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Increased risk of bone fractures for those with psychiatric disorders.
Debate over international definitions for diagnosing osteoporosis.
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IMPACT Strategic Research Centre (Barwon Health)
School of Medicine
PO Box 281
Geelong Victoria 3220
The Epi-UMMD sits within the IMPACT SRC, under the direction of Professor Julie Pasco. The major areas of research include musculoskeletal and metabolic disorders, infectious diseases, social determinants of health, the common mental disorders and the nexus between physical and mental health. The Epi-UMMD encompasses epidemiology of chronic disorders and infectious diseases, social epidemiology and psychiatric epidemiology. At the heart of the Epi-UMMD lie two prospective studies, known as the Geelong Osteoporosis Study (GOS) and the Vitamin D in Pregnancy (VIP) study, case-controls studies that utilise the GOS cohort as controls, and a comprehensive fracture grid, known as GOS-FracGrid.
The GOS is a large and ongoing population-based cohort study of men and women that was designed in the 1990s to describe the health burden of osteoporosis and identify risk factors for fragility fracture. Age-stratified samples of 1500 men and 1700 women have been recruited from electoral rolls for the Barwon Statistical Division. Detailed clinical, lifestyle and biochemical data were collected at baseline and every few years the participants attend the research centre at Barwon Health to update their health check. This prospective data collection provides an invaluable resource for health research. With time and a growing range of expertise, the scope of the GOS has broadened to study a range of chronic physical disorders, psychiatric disorders and infectious diseases.
The GOS generates credible data that describes the epidemiology of musculoskeletal disorders, specifically osteoporosis and sarcopenia, and identifies environmental and genetic risk factors for fracture. We report the impact of fracture on quality of life and independence, and investigate patterns of post-fracture treatment. This component is complemented by fracture case-control studies and the GOS-Fracture Grid (GOS-FracGrid), a comprehensive listing of all incident fractures that occur in the Barwon Statistical Division, which documents patterns of fracture according to time, age, sex, fracture site and area-based socioeconomic status. Together with collaborators, we describe the epidemiology of joint replacements in Australia and identify risk factors for osteoarthritis of the knee. GOS data is also being used to monitor the obesity epidemic and identify risk factors for coeliac disease, cardiovascular disease, diabetes and cancer.
As part of the GOS, we conduct sero-surveys that describe patterns of seropositivity for infectious diseases that circulate in the population. We conducted such a study for H1N1 influenza following the first wave of the pandemic in 2009 and are now working with collaborators to describe the pattern of seropositivity among residents of the Barwon Statistical Division for Mycobacterium Ulcerans infection. This complements an earlier case-control study we performed that investigated risk factors for transmission of M. Ulcerans infection among residents of the Bellarine Peninsula.
Dr Sharon Brennan is the Head of Social Epidemiology, a discipline that describes the social distribution and social determinants of health, together with specific psychosocial, environmental and societal factors that influence health and health service utilisation. Briefly, the social determinants of health are the "circumstances into which people are born, grow up, live, work and age, and the systems put in place to deal with illness" (World Health Organization Report, Commission for the Social Determinants of Health 2005-8), all of which are shaped by economic, social and political structures. The longitudinal study design of the GOS enables us to investigate how aspects of the area in which we live influences our health outcomes and health service utilisation, with a more recent focus investigating the interplay between social determinants and health literacy, and how best to use this knowledge to address poorer health outcomes for disadvantaged groups of the population.
Dr Lana Williams is the Head of Psychiatric Epidemiology, a discipline which seeks to study the prevalence, aetiology and outcomes associated with mental illness in society. Almost a decade ago, the GOS initiated a mental health component, designed to address the need for describing the epidemiology of the common mental health disorders in the population, to identify modifiable risk factors for depression and anxiety, and to determine the impact of these disorders on physical health and well-being. Most importantly, GOS participants undergo a structured clinical interview (SCID-I and -II) that yields information about current and past psychiatric disorders, including personality disorders. The impact of psycho-active drugs on physical health is under review in a study known as ProFrac, and these relationships are being investigated at the cellular level with collaborators. Complementing this work is a case-control study of Bipolar Disorder designed to identify lifestyles and physical comorbidity associated with bipolar disorder. Numerous opportunities exist for collaborative studies, both nationally and internationally and student projects.
This prospective study that was initiated in 2002, demonstrated that maternal serum 25-hydroxyvitamin D (25OHD) level during late gestation was associated with infant long bone length at birth. We are re-calling the mother-child pairs for assessment, as the children in this birth cohort turn 10-11 years of age. This provides a novel opportunity to investigate the relationship between gestational vitamin D levels and important indices of childhood growth, including body size, proportions and composition, adiposity, muscle mass, and bone geometry, density and estimated bone strength. We are also measuring the children's allergic response and behavioural development.
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