Europe PMC Team

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[by Emma Pewsey (University of Cambridge,
UK)]{style="font-family: \"arial\";"}  
[Winner of *[Access to
Understanding](http://europepmc.org/ScienceWritingCompetition)*
2013]{style="font-family: \"arial\";"}

[X-rays can now be used not only to show where bones have fractured,
but  
also to investigate why these bones break in the first place. Results
suggest  
the possibility of preventing the trauma of thousands of broken hips
using  
drugs already commonly used for treating
osteoporosis.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

[Normal healthy bones can be thought of as nature's scaffold poles.
The  
tightly packed minerals which make up the cortical bone form a sheath
around an  
inner core of spongy bone and provide the strength which supports our
bodies.  
Throughout our lives, our skeletons are kept strong by the continuous
creation  
of new, fresh bone and the destruction of old, worn out bone.
Unfortunately, as  
we age destruction becomes faster than creation, and so the cortical
layer  
thins, causing the bone to weaken and break more easily. In severe
cases, this  
is known as osteoporosis. As a result, simple trips or falls which only
bruise  
a younger patient can cause serious fractures in the elderly. However,
half of  
elderly patients admitted to hospital with a broken hip do not suffer
from  
osteoporosis.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

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[[[Medical illustration of broken
hip]{style="font-size: xx-small;"}]{style="color: black;"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[[[Shutterstock Image ID: 158328935 Copyright: Sebastian
Kaulitzki]{style="font-size: xx-small;"}]{style="color: black;"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[So why do those hips break? This is a question of great importance,
as  
hip fractures are debilitating. Repairing one requires traumatic surgery
that,  
even if successful, may not enable a patient to regain the full mobility
they  
had beforehand. The National Osteoporosis Society estimates that 13,800
people  
in the UK die every year as a direct result of hip fractures. This is
over 10%  
of patients injured.
(http://www.nhs.uk/conditions/hip-fracture/Pages/introduction.aspx)  
Therefore, understanding how these fractures occur and acting to prevent
them  
is vital for improving the quality and length of life of our aging
population.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

[To better understand why hips fracture, researchers in Cambridge and  
Prague analysed CT scans performed on the opposite, unbroken hips of a
group of  
elderly women admitted to Bulovka University Hospital, Prague with hip  
fractures. Previous studies have shown that these tend to be in a
similar  
condition to the broken hip
pre-fracture.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

[CT scanners are now standard pieces of equipment in most hospitals,
and  
are used to examine organs and tissues inside the body. Essentially a
rotating  
X-ray machine, a CT scanner takes many X-ray snapshots at different
angles  
around a body part to produce a 3D image of its internal structure.
X-rays are  
energetic waves of energy which are partially absorbed by the materials
they  
pass through. The amount of absorption depends on the density of the
structure  
encountered -- denser structures, like bone, absorb more of the X-ray
energy,  
leaving less energy to be measured by the detector on the other side.
However,  
the resolution of the images collected by a standard hospital CT scanner
is not  
sensitive enough to accurately determine the thickness of the cortical
bone.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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loading="lazy" border="0" height="266"
width="400"}](http://2.bp.blogspot.com/-PY61EMtF9eU/Umzt7PHWv7I/AAAAAAAAAKY/iziEM54gIr4/s1600/shutterstock_150772538.jpg){style="margin-left: 1em; margin-right: 1em;"}
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[CT
scanner]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif; font-size: xx-small;"}
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[[Shutterstock Image ID: 150772538 Copyright:
sfam_photo]{style="font-size: xx-small;"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[A new image processing technique has changed that. Using it, the  
researchers in Prague and Cambridge were able to extract information
from  
clinical CT scans that was sensitive enough to produce coloured maps on
the  
surface of a model hip showing the variation of cortical bone thickness
in more  
detail than ever. Variations in thickness of only 30 microns -- the size
of a  
grain of dust -- could be
detected.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

