FALL 2018 | UPDATE IN | GERIATRIC MEDICINE DIVISION OF GERIATRIC MEDICINE GERIATRIC OF DIVISION Inside This Edition Message from the Chief 2 Geroscience: Frontiers in the Biology of Aging I am pleased to share our latest issue of Update in Geriatric Medicine, especially our excitement for a 3 New Model of Care Is major augmentation of our research through the creation of a new, focused geroscience initiative led Making a Difference in Osteoporosis Treatment by Toren Finkel, MD, PhD, one of the most distinguished scientists in the field of aging research. 4 UPMC Physician Resources Recruited from the National Institutes of Health in 2017, Dr. Finkel has assembled an impressive team Video Rounds of new investigators to join him. Based on the observation that age itself is the most important risk 5 New Meta-Analysis Shows factor in many diseases affecting our geriatric patients — and data revealing dramatic extension Effects of Interventions on Adverse Drug Reactions of both lifespan and healthspan in experimental models — the goal is to determine which of these experimental strategies might hold the most promise for application in humans. Several of our 6 Testing New Models of Care for Chronic Low Division faculty already are collaborating in this enormous effort. Back Pain 8 Brain Amyloid Deposition Also in this issue of Update in Geriatric Medicine, we showcase new research findings from and the Cognition-Mobility Interface Susan Greenspan, MD, in preventing recurrent hip fractures; an important new initiative in chronic low back pain by Debra Weiner, MD; and new findings fromNeelesh Nadkarni, MD, PhD, on the 10 Welcome New Faculty role of brain amyloid in gait abnormalities. 11 Recent Publications Awards and We also are proud to share news of several recent awards bestowed on faculty members, recent Accomplishments published research from the Division, and the arrival of three talented, new faculty members. Finally, we celebrate the accomplishments of Joe Hanlon, PharmD, MS, whose internationally- recognized contributions have added immeasurably to our understanding of the role and risks of medications in the care of geriatric patients. With kind regards, Neil M. Resnick, MD Division Chief and Thomas Detre Professor of Medicine Associate Director, Aging Institute of UPMC Senior Services and the University of Pittsburgh Director, Hartford Center of Excellence in Geriatrics Affiliated with the University of Pittsburgh School of Medicine, UPMC Presbyterian Shadyside is ranked among America’s Best Hospitals by U.S. News & World Report. Geroscience: Frontiers in the Biology of Aging Can we discover and understand the basic biological mechanisms and pathways that regulate the aging process? Moreover, by fundamentally understanding how and why processes of aging occur, can we devise the tools and technologies that will allow us to intervene, modulate, or perhaps reverse the full range of age-related diseases and disabilities that occur as consequence of the biology of aging? This is the field of geroscience, and UPMC issues, and a host of quality control in a position to develop new drugs that and the University of Pittsburgh are investing mechanisms can go awry as individuals’ can regulate those mechanistic processes, heavily in the pursuit of answers that will age. Yes, there are multiple aspects or leading to effective treatments for a wide unlock the mysteries and complex processes hallmarks of aging, and it’s certainly range of age-related diseases. These studies of how and why human beings age, and complex, “But that is not to say these will “lead to new approaches and new ultimately how we can intervene to more processes are not regulated or cannot in classes of medicines that we think will effectively improve and extend one’s quality some sense be malleable to interventions improve the quality of people’s lives,” of life for as long as possible. on the cellular or molecular level. We know, says Dr. Finkel. for example, in simple organisms that Helping to lead these emerging efforts in modifications to certain genes or proteins geroscience is Toren Finkel, MD, PhD, A Translational Approach to can have profound effects on both lifespan director of the Aging Institute, professor of Modifying Aging Processes and health span. Similar modifications are medicine in the Division of Cardiology, and Driving Disease what we hope to accomplish with human | 2 UPDATE IN GERIATRIC MEDICINE | the G. Nicholas Beckwith III and Dorothy B. aging and age-related conditions such as Cardiovascular disease, cancer, neuro- Beckwith chair in translational medicine. Alzheimer’s disease,” says Dr. Frankel. degen erative diseases — these all have a Dr. Finkel arrived at the University of powerful age-related component. Until Pittsburgh and UPMC in June 2017 after Fundamentally, Dr. Finkel and the groups now, most of the strategies for treating a distinguished 25-year career with the working on these problems believe that these broad categories of illness have been National Institutes of Health, where he was once we more fully understand the basic very disease-specific with some successes