Medical doctors and physicists get to the bottom of bones and joints

Maintaining functional capacity in old age is largely dependent on musculoskeletal health, and this is something the University of Eastern Finland and Kuopio University Hospital are working hard to promote. Scholars of medicine and applied physics are collaborating to find new solutions for the prevention, diagnostics and treatment of osteoporosis and osteoarthritis.

As a result of this long-term collaboration, musculoskeletal disorders now constitute one of the university’s strategic focus areas in research.  The research area is led by Professor Heikki Kröger from the Institute of Clinical Medicine (Surgery/Orthopaedics), and by Professor Rami Korhonen from the Department of Applied Physics.

According to Kröger, a recent example of the dialogue between medical doctors and physicists is the development of a smart arthroscope for joint endoscopy. 

“The need to obtain more information from an arthroscopy to support diagnostics and treatment decisions arose from clinical work.”

In traditional arthroscopy, the condition of a joint is assessed by looking and feeling it. Now, however, physicists have developed a fiber optics device that uses infrared spectroscopy to accurately assess and diagnose cartilage tissue characteristics during an arthroscopy. 

“This information can directly influence the decisions made in surgery.”

The device is now further developed in the MIRACLE project, which secured funding from the EU’s Horizon2020 programme.

The outcome of earlier collaboration between UEF’s medical doctors and physicists is already commercially available on the markets: Bindex, the pocket-sized ultrasound device for the screening and diagnostics of osteoporosis.

“The device seems to be well suited for primary health care, which is where osteoporosis diagnostics should increasingly be focused on.”

SMS surveys collect recent data on elderly people’s falls

Kröger leads the Kuopio Osteoporosis Risk Factor and Prevention Study, OSTPRE, which has been monitoring the health of more than 14,000 women since 1989, at which time the participants had just reached their menopause. This extensive, population-based study has provided diverse insight into the risk and protective factors of bone and muscle loss, as well as fractures. With support from, e.g., the Academy of Finland, state research funding, the Ministry of Education and Culture, and the Juho Vainio Foundation, the study has taken an increasingly broad approach to factors contributing to physical, mental and social health, as well as mortality in the recent years.

Currently ongoing, the Kuopio Fall Prevention Study investigates whether it is possible to prevent falls among elderly women and to enhance their quality of life with the help of an exercise intervention. Every week, half of the intervention participants are offered guided gym training and taiji sessions, and more than 900 women from the OSTPRE study are participating.

“They have conscientiously responded to our SMS survey about possible falls every two weeks. This leads to the accumulation of very reliable data almost in real time. We are expecting to report our results in spring 2019,” Kröger says.

“We are also studying healthy ageing, that is, what kinds of factors contribute to well-being and good functional capacity in senior years. For example, research has shown that people with the high dietary protein intake will maintain their muscle mass and functional capacity longer.”

Heikki Kröger has been monitoring the bone health, and lately health in general, of women from menopause to old age. “This has led to collaboration with neurology researchers, among others.” 

Within the research area, the university’s strategic funding is targeted at register research, which is led by Professor Reijo Sund. Over the course of nearly 30 years, masses of data have been collected from the OSTPRE study participants through various surveys and measurements. By combining these data sets with Finland’s nationwide health care registers, researchers can also get new information about factors that are common in different diseases.

“For instance, the risk of hip fracture is increased in people with diabetes, although diabetes isn’t always associated with osteoporosis.”

Kröger points out that bone research is a broad field of study.

“It also includes several clinical trials in Kuopio University Hospital’s Orthopaedics Clinic. At the moment, for example, we are comparing the benefits of hip replacement surgery and rehabilitation.”

Histomorphometric analyses, which give information about bone metabolism, are a particular strength of the Kuopio Campus. Similar analyses for humans aren’t performed in very many places even globally. 

“For example, renal failure has an impact on bones as well, and renal transplantation isn’t always enough to normalise bone metabolism. A bone histomorphometric analysis will set the course for post-transplantation treatment. Soon, we will be able to update this analytics, thanks to infrastructure funding granted by the Faculty of Health Sciences.”

Individual prognosis helps in the planning of personalised treatment

Korhonen points out that we actually know very little about the pathogenesis and development of osteoarthritis. Research in this field is characterised by multidisciplinary collaboration, and input is needed not only from medical doctors and physicists, but also from engineers and biologists, for example.

With a better understanding of the mechanisms and biological factors contributing to the disease, it will be possible to develop better methods to predict the individual progression of the disease, and to plan personalised treatments.

“Osteoarthritis has different phenotypes, and these develop differently in different people. This is why it is important to find personalised treatment options for each patient,” Korhonen says.

“Imaging and modelling methods are constantly evolving, and research is used to develop diagnostic methods that hopefully will also have an effect on the cost-effectiveness of treatment decisions. A conservative approach may often be the best course of action,” Korhonen says.

Researchers working at the new Motion Analysis Laboratory of the Department of Applied Physics have already performed clinical studies and developed models to predict the progression of osteoarthritis in overweight people and those after weight loss. A number of clinicians, radiologists, physiatrists and orthopaedists have participated in the design and development of the studies, as well as in the collection of data and interpretation of the results. Indeed, this is a typical setting in most major projects.

“In the future, we can develop better methods to predict the individual progression of the disease, and to plan personalised treatments,” Rami Korhonen says.

“We do plenty of basic research, and an essential part of that work is to collect research material of human origin. We also utilise previously collected large data sets to develop new computational methods for predicting the progression of osteoarthritis. Currently, we are running a European Research Council project that investigates the business potential of this kind of analytics, and we are in the process of developing a software for the purpose,” Korhonen says.

In the future, the processes of diagnosis, imaging, segmentation (that is, the selection of different tissues) and modelling can be automated and made faster. Moreover, artificial intelligence can be used in osteoarthritis assessment.

“Artificial intelligence isn’t capable of assessing the future loading of a joint yet, but once it can, we may no longer need medical doctors,” Korhonen laughs.

Text: Ulla Kaltiala & Marianne Mustonen
Photos: Raija Törrönen

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