[The results were striking. Not only did the women with fractured hips  
have generally thinner cortical bone than normal, but some patients also
had  
local patches of even thinner bone. This was the case even in women who
did not  
suffer from osteoporosis. Most importantly, the extra-thin regions were
found  
on the femoral neck -- the part of the hip bone where fractures most
commonly  
occur. In some patients, these patches were 30% thinner than the
surrounding  
bone, and as big as a thumbnail. These weaker points provide the ideal
conditions  
for a crack to form and subsequently grow into a fracture. Further
studies are  
needed to confirm whether these localised regions do act as the starting
point  
for a fracture, but at the very least they affect the type, and hence
severity,  
of fracture which occurs. They could also explain the mystery of
spontaneous  
hip fracture, which accounts for 6% of hip fractures -- 4000 broken hips
a year  
in the UK, which break for no known
reason.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

[The research team have named these local patches of thinner bone
'focal  
osteoporosis'. However, despite the name it is not yet known if these
areas can  
be strengthened using standard osteoporosis drugs, which slow down the
natural  
destruction of bone cells. An extensive clinical trial will be needed
to  
investigate further, but if the focal patches do respond to treatment it
raises  
the tantalising possibility of a future where many fractures could be
treated  
before they even form. The improvement this would have on our quality of
life  
in our old age would be invaluable.
[]{style="mso-bidi-font-family: Calibri;"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
:::

  
[]{style="font-family: \"arial\";"}  
[*This entry[[[[
]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\"; mso-fareast-language: EN-GB; mso-hansi-font-family: Calibri;"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\"; mso-fareast-language: EN-GB; mso-hansi-font-family: Calibri;"}*]{style="font-family: \"arial\";"}

describes research published in the following article, selected by
Arthritis Research UK:

[[Cortical thickness mapping to identify focal osteoporosis in patients
with hip
fracture]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}](http://europepmc.org/articles/PMC3372523)  
[PMCID:
PMC3372523]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

::: {style="line-height: normal; margin: 0cm 0cm 0pt;"}
[Kenneth E. S. Poole, Graham M. Treece, Paul M. Mayhew, Jan Vaculík,  
Pavel Dungl, Martin Horák, Jan J. Štěpán, and Andrew H.
Gee]{style="font-size: x-small;"}

  

*[PLoS One
]{style="mso-bidi-font-family: Arial;"}*[(]{style="mso-bidi-font-family: Arial;"}[2012)
]{style="mso-bidi-font-family: Arial;"}**[7]{style="mso-bidi-font-family: Arial;"}****[(6)]{style="mso-bidi-font-family: Arial;"}****[,]{style="mso-bidi-font-family: Arial;"}**[
e38466]{style="mso-bidi-font-family: Arial;"}
:::

[]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}  
[*[Access to
Understanding](http://europepmc.org/ScienceWritingCompetition)* entrants
are asked to write a plain English summary of a research article. For
*Access to Understanding 2013* there were 9 articles to choose from,
selected by the [Europe PMC
funders](http://europepmc.org/Funders/).]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}  
[]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}  
**[The articles are all available from Europe PMC, are free to read and
download, and were supported by one or more of the Europe PMC
funders.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}**  
[]{style="font-family: \"arial\";"}  
[]{style="font-family: \"arial\";"}  
[Look out here and on Twitter
]{style="font-family: \"arial\";"}[[@EuropePMC_news]{style="font-family: \"arial\";"}](https://twitter.com/EuropePMC_news)[
for announcements about the
competition.]{style="font-family: \"arial\";"}
:::


[by Emma Pewsey (University of Cambridge, UK)]{style=“font-family: "arial";”} [Winner of
<em>
 Access to Understanding
</em>
2013]{style=“font-family: "arial";”}  [X-rays can now be used not only to show where bones have fractured, but also to investigate why these bones break in the first place.

Hip, Hip, Hooray!

