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Body Composition: A key in preventing fragility fractures

Addressing sarcopenia, loss of muscle, to reduce fragility fractures by monitoring body composition.

Photo of Mike DiChiappari
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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

How can seniors be encouraged to maintain healthy lifestyles? Poor nutrition and inactivity are leading factors of sarcopenia. Yet many seniors do not eat properly or get enough exercise.

Sarcopenia is the loss of muscle mass as one ages.  Up to 1% of muscle mass can be lost each year after age 50 (a).  

Osteoporosis is the loss of bone mass as one ages. 

Recent research suggests that sarcopenia and osteoporis are highly intertwined (b, c):  "Not surprising, therefore, the decrease in muscle strength leads to lower bone strength". (b)

"Dysmobility syndrome" has been suggested as a name that combines loss of muscle and bone (d, e).  The overall goal (clinically), being to identify all risk factors and conditions for fragility fractures.

Leading causes of sarcopenia include poor nutrition and sedentary lifestyle (f). Seniors can address these shortcomings by lifestyle improvements - eating better and getting exercise. 

We propose that body composition be used to monitor activity and nutrition and educate and motivate seniors to make lifestyle changes that reduce risk of future fractures.

While DXA is the gold standard for measuring bone density, it also can very accurately measure body composition.  DXA is widely being adopted as a reliable body composition tool.  DXA captures fat, lean, and bone and the distribution of those elements in the body.

FitTrace has developed an app for DXA based body composition.  The app electronically captures DXA body composition scans.  DXA produces quite a bit of numerical data, which may not be intuitive to understand. 

FitTrace presents the data in easy to understand ways. 


While FitTrace has largely focused on the fitness and athletics markets we can adapt to for applications for bone health.

FitTrace can:

1) Educate seniors regarding the causes of sarcopenia (lack of exercise and poor nutrition) and motivate them by showing them their body composition.  Here is a screenshot of chronic disease risk assessment based solely on a DXA scan (note this is based on published scientific research).  Similar tools can be added to the FitTrace app for dysmobility syndrome.  


2) Motivate and educate seniors about how changes in activity and nutrition affect their body composition over time.  Seniors can actually see their bodies (muscle mass) change and compare progress with each other within the FitTrace app.  See attached screenshot of a female on a weight loss program.  Note the loss of fat, while muscle mass is maintained.


3) Family members, caregivers, health coordinators, and clinicians can monitor the seniors' progress.  They are able to access a FitTrace user's body composition data.  FitTrace allows sharing of DXA measurements at the user’s discretion.  See screenshot of FitTrace dashboard with Share capability.

4) Most recently FitTrace integrated with Fitbit.  Seniors can observe how increased activity (as measured by Fitbit) leads to improved health and decreased risk of fragility fractures (as well as sarcopenia).  See this video on Youtube: https://www.youtube.com/watch?v=20uPQVZeJgQ&t=3s

5) Eventually, as FitTrace collects more data, the app may be able to identify users that are at high risk of future fractures, based on body composition.   FitTrace could notify the senior, caregivers, and clinicians.


REFERENCES

a) Sarcopenia Defined on Wikipedia

https://en.wikipedia.org/wiki/Sarcopenia

b) Sarcopenia and fragility fractures

Eur J Phys Rehabil Med. 2013 Feb;49(1):111-7.

https://www.ncbi.nlm.nih.gov/pubmed/23575205

c) The relationship between sarcopenia and fragility fracture-a systematic review

Osteoporos Int. 2019 Mar;30(3):541-553. doi: 10.1007/s00198-018-04828-0. Epub 2019 Jan 4.

https://www.ncbi.nlm.nih.gov/pubmed/30610245

d) What's in a name revisited: should osteoporosis and sarcopenia be considered components of "dysmobility syndrome?".

Osteoporos Int. 2013 Dec;24(12):2955-9. doi: 10.1007/s00198-013-2427-1. Epub 2013 Aug 1.

Binkley N1, Krueger D, Buehring B.

https://www.ncbi.nlm.nih.gov/pubmed/23903951

e) Prevalent fragility fractures as risk factor for skeletal muscle function deficit and dysmobility syndrome in post-menopausal women.

Aging Clin Exp Res. 2015 Oct;27 Suppl 1:S11-6. doi: 10.1007/s40520-015-0417-1. Epub 2015 Jul 24.

