C Cooper

The Scripps Research Institute, La Jolla, CA, United States

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Publications (601)2906.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary There is scarce data on the association between early stages of type 2 diabetes and fracture risk. We report a 20 % excess risk of hip fracture in the first years following disease onset compared to matched non-diabetic patients. Introduction Type 2 diabetes mellitus (T2DM) is a chronic disease that affects several target organs. Data on the association between T2DM and osteoporotic fractures is controversial. We estimated risk of hip fracture in newly diagnosed T2DM patients, compared to matched non-diabetic peers. Methods We conducted a population-based parallel cohort study using data from the Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP) database. Participants were all newly diagnosed T2DM patients registered in SIDIAP in 2006–2011 (T2DM cohort). Up to two diabetes-free controls were matched to each T2DM participant on age, gender, and primary care practice. Main outcome was incident hip fracture in 2006–2011, ascertained using the tenth edition of the International Classification of Diseases (ICD-10) codes. We used Fine and Gray survival modelling to estimate risk of hip fracture according to T2DM status, accounting for competing risk of death. Multivariate models were adjusted for body mass index, previous fracture, and use of oral corticosteroids. Results During the study period (median follow-up 2.63 years), 444/58,483 diabetic patients sustained a hip fracture (incidence rate 2.7/1,000 person-years) compared to 776/113,448 matched controls (2.4/1,000). This is equivalent to an unadjusted (age- and gender-matched) subhazard ratio (SHR) 1.11 [0.99–1.24], and adjusted SHR 1.20 [1.06–1.35]. The adjusted SHR for major osteoporotic and any osteoporotic fractures were 0.95 [0.89–1.01] and 0.97 [0.92–1.02]. Conclusions Newly diagnosed T2DM patients are at a 20 % increased risk of hip fracture even in early stages of disease, but no for all fractures. More data is needed on the causes for an increased fracture risk in T2DM patients as well as on the predictors of osteoporotic fractures among these patients.
    Osteoporosis International 12/2014; · 4.04 Impact Factor
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    ABSTRACT: Dear Editor,We thank Dr Sugiyama and colleagues for their comments [1] on our recent review on the role of vitamin D status in bone health during growth [2], and read with great interest their hypothesis relating to potential mechanisms.As Sugiyama et al. suggest, there are complex relationships among bone mineral density (BMD), bone size, bone strength and fracture risk in children. Indeed, physical activity has been positively associated with both measures of bone size and density in children [3, 4], yet is also associated with increased fracture risk in childhood [5]. The mechanostat theory recognises that muscular strains stimulate bone modelling and mineralisation [6]; however, more active children are also likely to have greater exposure to potential fracture-causing events. It is possible that a similar explanation also confounds associations between childhood vitamin D status and fracture occurrence: children following sedentary indoor lifestyles are more likely to have lower s ...
    Osteoporosis International 12/2014; · 4.04 Impact Factor
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    ABSTRACT: The worldwide uptake of FRAX is described. The aim of this report was to determine the usage of FRAX worldwide over a 1-year period from 1 May 2012. The number of FRAX calculations from each country was assessed over a 1-year period and expressed as calculations per million of the population aged 50 years or more. Countries were colour coded according to usage to populate a world map. Over the index year, there were estimated to be 2,391,639 calculations sourced from 173 counties. Uptake was high in North America, the Antipodes and most countries of Europe; intermediate in Latin America and the Middle East; and very low in Africa and much of South East Asia. It is expected that the comparative data will encourage the development of new FRAX models and the uptake of FRAX into assessment guidelines.
    Archives of Osteoporosis 12/2014; 9(1):166.
  • A Litwic, C Cooper, E Dennison
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    ABSTRACT: Osteoporosis is a systemic disorder characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. It has a significant impact on public health through the increased morbidity, mortality, and economic costs associated with fractures. Despite the severe medical and socioeconomic consequences of fragility fractures, relatively few adults with fractures are evaluated and/or treated for osteoporosis. In this review, we summarize the existing treatment options and promising new therapies for the prevention and treatment of osteoporosis.