::: {dir="ltr" style="text-align: left;"}
[By
]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}[Emma
Pewsey,  
Department of Materials Science, University of
Cambridge.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}

  

::: {style="margin: 0cm 0cm 10pt;"}
[I'm a relative newcomer to biosciences -- at school, physics  
and chemistry were more my thing. However, starting a PhD on the
corrosion of  
metal implants in the human body meant I needed to brush up on my
biology. It  
was time to hit the medical
journals.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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::: {style="margin: 0cm 0cm 10pt;"}
[It was easy enough to find papers. However, it was much  
harder to determine whether they were relevant. Abstracts seemed to
compete  
with each other in squeezing the most technical terms into one sentence.
I was  
lucky -- I had plenty of time to go and learn what they meant. Most
people  
don't.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[Once I'd broken through the jargon, I found many of the  
papers really interesting. I like interesting facts, and the majority of
research  
papers are full of them. Therefore, it's a shame that they're so
inaccessible  
to most people.
]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[So I love the idea behind the *Access to Understanding*  
competition. I was surprised to learn at the awards ceremony how many  
non-scientists nowadays need to access research papers -- from patient
groups to  
teachers. My own participation in science outreach events has also shown
me how  
much general interest there is in science. And making research more
accessible  
should be a priority for all researchers -- after all, who wouldn't
prefer their  
work to be read by thousands of people, rather than just a
couple?]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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::: {style="margin: 0cm 0cm 10pt;"}
[The competition also gave me an excuse to try some science  
writing -- something I'd been meaning to do for ages.
]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[Looking down the list of articles to choose from, I saw one  
I had to write about. [Cortical thickness mapping to identify  
focal osteoporosis in patients with hip fracture? Yes
please.]{style="mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\";"}]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}
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[[[You see, I have a guilty not-so-secret.  
I love bones. They are the most fantastic objects in the universe. In  
particular, I love how they adapt to the forces which we place on them
in our  
everyday lives to create a framework that supports our bodies that tries
to be  
exactly as strong as it needs
to]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="font-family: \"calibri\";"}[
be. But sometimes this goes wrong, and bones  
break. Thanks to the *Access to Understanding* competition, I got to
read a  
fascinating piece of research that investigated why this happens in
hips. If I  
hadn't entered the competition, I wouldn't have read it. I wouldn't even
have  
known it
existed.]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\";"}
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[[When I sent off my entry, I didn't  
expect I'd hear anything back about it. I was just happy that I had a
new set  
of interesting facts about hips to share with anyone looking for an
interesting  
fact. I am delighted that winning has brought attention on the work done
by Dr  
Poole's group at Cambridge, and the range of work funded by Arthritis
Research  
UK. And of course, I'm thrilled with the trophy that now sits in my
living  
room!]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\";"}
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[[My next writing challenge is completely  
different: a 60,000 word PhD thesis. I'll make sure to include a lay
summary!]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\";"}
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[[]{style="font-family: \"helvetica neue\" , \"arial\" , \"helvetica\" , sans-serif;"}]{style="mso-bidi-font-family: \"Times New Roman\"; mso-fareast-font-family: \"Times New Roman\";"}

Note: Emma recently won the 2013 [Access to
Understanding](http://www.access2understanding.org/competition/)
science-writing competition for her entry 'Hip, hip, hooray!' explaining
[research that investigated the causes of hip fracture in the
elderly](http://europepmc.org/articles/PMC3372523).
:::
:::


[By ]{style=“font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;”}[Emma Pewsey, Department of Materials Science, University of Cambridge.]{style=“font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;”}  [I’m a relative newcomer to biosciences – at school, physics and chemistry were more my thing. However, starting a PhD on the corrosion of metal implants in the human body meant I needed to brush up on my biology.

Messaggi di Rogue Scholar

Hip, Hip, Hooray!

Why I entered the Access to Understanding competition