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Disorders of Mineralisation

From before you are born, following birth and as you grow and develop towards maturity into early adulthood, your bones continue to change in size and shape to develop into a strong and durable skeleton. However, your bones do not always develop normally or optimally due to many influential factors, including hormones, genes, iatrogenesis, chronic disease, movement disorders, in-born errors of metabolism, and lifestyle (diet, physical activity and exercise). Furthermore, from adulthood, as you age, you start to have less bone in your bones leading to osteoporosis, and more “bone” in your blood vessels leading to vascular calcification which is an indicator of cardiovascular disease. These disorders of mineralisation in older individuals lead to increased risk of fractures, heart attacks and strokes. Our research is focused in two key areas: (1) vascular calcification, and (2) bone and mineral metabolism, and how these two systems are linked across the lifespan.

Professor Josh Lewis leads the disorders of mineralisation research group within the Nutrition & Health Innovation Research Institute, in the School of Medical and Health Sciences. His research aims to develop better ways to identify and prevent disease before the onset of clinical symptoms. Josh supervises postgraduate students in a range of research areas including developing medical imaging tests for chronic diseases such as osteoporosis and cardiovascular diseases, clinical nutrition and lifestyle research as well as clinical trials to develop better evidence for healthy ageing. Josh is the PI for the 15-year Perth Longitudinal Study of Ageing Women (PLSAW) investigating the role of environmental, anatomical, physiological, metabolic and genetic factors on bone, cardiovascular and neurocognitive health outcomes in older women. He also leads the international Digital Lateral Spine Imaging to Better Predict Health and Prognosis consortium. Currently, he is conducting research on developing convenient, reliable and safe tests for vascular calcification as well as the identification of mechanism(s) and modifiable factors related to vascular calcification.

For more information, contact Professor Joshua Lewis 

Current projects

  • Modification of Diet, Exercise and Lifestyle: The MODEL randomised controlled trial.
  • Wise & Well: Randomised controlled trial.
  • Disentangling the vascular-musculoskeletal nexus.
  • Lipocalin 2 project evaluates the association between a novel marker of satiety and physical activity and its relationship with cardiometabolic health during ageing.
  • Modifiable dietary and lifestyle factors related to abdominal aortic calcification (MOD-AAC) consortium.
  • Digital Lateral Spine Imaging to Better Predict Health and Prognosis (DECIPHER) Consortium.
  • Perth longitudinal Study of Ageing Women cardiovascular & biomarkers programs.
  • Subclinical cardiovascular disease and musculoskeletal health.
  • Better evaluation and treatment for arterial calcification.
  • Improving cardiovascular risk estimation in older women.

No results were found

Postgraduate student project opportunities

Better understanding of the pathophysiological consequences of abdominal aortic calcification

Novel approaches to primary prevention of clinical cardiovascular disease.

Novel dietary factors and vascular calcification.

Better understanding how and why abdominal aortic calcification develops and progresses

Investigating the vascular-musculoskeletal nexus

For more information visit the SMHS Higher Degree by Research or HDR students project opportunities webpages.

Recent Research Grants

Improving screening, understanding, prevention and treatment of abdominal aortic calcification, Heart Foundation, NHF - Future Leader Fellowships, 2024 ‑ 2029, $792,623.

Triaging cardiovascular disease and multimorbidity, National Research Foundation (South Africa), Competitive Support for Unrated Researchers, 2025 ‑ 2028, $4,404.

Fractures in Sub-Saharan Africa: epidemiology, economic impact and ethnography, Wellcome Trust, Global Health Research Collaborative Award, 2026 ‑ 2028.

Forrest Research Foundation Scholarship - Carlos Toro Huamanchumo, Forrest Research Foundation, Forrest Research Foundation Scholarship, 2024 ‑ 2027, $12,000.

A new tool to screen for blood vessel calcification., Heart Foundation, Catalyst Partnership Grants, 2025 ‑ 2027, $270,000.

Collaboration on abdominal aortic calcification study - KURE Korean AAC Study, Yonsei University, Grant, 2024 ‑ 2027, $15,107.

Tracking Heart and Health risks in people with Cystic Fibrosis (CF), Australian Cystic Fibrosis Research Trust, WA Cystic Fibrosis Collaborative Program 2025 – Stream 2: Research Innovation Grant, 2026 ‑ 2027, $29,000.

Harnessing the power of AI on DXA images for predicting physical ability and decline, Raine Medical Research Foundation, Raine Priming Grants, 2026 ‑ 2027, $238,076.

Investigating genetic and lifestyle determinants of abdominal aortic calcification, and their relationship with cardiovascular disease, National Health and Medical Research Council, MRFF - Cardiovascular Health Mission, 2023 ‑ 2027, $1,428,095.

Getting to the heart of healthy aging: a behaviour change program to promote dietary pattern changes, National Health and Medical Research Council, MRFF - Dementia, Ageing and Aged Care Mission - 2025 Dementia, Ageing and Aged Care Grant, 2022 ‑ 2026, $626,963.

