About this study

eraSmus medIsch ceNTrum skEletaal bReekbaarheid (SINTER) studie

Study Investigating the determinants of skeletal fragility in patients with predisposing conditions.

General Information About the SINTER Study

The SINTER Study (eraSmus medIcal ceNTer skEletal fRagility (SINTER) Studie) is led by Erasmus MC and conducted by a team of doctors, researchers, and nurses across different outpatient clinics.

The study includes both healthy individuals and patients and is divided into two phases. It aims to recruit 5,650 participants from eight outpatient clinics:

 

What is the purpose of the study?

This study compares bone strength between two groups:

  • People with genetically predicted low bone density
  • People with genetically predicted high bone density

 

Study Goals

The study aims to combine genetic data with physical and nutritional assessments to better understand what affects bone strength. By looking at both genetic and physical factors, researchers hope to discover new biological reasons why some people have stronger bones than others. This could lead to more personalized ways to prevent and treat weak bones (skeletal fragility).

Additionally, the study will explore participants’ experiences and opinions on genetic research in bone health. This will help future studies be more effective while considering participants’ needs and concerns.

What is the background of the study?

What is Bone Strength?

Bone strength refers to how strong and durable bones are. It mainly depends on:

  • Bone Density: How thick and compact bones are. Higher density usually means stronger bones with more minerals like calcium.
  • Bone Quality: The material that makes up bones, including proteins like collagen, which help maintain bone strength.

 

Why is Bone Strength Important?

Keeping bones strong is crucial for staying active and healthy as we age. Weak bones can lead to fractures, mobility issues, and even serious health problems.

Doctors use DXA scans to measure bone mineral density (BMD) and diagnose conditions like osteoporosis.

 

What Affects Bone Strength?

Bone strength varies due to several factors:

  • Genetics: Some people naturally have stronger bones.
  • Age: Bones weaken as we get older.
  • Lifestyle: Diet, exercise, and habits like smoking or drinking alcohol impact bone health.
  • Health Conditions: Certain diseases can weaken bones.

Because many factors contribute to bone strength, current medical tools may not fully predict who is at risk for fractures.

 

Using Genetics to Understand Bone Strength

While aging, lifestyle, and diseases influence bone strength, they don’t explain why some people are more prone to fractures than others. This suggests that genetics plays an important role.

Everyone’s DNA contains many small genetic variations that, when combined, can affect bone strength. By studying these variations, scientists can calculate a polygenic risk score (PRS)—a measure of genetic risk for weak or strong bones.

Researchers compare people with genetically predicted low and high BMD to understand the biological mechanisms behind bone strength. However, genetics is only one piece of the puzzle. Lifestyle factors like exercise and diet can also influence actual bone strength, sometimes overriding genetic predictions.

If neither genetics nor lifestyle fully explains someone’s bone density, researchers may look for rare genetic mutations that could be affecting bone strength in unexpected ways.

What happens during the study?

How Long Does the Study Take?

If you take part in both Stage 1 and Stage 2, you will have two appointments:

  1. Stage 1 – During a routine hospital visit, an extra tube of blood will be taken.
  2. Stage 2 – If selected, you will be invited for additional tests at a research center within the next year.

The entire study can take up to 18 months.

Step 1: Are You Eligible?

Before joining, we need to check if you qualify.

For Stage 1, You Must:

✔ Be 18 years or older
✔ Be a patient at Erasmus MC in one of these clinics: diabetes, kidney, geriatric, vascular medicine, healthy weight, bone center, or mastocytosis
✔ Agree to an extra blood sample during your routine care
✔ Be mentally able to give consent or have a legal representative
✔ Be willing to return for further tests if selected for Stage 2

For Stage 2, You Must Also:

✔ Have a genetic score showing “low” or “high” bone mineral density
✔ Not be pregnant

Step 2: Study Process & Measurements

Stage 1: Blood Sample at Erasmus MC

  • This will be done during your routine hospital visit—no extra appointments needed.
  • A small blood sample (about 20ml) will be collected, similar to a standard blood test.
  • We will contact you to answer any questions before the test.

Stage 2: Additional Tests at ERGO Research Center

If your genetic results classify you as having “low” or “high” predicted bone density, you will be invited for a 90-minute visit at the Erasmus Rotterdam Gezondheid Onderzoek (ERGO) research center.

What Happens During This Visit?

– EOS Edge Imaging – A special scan that takes high-quality images of your bones while you stand, providing a clearer picture of your skeletal structure. It’s quick, producing 2D and 3D images in seconds.

These tests help us better understand bone strength and potential risks of fractures.

 

SINTER-onderzoek@erasmusmc.nl

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