Protecting Astronauts' Bones, Improving Care for Veterans: Inside a NASA-VA Study in Richmond

The study is testing whether a new MRI-based imaging technique can detect subtle changes in bone density earlier than current methods. If successful, it could help clinicians identify bone loss before fractures occur, improving care for Veterans living with spinal cord injuries (SCI).

A one-of-a-kind study

Richmond is the only VA site conducting this specialized NASA-funded study. Researchers are focusing on bone density in the hip, an area especially vulnerable when people are no longer able to bear weight.

The question driving the research is straightforward: Can clinicians detect bone loss sooner and more accurately? The answer could influence how NASA monitors astronauts during and after spaceflight and how VA providers care for Veterans recovering from spinal cord injuries.

A partnership with NASA

The study is led at the Richmond VA Medical Center (VAMC) by principal investigator Dr. Robert Adler, chief of endocrinology, an Army Veteran and physician, and a global leader in bone health. He works closely with NASA co-principal investigator Dr. Jean Sibonga, who serves as the bone lead for NASA's Human Research Program and oversees the agency's research on bone health in space.

Their collaboration grew out of previous bone health research and NASA's efforts to better understand the effects of long-duration spaceflight on the skeleton.

Richmond was selected because the Central Virginia VA Health Care System includes one of the nation's major spinal cord injury rehabilitation centers, providing access to the patient population needed for the study.

From the lab to Veteran care

Helping lead the study's day-to-day operations is Emily Moran, a clinical research coordinator at the Central Virginia VA Health Care System.

After graduating from James Madison University in 2023 and conducting neuroscience research under Dr. Mark Gabriele, Moran joined VA research. She now coordinates participant recruitment, imaging appointments, informed consent, and follow-up visits, serving as a bridge between research protocols and the Veterans who volunteer for the study.

Why bone health matters

Bone is living tissue that becomes weaker when it isn't regularly bearing weight.

Astronauts experience this during extended stays in microgravity, where the skeleton is no longer subjected to Earth's normal forces. Veterans with spinal cord injuries often face the same challenge when they lose the ability to stand or walk.

As bone density decreases, the risk of fractures increases. Those fractures can complicate rehabilitation, reduce independence, and slow recovery.

Today, the standard test for measuring bone density is dual-energy X-ray absorptiometry, commonly known as DEXA. The scan is fast, widely available, and commonly used to diagnose osteoporosis. However, researchers believe DEXA may not detect the earliest, most subtle changes in bone density.

Looking beyond DEXA

While DEXA remains the standard for measuring bone density, researchers are evaluating a new MRI-based technique that may detect subtle changes earlier without exposing patients to additional radiation. Developed through a collaboration between the Richmond VA, New York University, and the University of Pennsylvania, the technology could provide clinicians with another tool for monitoring bone health in both Veterans and astronauts.

Researchers compare the MRI findings with established imaging methods to determine how well the new technique detects early bone loss.

Studying two groups

Researchers are following two groups of participants: Veterans with spinal cord injuries and healthy volunteers from the Richmond community.

Veterans with spinal cord injuries

Veterans typically enter the study shortly after admission to the spinal cord injury unit. Participants receive imaging early in their rehabilitation and return approximately one year later for follow-up scans.

Researchers expect many participants to experience measurable bone loss because they are unable to bear weight on their legs during recovery.

In addition to evaluating the MRI technique, the study is collecting long-term data on bone health after spinal cord injury. Those findings could help shape future standards of care for Veterans.

Healthy volunteers

Healthy volunteers ages 18 to 65 serve as the study's control group. During a single visit, participants complete two MRI scans, two DEXA scans, and other testing, allowing researchers to compare the precision and consistency of each imaging method. Researchers match volunteers as closely as possible to the Veteran participants while excluding individuals with conditions known to affect bone health.

Safety comes first

Although the study evaluates new ways of measuring bone density, the imaging procedures themselves are well established.

Participants undergo MRI, DEXA, and high-resolution peripheral quantitative CT (HR-pQCT) imaging. They may also choose to provide optional blood samples.

Before each MRI, staff carefully screen participants for metal implants and other safety concerns. Patients are also asked about claustrophobia and reminded that participation is voluntary and that they may pause or stop the scan at any time. Each MRI scan is conducted by MRI Technologist Daniel Palenski, whose expertise and consistency have been essential to the study.

DEXA and HR-pQCT involve only low levels of radiation similar to standard medical imaging. Blood draws remain optional for participants who prefer not to have them.

"It's all in their hands," Moran said, emphasizing that participants decide which procedures they are comfortable completing.

Building the study

Recruitment has included hospital flyers, referrals, and word of mouth.

Enrollment for Veterans with spinal cord injuries has concluded, while recruitment of healthy volunteers continues.

To date, researchers have enrolled 41 participants, including 18 Veterans with spinal cord injuries and 23 healthy controls. Researchers hope to enroll between 20 and 30 healthy controls before imaging concludes in March 2027.

Making a difference

Marine Corps Veteran Peter Ramirez is one of the first participants to volunteer for the Richmond NASA-VA bone health study, lending his time and experience as he recovers from a spinal cord injury.

A father and husband, Ramirez completed his latest bone density scan, which will be compared with scans from the previous year. During the visit, he also spoke about his rehabilitation progress and the goals he is working toward, including spending more time outdoors, playing sports, and doing more activities with his daughter.

His willingness to undergo advanced imaging and follow-up visits helps researchers better understand how bone density changes after injury, paving the way for improved rehabilitation strategies and fracture prevention for future Veterans.

He has dedicated time to both the NASA study and another SCI study at the Richmond VA, continuing his legacy of service by supporting both fellow Veterans and the astronauts who will rely on these findings during long-duration space missions.

Already improving Veteran care

Even before the study ends, the research is already influencing care for Veterans with spinal cord injuries.

The project has helped expand the use of DEXA scans within the spinal cord injury unit, supporting clinicians who have long wanted to incorporate routine bone density monitoring into rehabilitation.

Researchers are also working to bring a second DEXA scanner within the spinal cord injury unit into regular clinical use, making bone density testing more accessible for Veterans with limited mobility.

The goal is simple: help prevent fractures that can interrupt rehabilitation and preserve the progress Veterans make during recovery.

Veterans make the research possible

For Moran, the study's greatest strength is the Veterans who volunteer to participate.

She credits Dr. Adler with leading the project and says the Veterans' commitment continues to inspire the research team.

"There's so much that they have to be scheduling in terms of their rehab already," Moran said. "The fact that they still volunteer their time to help future Veterans and even astronauts is really impressive."