Bone Health in Patients with Urinary Stone Disease

项目摘要 这项K23计划将为Calyani Ganesan，MD，MS提供专门的时间、指导、培训和 研究经验，成为一名独立的临床调查员。Ganesan博士是一位临床医生兼科学家， 改善尿路结石患者护理质量的长期愿景。在强者的指引下 指导团队，她将获得以下方面的技能：1)药物流行病学中使用的先进统计方法 研究；2)收集和分析预期的患者数据；以及3)新的骨骼成像技术， 高分辨率外周定量计算机断层扫描(HR-pQCT)，以评估骨骼状态。 这笔赠款建议改善对尿路结石患者的筛查和管理，并 骨骼强度减弱。尽管尿路结石患者骨折的风险增加，但 目前没有关于这些患者骨质疏松症的筛查和治疗的指南。它也是 不清楚哪些药物在降低骨骼脆性和减少结石方面可能具有双重好处 这些患者的复发。该项目的目标是：1)识别患有尿路结石疾病的患者 骨质疏松或骨折的高风险；2)确定用于治疗骨质疏松症的药物对 尿石症；3)确定尿石症患者潜在的骨缺陷 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Optus数据集的全国数据。对于第三个 目的，Ganesan博士将从斯坦福大学和退伍军人中招募尿路结石患者 帕洛阿尔托医疗保健系统肾结石诊所。她将使用HR-pQCT和血清生物标志物 随着时间的推移，测量和监测这些患者的骨参数。 这项拟议的工作有可能产生重大的临床影响。成功完成后将启用 临床医生确定哪些尿路结石患者应筛查骨质疏松并告知 临床医生如何最好地治疗这些患者，以便骨折相关的并发症和复发的结石可以 减少了。拟议的工作在授权期内是现实和可行的，研究基础设施位于 斯坦福已经就位了。Ganesan博士准备在她的研究技能的基础上，推动和传播 科学知识，创建更多的协作网络，并最终竞争R01或同等产品 资金问题。总而言之，K23奖项将提供支持，使甘尼桑博士成为一名成功的 独立的临床调查员。

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.