    Panminerva medica 12/2014; 56(4):273-83. · 2.28 Impact Factor
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    ABSTRACT: This paper provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral anti-resorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1-15%) where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include anti-resorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including anti-angiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of anti-resorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding anti-resorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, as well as the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced non-responsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 11/2014; · 6.04 Impact Factor
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    ABSTRACT: We previously reported an association between high bone mass (HBM) and a bone-forming phenotype of radiographic hip osteoarthritis (OA). As knee and hip OA have distinct risk factors, in this study we aimed to determine (i) whether HBM is also associated with knee OA, and (ii) whether the HBM knee OA phenotype demonstrates a similar pattern of radiographic features to that observed at the hip.HBM cases (defined by DXA BMD Z-scores) from the UK-based HBM study were compared with unaffected family controls and general population controls from the Chingford and Hertfordshire cohort studies. A single blinded observer graded AP weight-bearing knee radiographs for features of OA (Kellgren–Lawrence score, osteophytes, joint space narrowing (JSN), sclerosis) using an atlas. Analyses used logistic regression, adjusting a priori for age and gender, and additionally for BMI as a potential mediator of the HBM–OA association, using Stata v12.609 HBM knees in 311 cases (mean age 60.8 years, 74% female) and 1937 control knees in 991 controls (63.4 years, 81% female) were analysed. The prevalence of radiographic knee OA, defined as Kellgren–Lawrence grade ≥ 2, was increased in cases (31.5% vs. 20.9%), with age and gender adjusted OR [95% CI] 2.38 [1.81, 3.14], p < 0.001. The association between HBM and osteophytosis was stronger than that for JSN, both before and after adjustment for BMI which attenuated the ORs for knee OA and osteophytes in cases vs. controls by approximately 50%.Our findings support a positive association between HBM and knee OA. This association was strongest for osteophytes, suggesting HBM confers a general predisposition to a subtype of OA characterised by increased bone formation.
    Bone 10/2014; · 4.46 Impact Factor
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    ABSTRACT: Information on the epidemiology of rheumatoid arthritis (RA) in Southern Europe is scarce. We estimated the age- and gender-adjusted incidence and prevalence of RA in Catalonia using routinely collected primary care records. We identified incident (2009-2012) and prevalent (on 31 December 2012) cases of RA in the SIDIAP database using ICD-10 codes. SIDIAP contains anonymized data from computerized primary care records for about five million adults (>80 % of the population). We estimated age- (5-year groups) and gender-specific, and directly standardized incidence and prevalence of RA and confidence intervals (95% CIs) assuming a Poisson distribution. A total of 20,091 prevalent (among whom 5,796 incident) cases of RA were identified among 4,796,498 study participants observed for up to 4 years. Rates of RA increased with age in both genders, peaking at the age of 65-70 years. Age- and gender-standardized incidence and prevalence rates were 0.20/1,000 person-years (95% CI 0.19-0.20) and 4.17/1,000 (4.11-4.23) respectively. Rheumatoid factor was positive (≥10 IU/mL) in 1,833 (73.9 %) of 2,482 cases tested in primary care. The incidence and prevalence of RA in Catalonia are similar to those of other Southern European regions, and lower than those of northern areas. This data will inform health care planning and resource allocation.
    Clinical rheumatology. 10/2014;
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    ABSTRACT: Ankylosing spondylitis (AS) leads to osteopenia/osteoporosis and spine rigidity. We conducted a case-control study and found that AS-affected patients have a 5-fold and 50 % increased risk of clinical spine and all clinical fractures, respectively. Excess risk of both is highest in the first years and warrants an early bone health assessment after diagnosis.
    10/2014;
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    ABSTRACT: Reference Point Indentation (RPI) is a novel microindentation tool that has emerging clinical potential for the assessment of fracture risk as well as use as a laboratory tool for straight-forward mechanical characterisation of bone. Despite increasing use of the tool, little research is available to advise the set-up of testing protocols or optimisation of testing parameters. Here we consider five such parameters: maximum load, sample orientation, mode of use, sample preparation and measurement spacing, to investigate how they affect the Indentation Distance Increase (IDI), the most published measurement parameter associated with the RPI device. The RPI tool was applied to bovine bone; indenting in the proximal midshaft of five femora and human bone; indenting five femoral heads and five femoral neck samples. Based on the findings of these studies we recommend the following as the best practice. (1) Repeat measurements should be utilised to reduce the coefficient of variation (e.g. 8-15 repeats to achieve a 5-10% error, however the 3-5 measurements used here gives a 15-20% error). (2) IDI is dependent on maximum load (r=0.45 on the periosteal surface and r=0.94 on the machined surface, p<0.05), mode of use (i.e. comparing the device held freehand compared