Bone Health in Patients with Urinary Stone Disease

项目摘要 这个K23提案将为Calyani Ganesan，MD，MS提供专门的时间，指导，培训， 研究经验，成为一名独立的临床研究者。Ganesan博士是一位临床科学家， 提高泌尿系结石患者护理质量的长远愿景。在一个强大的指导下， 导师团队，她将获得以下技能：1）药物流行病学中使用的高级统计方法 研究; 2）前瞻性患者数据的收集和分析;以及3）新的骨成像技术， 高分辨率外周定量计算机断层扫描（HR-pQCT），以评估骨骼状态。 该补助金旨在改善泌尿系结石患者的筛查和管理， 骨强度下降。尽管泌尿系结石患者骨折的风险增加， 目前没有关于这些患者骨质疏松症的筛查和治疗的指南。也是 尚不清楚哪些药物可能在降低骨骼脆弱性和减少结石方面提供双重益处 在这些患者中复发。该项目旨在：1）识别患有泌尿系结石疾病的患者， 骨质疏松症或骨折的高风险; 2）确定用于治疗骨质疏松症的药物对 泌尿系结石病;和3）确定潜在的骨缺损的泌尿系结石病患者使用 HR-pQCT和反映骨形成和吸收的骨生物标志物。前两个目标将得到回应 通过分析来自退伍军人健康管理局（VHA）和Optum数据集的国家数据。第三 Ganesan博士的目标是从斯坦福大学和退伍军人中招募泌尿系统结石患者 事务帕洛阿尔托卫生保健系统肾结石诊所。她将使用HR-pQCT和血清生物标志物， 测量和监测这些患者随时间推移的骨参数。 拟议的工作有可能产生重大的临床影响。成功完成将使 临床医生，以确定哪些患者泌尿系结石病应筛查骨质疏松症，并告知 临床医生如何最好地治疗这些患者，使骨折相关的合并症和复发性结石， 降低建议的工作在奖励期内是现实可行的，研究基础设施在 斯坦福大学已经就位。Ganesan博士准备以她的研究技能为基础， 科学知识，创建额外的合作网络，并最终竞争R 01或同等产品 经费总之，K23奖将提供支持，使Ganesan博士成为一个成功的 独立临床研究者。

Project Summary This K23 proposal will provide Calyani Ganesan, MD, MS with dedicated time, mentorship, training, and research experience to become an independent clinical investigator. Dr. Ganesan is a clinician-scientist with a long-term vision of improving the quality of care for patients with urinary stones. Under the guidance of a strong mentorship team, she will acquire skills in: 1) advanced statistical methods used in pharmacoepidemiology studies; 2) the collection and analysis of prospective patient data; and 3) a novel bone imaging technique, high-resolution peripheral quantitative computed tomography (HR-pQCT), to assess skeletal status. This grant proposes to improve the screening and management of patients with urinary stone disease and diminished bone strength. Despite an increased risk of fracture in patients with urinary stone disease, there are currently no guidelines regarding the screening and treatment of osteoporosis in these patients. It is also unclear which medications might provide dual benefit in decreasing skeletal fragility and reducing stone recurrence in these patients. This project aims to: 1) identify patients with urinary stone disease who are at high risk for osteoporosis or fracture; 2) determine the effects of medications used to treat osteoporosis on urinary stone disease; and 3) identify the underlying bone deficits in patients with urinary stone disease using HR-pQCT and bone biomarkers reflecting bone formation and resorption. The first two aims will be answered by analyzing national data from the Veterans Health Administration (VHA) and Optum datasets. For the third aim, Dr. Ganesan will recruit patients with urinary stone disease from the Stanford University and Veterans Affairs Palo Alto Health Care System Kidney Stone clinics. She will use HR-pQCT and serum biomarkers to measure and monitor bone parameters over time in these patients. The proposed work has potential to make a significant clinical impact. Successful completion will enable clinicians to identify which patients with urinary stone disease should be screened osteoporosis and inform clinicians how best to treat these patients so that fracture associated comorbidity and recurrent stones can be reduced. The proposed work is realistic and feasible within the award period, and the research infrastructure at Stanford is already in place. Dr. Ganesan is poised to build on her research skills, advance and disseminate scientific knowledge, create additional collaborative networks, and eventually compete for R01 or equivalent funding. In summary, the K23 award will provide the support to enable Dr. Ganesan to become a successful independent clinical investigator.