-pQCT) to see if there are differences between those with and without fracture. Subjects will be recruited through established databases of clinical study volunteers, attendees at falls and fracture clinics as well as through approaches to GPs and primary care lists.

In addition to the cross-sectional studies described above, obese individuals with a history of falls will be randomised to a study of diet alone vs. diet and exercise to determine the impact of both approaches on the measures associated with falls risk.

The information from this study will be used to develop studies of interventions to reduce falls and fracture risk in older obese men and women.
This interdisciplinary project will represent a unique opportunity for the candidate to work in collaboration with researchers at both the Faculty of Medicine, under the supervision of the clinical experts, Prof Eugene McCloskey and Dr Jennifer Walsh, and at the Faculty of Engineering, under the supervision of the movement analysis expert, Claudia Mazzà. In addition, the project will be carried out under the umbrella of CIMA (Centre for Integrated research on Musculoskeletal Ageing) and of INSIGNEO (Institute for in silico medicine) with the opportunity for collaborations that these institutions bring.

Funding notes:
DiMeN (Discovery Medicine North) DTP studentships are funded for 3.5 years and include the following annual package of financial support over the duration of the studentship:
•A tax-free maintenance grant set at the UK Research Council's national postgraduate rate
•Full payment of tuition fees at the Home/EU rate
•A research training support grant (RTSG) to support your research studies (managed through the host institution)
•Opportunity to apply to our Flexible Fund to enable you to attend training workshops and visit research groups to advance your skills training.

Successful Home students will receive a full studentship. EU students will be considered for a full studentship or just fee support depending on the excellence of their qualifications and their employment/residency status (http://www.mrc.ac.uk/skills-careers/studentships/studentship-guidance/student-eligibility-requirements/). Overseas students are not eligible to apply.

Entry requirements:
You should be someone with an outstanding academic track record and can demonstrate your potential for the research project of your choice.
You must hold (or be expected to hold by October 2016) a First or a good 2:1 UK undergraduate degree, a suitable qualification at Masters level or an equivalent degree from a recognised EU institution, in the biosciences or a related area. The multidisciplinary training experience and interdisciplinary nature of some of our projects means that we welcome applications from students with physical science and/or mathematical backgrounds who are interested in using their skills to address the challenges of 21st century bioscience research.

How to apply:
Please carefully read the instructions on how to apply at our website and use the link on the page to apply: http://www.dimen.org.uk/how-to-apply/application-overview