the chief of the Center for Molecular mechanisms that drive aging, we will be and equivalent number of failures. The Medicine in the National Heart, Lung, and approach that Dr. Finkel and colleagues Blood Institute (NHLBI) immedi ately are taking — the geroscience approach — preceding his arrival in Pittsburgh. means that, “We are not necessarily looking “The support and commitment from both for or hoping to develop disease-specific the University of Pittsburgh and UPMC to therapies per se. We are interested in the grow into one of the premier basic biology molecules and processes that underlie the of aging and translational research centers biology of aging, which, if we can intervene in the world was what really attracted me to in, we think will prevent these sorts of come to Pittsburgh — to pursue my own illnesses from happening in the first place,” research in the biology of aging front but says Dr. Finkel. also to help lead this effort with so many The Aging Institute, which Dr. Finkel now dedicated faculty across many disciplines,” leads, has begun to expand its research focus says Dr. Finkel. and capabilities to pursue many avenues of basic and translational research with respect Understanding and Modifying “ We are not necessarily to the goals of geroscience writ large. the Basic Biology and Pathways looking for or hoping to “In the end, we will have approximately 15 of Aging develop disease-specific different laboratories all working on various therapies per se. We We know much about the basic biology aspects of aging biology, so the work here are interested in the of aging and its pathways, but significant will be incredibly diverse. Coupled with the molecules and processes gaps remain to be explored and understood. basic science labs will be a high throughput that underlie the biology At the molecular level, it is known that screening facility that will help significantly of aging, which, if we can accumulated nuclear DNA damage, in our mission to develop entirely new intervene in, we think will shor tening of the telomeres, problems classes of anti-aging drugs. We also hope prevent these sorts of with mitochondria, protein aggregation illnesses from happening Continued on Page 10 in the first place.” Toren Finkel, MD, PhD FALL 2018 New Model of Care Is Making a Difference in Osteoporosis Treatment The risk of osteoporotic fractures in adults over the age of 50 remains significantly high. For women, 50 percent will sustain an osteoporotic fracture sometime during their life. Twenty-five percent of men will experience a fracture. These individuals also are at significant risk (more than two-fold) for a second fracture and concomitant morbidity and mortality. “Generally speaking, we’re grossly under- scan and appropriate lab testing. The results treating individuals hospitalized with of these tests and their implications are osteoporotic fractures. Only about carefully reviewed with the patients to 20 percent of people are treated, and ensure they adequately comprehend the that is simply far too few. The reasons are information. Treatment options are recom - many, but probably the largest problem we mended and discussed, medications are facing is a breakdown in communication prescribed if necessary, and direct follow- between providers coupled with the fact ups with patients occur several months | 3 DIVISION OF GERIATRIC MEDICINE | that the majority of these individuals have after the initial visit. “We discuss fall other serious health conditions that may prevention and strategies at home to take priority in their primary care,” says decrease that risk. If they smoke, we talk Susan L. Greenspan, MD. about its impact on bone density and the various cessation programs available. Dr. Greenspan is dually trained in geriatrics I explain the vital importance of calcium and endocrinology, and currently serves and vitamin D. Patients have my contact as director of the UPMC Osteoporosis information, along with an education Prevention and Treatment Center, director packet so they can call me directly with of the Bone Health Program at UPMC any questions or concerns once they Magee-Womens Hospital, and as principal leave,” says Karen Vujevich, MSN, CRNP, investigator of both the Pittsburgh Claude who is the fracture liaison coordinator at D. Pepper Older Americans Independence UPMC working alongside Dr. Greenspan. “ Generally speaking, we’re grossly Center and the Division’s NIH-funded Importantly, all of this is communicated under treating individuals with T32 Program in Research Training in to the patient’s primary care provider osteoporotic fractures. Only about geriatrics. Dr. Greenspan’s research focus for continuity of care and follow-up. 20 percent of people are treated, encompasses the pathophysiology, and that is simply far too few. ” evaluation, and treatment of osteoporosis. FLS Program Shows Susan L. Greenspan, MD In 2014, Dr. Greenspan and the Division of Positive Results in Newly Geriatric Medicine piloted a Fracture Liaison Published Findings Service (FLS) as part of a combined quality improvement (QI) study with two other In February 2018, Dr.