Evelyn Hsieh, MD, PhD

Bridging biomedical and behavioral sciences methodologies to risk stratify and identify feasible prevention strategies for osteoporosis, fractures and sarcopenia among individuals with HIV in low-resource settings. Projects have explored mechanistic, epidemiologic, health services and behavioral aspects of this issue in China (collaborating institution: Peking Union Medical College Hospital) and Peru (collaborating institution: Universidad Peruana Cayetano Heredia), two countries undergoing economic transition where incidence of these conditions is increasing, but infrastructure and capacity to diagnose and manage these comorbidities remains fragmented, particularly for vulnerable populations such as persons with HIV. Example projects:

• Quarterly Vitamin D Supplementation for the Prevention of Osteoporosis and Fractures Among Individuals with HIV in China
• Longitudinal Increase in Vitamin D Binding Protein Levels after Initiation of Tenofovir/Lamivudine/Efavirenz Therapy among HIV-Infected Individuals
• Long-term Trabecular Bone Score and Bone Mineral Density Changes in Chinese Antiretroviral-Treated HIV-Infected Individuals
• Expanding the toolbox for prevention of sarcopenia and osteoporosis among people aging with HIV in Peru: A validation study
• Musculoskeletal and Broader NCD Care for Persons Living with HIV in Peru: A Mixed Methods Study of HIV Care Providers and Regional HIV Program Coordinators
• Osteoporosis, Vertebral Fractures, Sarcopenia and Health-Related Quality of Life among Women Aging with HIV in Lima, Peru

Musculoskeletal and Rheumatic Disease Outcomes among U.S. Veterans Leveraging the VA Cohorts Family. As co-Director of the Rheumatology, Endocrine and Geriatrics Syndrome Core, I support and foster research to expand the scope of projects focused on rheumatologic and musculoskeletal conditions and outcomes within the VA Cohorts Family. Beyond work focused on fracture and falls outcomes, these have also examined sarcoidosis, rheumatoid arthritis and orthopaedic outcomes. Example projects:

• Development and Validation of a Novel and HIV-Relevant Prediction Model for Fracture
• Incidence and Presentation of Sarcoidosis with and without HIV Infection
• Incident Rheumatoid Arthritis in Human Immunodeficiency Virus Infection: Epidemiology and Treatment
• Development and Validation of Case-Finding Algorithms to Identify Prosthetic Joint Infections After Total Knee Arthroplasty in Veterans Health Administration Data

Secondary Osteoporosis and Fracture Risk. Secondary osteoporosis is often under-recognized. This is particularly the case for patients with underlying conditions leading to inflammation/immune activation or those requiring long-term therapies that impact bone metabolism. In addition to my work in HIV, these projects focus on understanding the biology, epidemiology and health services related gaps with regards to risk for osteoporosis and fractures among patients with chronic conditions such as rheumatoid arthritis, breast cancer, and chronic osteomyelitis. Most recently we have expanded this work to explore long-term musculoskeletal outcomes in older individuals hospitalized for COVID-19. Example projects:

• Musculoskeletal outcomes among older patients after hospitalization for COVID-19: A pilot study
• Bone mineral density and microarchitecture among Chinese patients with rheumatoid arthritis: a cross-sectional study with HRpQCT
• Soy Food Consumption, Exercise and Body Mass Index in Association with Osteoporotic Fracture among Breast Cancer Survivors: A report from Shanghai Breast Cancer Survival Study
• Vertebral Fractures among Breast Cancer Survivors in China: A Cross-Sectional Study of Prevalence and Health Services Gaps
• Increased Fragility Fracture Rates in Older Men with Osteomyelitis

Additional Recent Projects Related to Global Rheumatology and Global Non-Communicable Diseases.

• A Pilot Educational Intervention to Improve Knowledge and Readiness for Self-Management among Patients with Rheumatic Diseases in Uganda
• Improving Self-care Among People with Non-Communicable Diseases in a Rural District of Uganda
• Research Capacity Building Programs for Noncommunicable Diseases in Lower- and Middle-Income Countries