About this study

eraSmus medIsch ceNTrum skEletaal bReekbaarheid (SINTER) studie

Study Investigating the determinants of skeletal fragility in patients with predisposing conditions.

General Information About the SINTER Study

The SINTER Study (eraSmus medIcal ceNTer skEletal fRagility (SINTER) Studie) is led by Erasmus MC and conducted by a team of doctors, researchers, and nurses across different outpatient clinics.

The study includes both healthy individuals and patients and is divided into two phases. It aims to recruit 5,650 participants from eight outpatient clinics:

 

What is the purpose of the study?

This study compares bone strength between two groups:

  • People with genetically predicted low bone density
  • People with genetically predicted high bone density

 

Study Goals

The study aims to combine genetic data with physical and nutritional assessments to better understand what affects bone strength. By looking at both genetic and physical factors, researchers hope to discover new biological reasons why some people have stronger bones than others. This could lead to more personalized ways to prevent and treat weak bones (skeletal fragility).

Additionally, the study will explore participants’ experiences and opinions on genetic research in bone health. This will help future studies be more effective while considering participants’ needs and concerns.

What is the background of the study?

What is Bone Strength?

Bone strength refers to how strong and durable bones are. It mainly depends on:

  • Bone Density: How thick and compact bones are. Higher density usually means stronger bones with more minerals like calcium.
  • Bone Quality: The material that makes up bones, including proteins like collagen, which help maintain bone strength.

 

Why is Bone Strength Important?

Keeping bones strong is crucial for staying active and healthy as we age. Weak bones can lead to fractures, mobility issues, and even serious health problems.

Doctors use DXA scans to measure bone mineral density (BMD) and diagnose conditions like osteoporosis.

 

What Affects Bone Strength?

Bone strength varies due to several factors:

  • Genetics: Some people naturally have stronger bones.
  • Age: Bones weaken as we get older.
  • Lifestyle: Diet, exercise, and habits like smoking or drinking alcohol impact bone health.
  • Health Conditions: Certain diseases can weaken bones.

Because many factors contribute to bone strength, current medical tools may not fully predict who is at risk for fractures.

 

Using Genetics to Understand Bone Strength

While aging, lifestyle, and diseases influence bone strength, they don’t explain why some people are more prone to fractures than others. This suggests that genetics plays an important role.

Everyone’s DNA contains many small genetic variations that, when combined, can affect bone strength. By studying these variations, scientists can calculate a polygenic risk score (PRS)—a measure of genetic risk for weak or strong bones.

Researchers compare people with genetically predicted low and high BMD to understand the biological mechanisms behind bone strength. However, genetics is only one piece of the puzzle. Lifestyle factors like exercise and diet can also influence actual bone strength, sometimes overriding genetic predictions.

If neither genetics nor lifestyle fully explains someone’s bone density, researchers may look for rare genetic mutations that could be affecting bone strength in unexpected ways.

What happens during the study?

How long will the study take?
The study runs for about 18 months. First, we determine if you are suitable to participate. If so, you will be asked to give an extra tube of blood during your scheduled blood draw for your appointment. Then genetic profiles are calculated to predict whether your bones are “weak,” “average” or “strong.” If you have a profile with “weak” or “strong” bones, you will be invited to visit Erasmus MC’s ERGO (Erasmus Rotterdam Health Research) research center (location Briandplaats 15, in Ommoord, Rotterdam) to undergo measurements. If your bone strength has an “average” profile, you will not be invited for further examination and will not have to do anything further. You will not be notified about this.

Examination and Measurements
During your visit to our examination center, the following measurements will be taken:
– We will measure your height and weight.
– We take pictures of your entire skeleton with an X-ray machine and take 3D pictures of the wrist with a small CT scanner.
– We measure your bones, muscles and fat. We do this with special x-rays of the whole body, hip and back.
– We measure your bone quality with a device that pricks the bone of your lower leg with a very small needle.
– We will test your muscle function by measuring the squeezing force of your hand and the force of your leg while jumping.
– This visit will last about an hour and a half.

 

Additional Measurements
– We want to measure the level of your physical activity (exercise) and your eating habits (diet). We do this with questionnaires that you can fill out at home. This will take about 30 minutes.
– We want to measure the bacteria and other microorganisms in your stool (microbiome). To do this, you will be asked to collect some stool samples at home and send them to us.
– You may also be approached with a questionnaire about your views on genetic testing. It will take about 15 minutes to complete.

What is different from regular care?
This study does not affect your care. You will continue to receive regular care in the same way ?

SINTER-onderzoek@erasmusmc.nl

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