to fixed in its stand, p=0.04) and surface preparation (p=0.004) so these should be kept consistent throughout testing. Though sample orientation appears to have minimal influence on IDI (p>0.05), care should also be taken in combining measurements from different orientations. (3) The coefficient of variation is higher (p=0.04) when holding the device freehand, so it should ideally be kept supported in its stand. (4) Removing the periosteum (p=0.04) and machining the surface of the bone (p=0.08) reduces the coefficient of variation, so should be performed where practical. (5) There is a hyperbolic relationship between thickness and IDI (p<0.001) with a sample thickness 10 fold greater than the maximum indentation depth recommended, to ensure a representative measurement. (6) Measurement spacing does not appear to influence the IDI (p>0.05), so it can be as low as 500µm. By following these recommendations, RPI users can minimise the potential confounding effects associated with the variables investigated here and reduce the coefficient of variation, hence achieving more consistent testing. This optimisation of the technique enhances both the clinical and laboratory potential of the tool. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Journal of the Mechanical Behavior of Biomedical Materials 10/2014; · 2.37 Impact Factor
  • 09/2014;
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    ABSTRACT: Investigators have suggested a link between birth weight and both hand and lumbar spine osteoarthritis (OA). In this study, we sought to extend these observations by investigating relationships between growth in early life, and clinical and radiological diagnoses of OA at the hand, knee and hip, among participants from the Hertfordshire Cohort Study. Data were available for 222 men and 222 women. Clinical OA was defined based on American College of Rheumatology criteria. Radiographs were taken of the knees and hips, and graded for the presence of osteophytes and overall Kellgren and Lawrence (KL) score. Lower weight at year one was associated with higher rates of clinical hand OA (OR 1.396, 95% CI 1.05, 1.85, P=0.021). Individuals with lower birth weights were more likely to have hip osteophytes (OR 1.512, 95% CI 1.14, 2.00, P=0.004) and this remained robust after adjustment for confounders. Furthermore, a low weight at one year was also associated with a higher osteophyte number in the lateral compartment of the knee, after adjustment for confounders (OR 1.388, 95% CI 1.01, 1.91, P=0.043). We have found further evidence of a relationship between early life factors and adult OA. These findings accord with previous studies.
    Journal of Developmental Origins of Health and Disease 08/2014; · 1.21 Impact Factor
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    ABSTRACT: During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed, rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review, we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however, there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High-quality randomised trials are now required to confirm this benefit.
    08/2014;
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    ABSTRACT: FTO is the strongest known genetic susceptibility locus for obesity. Experimental studies in animals suggest the potential roles of FTO in regulating food intake. The interactive relation among FTO variants, dietary intake, and body mass index (BMI) are complex and results from previous often small-scale studies in humans are highly inconsistent. We performed large-scale analyses based on data from 177,330 adults (154,439 whites, 5,776 African Americans, and 17,115 Asians) from 40 studies to examine: 1) the association between the FTO-rs9939609 variant (or a proxy SNP) and total energy and macronutrient intake; and 2) the interaction between the FTO variant and dietary intake on BMI. The minor allele (A-allele) of the FTO-rs9939609 variant was associated with higher BMI in whites (effect per allele =0.34 [0.31, 0.37] kg/m(2), P=1.9×10(-105)), and all participants (0.30 [0.30, 0.35] kg/m(2), P=3.6×10(-107)). The BMI-increasing allele of the FTO variant showed a significant association with higher dietary protein intake (effect per allele =0.08[0.06, 0.10]%, P=2.4×10(-16)), and relative weak associations with lower total energy intake (-6.4[-10.1, -2.6] kcal/day, P=0.001) and lower dietary carbohydrate intake (-0.07 [-0.11, -0.02]%, P=0.004). The associations with protein (P=7.5×10(-9)) and total energy (P =0.002) were attenuated but remained significant after adjustment for BMI. We did not find significant interactions between the FTO variant and dietary intake of total energy, protein, carbohydrate, or fat on BMI. Our findings suggest a positive association between the BMI-increasing allele of FTO variant and higher dietary protein intake and offer insight into potential link between FTO, dietary protein intake and adiposity.
    Human Molecular Genetics 08/2014; · 7.69 Impact Factor
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    ABSTRACT: This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement.
    Osteoporosis International 07/2014; · 4.04 Impact Factor
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    ABSTRACT: There is variation in how services to prevent second fractures after hip fracture are organised. We explored this in more detail at 11 hospitals. Results showed that there was unwarranted variation across a number of aspects of care. This information can be used to inform service delivery in the future.
    Osteoporosis International 06/2014; 25(10). · 4.04 Impact Factor
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    ABSTRACT: Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of radiographic hip OA compared with controls.
    Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 06/2014;
  • Journal of Developmental Origins of Health and Disease 06/2014; 5(3):161-3. · 1.21 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate fracture risk in patients with Guillain-Barré syndrome (GBS). No association with risk of fracture was observed for GBS patients compared with controls. Only GBS patients using pain treatment had a doubled risk of fracture. Symptoms of Guillain-Barré syndrome (GBS) may vary from mild difficulty in walking to complete paralysis, which may increase the risk of fractures. Therefore, the aim of this study was to evaluate fracture risk in patients with GBS. We conducted a retrospective cohort study using the UK Clinical Practice Research Datalink (1987-2012). Each patient with GBS was matched by year of birth, sex, and practice, up to six patients without a history of GBS. Outcome measure was any fracture. There were no associations between GBS and any fracture, adjusted hazard ratio (AHR) 1.01 (95 % confidence interval [CI] 0.77-1.33), or osteoporotic fracture, AHR 0.76 (95 % CI 0.50-1.17), compared with controls. Stratification to gender, age, and duration since diagnosis did not show an association either. Only for GBS patients using pain treatment, risk of fracture was doubled AHR 1.97 (95 % confidence CI 1.21-3.21) compared with controls. The risk of fracture in GBS patients exposed to pain treatment was equivalent to risk of fracture among controls exposed to pain treatment. No association with risk of fracture was observed for GBS patients compared with controls. Only GBS patients using pain treatment had a doubled risk of fracture, but their risk was equivalent to fracture risk among controls exposed to pain treatment.
    Osteoporosis International 04/2014; · 4.04 Impact Factor
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    ABSTRACT: Objective Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of radiographic hip OA compared with controls. Design HBM cases came from the UK-based HBM study: HBM was defined by BMD Z-score. Unaffected relatives of index cases were recruited as family controls. Age-stratified random sampling was used to select further population controls from the Chingford and Hertfordshire cohort studies. Pelvic radiographs were pooled and assessed by a single observer blinded to case-control status. Analyses used logistic regression, adjusted for age, gender and BMI. Results 530 HBM hips in 272 cases (mean age 62.9 years, 74% female) and 1702 control hips in 863 controls (mean age 64.8 years, 84% female) were analysed. The prevalence of radiographic OA, defined as Croft score ≥3, was higher in cases compared with controls (20.0% vs. 13.6%), with adjusted OR [95% CI] 1.52 [1.09,2.11], p=0.013. Osteophytes (OR 2.12 [1.61,2.79], p<0.001) and subchondral sclerosis (OR 2.78 [1.49,5.18], p=0.001) were more prevalent in cases. However, no difference in the prevalence of joint space narrowing was seen (OR 0.97 [0.72,1.33], p=0.869). Conclusions An increased prevalence of radiographic hip OA and osteophytosis was observed in HBM cases compared with controls, in keeping with a positive association between HBM and OA and suggesting that OA in HBM has a hypertrophic phenotype.
    Osteoarthritis and Cartilage 04/2014; · 4.26 Impact Factor
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    ABSTRACT: We used a large population-based health care database to determine the impact of common co-morbidities on hip fracture risk amongst elderly men. We demonstrated that diabetes, chronic obstructive pulmonary disease, renal failure, HIV infection, dementia, and cerebrovascular disease are independent predictors of hip fracture, as is a Charlson score of ≥3. Risk factors for hip fractures in men are still unclear. We aimed to identify common co-morbidities (amongst those in the Charlson index) that confer an increased risk of hip fracture amongst elderly men. We conducted a population-based cohort study using data from the SIDIAP (Q) database. SIDIAP(Q) contains primary care and hospital inpatient records of a representative 30 % of the population of Catalonia, Spain (>2 million people). All men aged ≥65 years registered on 1 January 2007 were followed up until 31 December 2009. Both exposure (co-morbidities in the Charlson index) and outcome (incident hip fractures) were ascertained using ICD codes. Poisson regression models were fitted to estimate the effect of (1) each individual co-morbidity and (2) the composite Charlson index score, on hip fracture risk, after adjustment for age, body mass index, smoking, alcohol drinking, and use of oral glucocorticoids. We observed 186,171 men for a median (inter-quartile range) of 2.99 (2.37-2.99) years. In this time, 1,718 (0.92 %) participants had a hip fracture. The following co-morbidities were independently associated with hip fractures: diabetes mellitus, chronic obstructive pulmonary disease (COPD), renal failure, HIV infection, dementia, and cerebrovascular disease. A Charlson score of ≥3 conferred an increased hip fracture risk. Common co-morbidities including diabetes, COPD, cerebrovascular disease, renal failure, and HIV infection are independently associated with an increased risk of hip fracture in elderly men. A Charlson score of 3 or more is associated with a 50 % higher risk of hip fracture in this population.
