Candidate: Dr. Hansen's goal is to emerge as an excellent independent investigator, concentrating initially on studies of vitamin D metabolism in subjects with rheumatoid arthritis and developing over time multiple interrelated, well-focused and productive clinical research pursuits in bone and mineral metabolism. Receipt of the K23 award will allow Dr. Hansen to complete the University of Wisconsin Clinical Investigator Preparatory Program (CIPP, NIH K30, PI Frank Graziano). The CIPP provides advanced training in the core competencies of patient-oriented research: biostatistics, study design, ethics, scientific writing, presentation and leadership. Environment: The University of Wisconsin is a premier research institution; its Department of Medicine ranks 18th in the country for NIH funding. Dr. Hansen will have access to the Osteoporosis Clinical Research Center, Institute on Aging, and the Biostatistics Department for assistance with her research. Research: Osteoporosis is twice as common in people with rheumatoid arthritis (RA) as non-affected individuals matched for age and gender, leading to two to three-fold higher rates of spine and hip fracture compared to age-matched controls. These osteoporotic fractures are associated with a decline in function and quality of life, and increased medical costs, as is RA itself. An intervention targeting both RA and osteoporosis, which 1) improves bone metabolism, 2 ) elevates functional capacity, and 3) offers immunemodulating benefits would potentially be of great import. Vitamin D is inexpensive, widely available, and likely to offer such benefits. Both hypovitaminosis D and RA cause high bone turnover and subsequent osteoporosis. Existing, albeit limited, data suggest that hypovitaminosis D is common in RA. Thus, it is likely that hypovitaminosis D contributes to osteoporosis in RA. It follows that treatment with vitamin D should reduce bone turnover and improve bone mass. Furthermore, low vitamin D leads to muscle weakness and falls; vitamin D therapy reduces falls by half. Finally, immune-modulating benefits of vitamin D are noted in both animal models of, and humans with, RA. This information provides a compelling rationale for conduct of the proposed study, whereby the prevalence of hypovitaminosis D in RA is estimated, and the deficit is then corrected in half of subjects in a placebo-controlled manner, to document the skeletal, functional and immunologic benefits of vitamin D therapy.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAR1-RJB-F (J1))
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Witter, James
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University of Wisconsin Madison
Internal Medicine/Medicine
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United States
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Ramsubeik, Karishma; Keuler, Nicholas S; Davis, Lisa A et al. (2014) Factors associated with calcium absorption in postmenopausal women: a post hoc analysis of dual-isotope studies. J Acad Nutr Diet 114:761-7
Hansen, Karen E; Bartels, Christie M; Gangnon, Ronald E et al. (2014) An evaluation of high-dose vitamin D for rheumatoid arthritis. J Clin Rheumatol 20:112-4
Hansen, K E; Blank, R D; Palermo, L et al. (2014) What analytic method should clinicians use to derive spine T-scores and predict incident fractures in men? Results from the MrOS study. Osteoporos Int 25:2181-8
Swenson, Erik D; Hansen, Karen E; Jones, Andrea N et al. (2013) Characteristics associated with bone mineral density responses to alendronate in men. Calcif Tissue Int 92:548-56
Jones, A N; Shafer, M M; Keuler, N S et al. (2012) Fasting and postprandial spot urine calcium-to-creatinine ratios do not detect hypercalciuria. Osteoporos Int 23:553-62
Tevaarwerk, Amye; Burkard, Mark E; Wisinski, Kari B et al. (2012) Aromatase inhibitors and calcium absorption in early stage breast cancer. Breast Cancer Res Treat 134:245-51
Nansera, D; Graziano, F M; Friedman, D J et al. (2011) Vitamin D and calcium levels in Ugandan adults with human immunodeficiency virus and tuberculosis. Int J Tuberc Lung Dis 15:1522-7, i
Jones, Andrea N; Hansen, Karen E (2010) Re: Hong et al.:Twenty-four hour and spot urine metabolic evaluations: correlations versus agreements. (Urology 2010;75:1294-1298). Urology 76:1021-2; author reply 1022-3
Kramm, Heather; Gangnon, Ronald; Jones, Andrea N et al. (2010) The effect of physician workload on an educational intervention to increase vitamin D screening. WMJ 109:136-41
Hansen, Karen E; Jones, Andrea N; Lindstrom, Mary J et al. (2010) Do proton pump inhibitors decrease calcium absorption? J Bone Miner Res 25:2786-95

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