Iolascon G1, Moretti A2, Giamattei MT2, Migliaccio S3, Gimigliano F4.

https://www.ncbi.nlm.nih.gov/pubmed/26204997

f) Sarcopenia: What you need to know

Medical New Today; Friday, July 2017

MaryAnn de Pietro

https://www.medicalnewstoday.com/articles/318501.php




Who is your target end user and why will they be interested? (650 characters or less)

FitTrace technology could easily transfer to healthy bones applications. Here is a story regarding fitness and weight loss. A similar scenario would be adapted for healthy bones. A female user wanted to lose weight. One can track weight loss with a scale. However, DXA is much more effective, showing fat, lean, and bone. While DXA produces a printout, the information presented can be somewhat cryptic (see attached pic). FitTrace makes understanding DXA data easier to understand. In addition, FitTrace is interactive. And specific capabilities could be added that address sarcopenia. In short, this user was able to maintain a regimen where 14 lbs of total mass was lost over 4 months. Lean mass was maintained (at 96.3lbs) while fat decreased by 14 lbs. FitTrace was able to help this user understand her progress. It helped her determine if her lifestyle changes were effective. She could see changes in her body over time which also helped motivate her further

How is your idea scaleable? (650 characters or less)

DXA is widely available. There are over ten thousand DXA machines in operation in the U.S. today. Most of these are used for bone density testing and are located in hospitals, radiology departments, and imaging centers. However, working with many of these DXA operators is daunting, for a variety of reasons. 1) Many hospitals are not able to accept cash payment. DXA body composition is not reimburseable by insurance. 2) Many hospitals are reluctant to transfer imaging data directly from a DXA to FitTrace, due to privacy and security concerns. 3) Hosptials have lengthy registration processes, which act as a barrier for those wanting a DXA body composition scan. FitTrace does work with some hospitals, but largely relies on a crop of new businesess that are now offering DXA scans to consumers (see the FitTrace website for a list of DXA partners). Many of these consumer oriented businesses provide DXA scans at very reasonable costs ($50/scan). Some offer mobile DXAs.

What do/will you measure to know if your solution worked? (500 characters or less)

1) The ultimate goal would be a reducation in fracture rates. This may difficult to determine if data for comparison is not available. 2) Improvement in healthy lifestyles could easily be tracked by aggregate analysis of body composition data. Ideally, improved body composition would be observed, which is an indicator of increased activity and improved nutrition. 3) We may be able to learn about what motivates seniors by observing their use of FitTrace. Are they interested in: tracking their own progress, comparing with each other (as a motivational tool), interactions with others (family members, caregivers, clinicians, nutritionists, trainers), etc.

What is the current stage of development of your idea?

  • Prototype: We have done some small tests or experiments with prospective users to continue developing the idea.

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I want my idea piloted, and I prefer to do my own piloting in collaboration with the health system and with assistance from the Challenge partner
  • I want my idea piloted, but I’d prefer not to be involved in the pilot and prefer that the health system adopts my idea for piloting with assistance from the Challenge partner

Company / Organization Name, if applicable (140 characters or less)

FitTrace, Inc.

Website (if applicable)

Website: http://www.fittrace.com Youtube channel: https://www.youtube.com/channel/UCtL9ut48hrofvWDAu7lLpsw?view_as=subscriber NOTE: Our CURRENT STAGE is set to protoype. We have a product that is generating revenue. But have not applied it to healthy bones.

Tell us about yourself or your team (500 characters or less)

Mike DiChiappari (CEO/Co-founder) is an entreprenuer. He also runs Cardea Technology, the developer of BoneStation. BoneStation is a web-based system for interpreting DXA bone density scans. BoneStation is used at large hospitals throughout the U.S., such as MGH, Beth Israel Deaconess, Emory, Swedish Physicians, and others. Jordan Moon, PhD (Chief Scientist/Co-founder) is our resident expert in body composition. Jordan has published over 120 abstracts and publications in nutrition, exercise, and body composition. Arnold Garron, former UNH Hall of Fame athlete, NFL player, and 14 year coach of youth football, is VP of Sales. Dr. Mary Oates, is medical advisor and expert in DXA body composition.

Location (50 characters)

Los Angeles, CA USA.

What is your legal / organizational structure?

  • We are a For-Profit Startup or Startup Social Enterprise

How did you hear about the Challenge?

  • Partner Network website or social media

Why are you participating in this Challenge?

So far we have focused on the sports and fitness industries because they seem most receptive. Consumer oriented DXA providers are easy to work with too. However, we believe we can offere tremendous value in other markets too, such as fracture prevention. Hopefully, partnering with OPENIDEO will help open doors to this market as well as help us adapt our application's design to be most easily usable.

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Photo of Manisha Laroia
Team

Hi Mike DiChiappari 
Thank you for being a part of the Ideas Phase of the Healthy Bones Challenge.
It was lovely to hear from you on the Office Hours last Friday. Love the research and date you have shared, remember to connect you idea back to the challenge focus, i.e. Osteoporosis.

Please make any last minute tweaks you wish to, asap. Like adding images or changes in text.
The DEADLINE for idea submission is Wednesday July 3rd, 2019 5pm PST.

A CHECKLIST to guide you is here:
Please make sure your idea does the following:
1) Clearly define the problem
2) Connects to at least one opportunity area
3) States how & when user accesses the solution
4) Tells the story

Let me know if you need anything.
All the best for the next phase of the challenge.

Manisha
OpenIDEO Challenge Team

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