    Osteoporosis International 03/2014; · 4.04 Impact Factor

Publication Stats

26k Citations
2,906.59 Total Impact Points

Institutions

  • 2014
    • The Scripps Research Institute
      • Department of Molecular and Experimental Medicine
      La Jolla, CA, United States
    • NIHR Oxford Biomedical Research
      Oxford, England, United Kingdom
  • 1989–2014
    • University of Southampton
      • • MRC Lifecourse Epidemiology Unit
      • • Developmental Origins of Health and Disease
      • • Faculty of Medicine
      Southampton, England, United Kingdom
  • 2013
    • Skåne University Hospital
      Malmö, Skåne, Sweden
    • Maulana Azad Medical College
      New Dilli, NCT, India
  • 2012–2013
    • Autonomous University of Barcelona
      • Department of Medicine
      Cerdanyola del Vallès, Catalonia, Spain
    • International Osteoporosis Foundation
      Nyon, Vaud, Switzerland
    • Medanta The Medicity
      Гургаон, Haryana, India
    • Aarhus University Hospital
      • Department of Endocrinology and Internal Medicine
      Århus, Central Jutland, Denmark
    • University of East Anglia
      Norwich, England, United Kingdom
    • Ghent University
      Gand, Flanders, Belgium
  • 2008–2013
    • VU University Medical Center
      • • Department of Rheumatology
      • • Department of Internal Medicine
      Amsterdamo, North Holland, Netherlands
  • 2000–2013
    • Universiteit Utrecht
      • • Division of Pharmacoepidemiology and Pharmacotherapy
      • • Utrecht Institute for Pharmaceutical Sciences
      Utrecht, Provincie Utrecht, Netherlands
  • 2011–2012
    • University of Oxford
      • • Botnar Research Centre Institute of Musculoskeletal Sciences
      • • Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)
      Oxford, ENG, United Kingdom
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
    • Alfried Krupp Krankenhaus
      Essen, Lower Saxony, Germany
    • The University of Tokyo
      • Center for 22nd Century Medical and Research
      Tokyo, Tokyo-to, Japan
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
  • 2008–2012
    • The University of Sheffield
      • Medical School
      Sheffield, England, United Kingdom
  • 2000–2012
    • University Hospital Southampton NHS Foundation Trust
      • • Department of Rheumatology
      • • Department of Medical Physics and Bioengineering
      Southampton, England, United Kingdom
  • 2010
    • Imperial College London
      Londinium, England, United Kingdom
    • King's College London
      • Department of Twin Research and Genetic Epidemiology
      London, ENG, United Kingdom
    • University of Geneva
      • Division of Bone Diseases
      Genève, GE, Switzerland
  • 2009
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
    • University Medical Center Utrecht
      Utrecht, Utrecht, Netherlands
    • Copenhagen University Hospital Gentofte
      Hellebæk, Capital Region, Denmark
  • 2008–2009
    • Circumcision Resource Center
      Boston, Massachusetts, United States
  • 2006
    • University of Leuven
      Louvain, Flanders, Belgium
  • 1995–2006
    • Medical Research Council (UK)
      Londinium, England, United Kingdom
  • 2005
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
    • University of Brighton
      • Brighton and Sussex Medical School
      Brighton, ENG, United Kingdom
  • 2004
    • Netherlands Institute for Space Research, Utrecht
      Utrecht, Utrecht, Netherlands
    • CUNY Graduate Center
      New York City, New York, United States
  • 1992–2004
    • The University of Manchester
      Manchester, England, United Kingdom
  • 2003
    • Copenhagen University Hospital Hvidovre
      Hvidovre, Capital Region, Denmark
  • 2002
    • Keele University
      Newcastle-under-Lyme, England, United Kingdom
  • 1989–2001
    • The Chinese University of Hong Kong
      Hong Kong, Hong Kong
  • 1998–2000
    • Procter & Gamble
      Cincinnati, Ohio, United States
    • University of Nottingham
      • Centre for Sports Medicine
      Nottingham, ENG, United Kingdom
    • Poole Hospital NHS Foundation Trust
      Poole, England, United Kingdom
  • 1999
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Department of Endocrinology and Metabolism
      Amsterdam, North Holland, Netherlands
  • 1992–1999
    • Mayo Clinic - Rochester
      • Department of Health Science Research
      Rochester, MN, United States
  • 1997–1998
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1995–1998
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
  • 1996
    • University of Amsterdam
      • Department of Endocrinology
      Amsterdam, North Holland, Netherlands
  • 1993
    • University of Newcastle
      • Centre for Clinical Epidemiology and Biostatistics
      Newcastle, New South Wales, Australia
  • 1992–1993
    • Mayo Foundation for Medical Education and Research
      • Department of Health Sciences Research
      Scottsdale, AZ, United States