Recent selected publications

Gebre, A., Mundt, M., Dent, Webster J, E., Saleem, A., Gilani, Z., Zhang, Y., Smith, C., Raina, Kemp J, Leslie W, Schousboe T, Harvey N, P., Lewis, J., Sim, M. (2026). Machine learning derived abdominal aortic calcification is associated with physical frailty in community-dwelling adults: the UK Biobank Imaging Study. GeroScience, -(-), -. https://doi.org/10.1007/s11357-026-02375-9.

Sim, M., Webster, J., Smith, C., Saleem, A., Gilani, Z., Toro Huamanchumo, C., Suter, D., Figtree, G., Lagendijk, AK., Duncan, EL., Schultz, C., Szulc, P., Hung, J., Lim, WH., Raina, P., Bondonno, N., Woodman, R., Hodgson, J., Kiel, DP., Prince , RL., Leslie, WD., Kamp, JP., Harvey, NC., Schousboe, JT., Lewis, J. (2026). Automated abdominal aortic calcification scores and atherosclerotic cardiovascular disease in the UK Biobank Imaging Study. Journal of the American College of Cardiology: Advances, 5(3), Article number 102570.

Smith, C., Sim, M., Dalla Via, J., Lim, W., Coats , Figtree G, Prince Rl, A., Lewis, J. (2026). The Australian cardiovascular risk calculator and atherosclerotic vascular disease risk in community-dwelling older women. Heart Lung and Circulation, -(-), -.

Saleem, A., Lewis, J., Gilani, Z. (2026). A Hybrid Contrastive Ordinal Regression Method for Advancing Disease Severity Assessment in Imbalanced Medical Datasets. Proceedings of the 28th International Conference on Medical Image Computing and Computer Assisted Intervention (14-23). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/978-3-032-05169-1_2.

Smith, C., Sim, M., Ilyas, Z., Gilani, Z., Suter, D., Reid, S., Monchka, B., Jozani, M., Figtree, G., Schousboe , J., Lewis, J., Leslie, W. (2025). Automated abdominal aortic calcification and major adverse cardiovascular events in people undergoing osteoporosis screening: the Manitoba Bone Mineral Density Registry. Journal of Bone and Mineral Research, 40(3), 323-331. https://doi.org/10.1093/jbmr/zjae208.

Ghasemifard, N., Lewis, J., Radavelli Bagatini, S., Laws, S., Stephan, B., Hodgson, J., Zhu, K., Prince, R., Sim, M. (2025). Calcium supplementation and the risk of dementia in the Perth Longitudinal Study of Aging Women: a post-hoc analysis of a randomised clinical trial for fracture prevention. The Lancet Regional Health - Western Pacific, 63(Ocotober 2025), Article number 101694. https://doi.org/10.1016/j.lanwpc.2025.101694.

Connolly, E., Liu, A., Radavelli Bagatini, S., Shafaei Darestani, A., Boyce, M., Wood, LG., McCahon, L., Koch, H., Sim, M., Hill, C., Parmenter, B., Bondonno, N., Devine, A., Croft, KD., Mithen, R., Gan, SK., Schultz, CJ., Woodman, RJ., Bondonno, C., Lewis, J., Hodgson, J., Blekkenhorst, L. (2024). Cruciferous vegetables lower blood pressure in adults with mildly elevated blood pressure in a randomized, controlled, crossover trial: the VEgetableS for vaScular hEaLth (VESSEL) study. BMC Medicine, 22(1), article number 353. https://doi.org/10.1186/s12916-024-03577-8.

Bondonno, N., Parmenter, B., Murray, K., Bondonno, C., Blekkenhorst, L., Wood, AC., Post, WS., Allison, M., Criqui, MH., Lewis, J., Hodgson, J. (2024). Associations Between Flavonoid Intake and Subclinical Atherosclerosis: The MESA. Arteriosclerosis, Thrombosis and Vascular Biology, 44(11), 2347-2359. https://doi.org/10.1161/ATVBAHA.124.321106.

Radavelli Bagatini, S., Bondonno, C., Dalla Via, J., Sim, M., Gebre, A., Blekkenhorst, L., Connolly, E., Bondonno, N., Schousboe, JT., Woodman, RJ., Zhu, K., Mullin, S., Szulc, P., Jackson, B., Dimmock, J., Schlaich, MP., Cox, KL., Kiel, DP., Lim, W., Stanley, M., Devine, A., Thompson, PL., Williams, EJ., Wood, LG., Sim, M., Daly, RM., Hodgson, J., Lewis, J. (2024). Impact of provision of abdominal aortic calcification results on fruit and vegetable intake: 12-week randomized phase 2 controlled trial. Nature Communications, 15(1), article number 8126. https://doi.org/10.1038/s41467-024-52172-1.

Smith, C., Sim, M., Dalla Via, J., Gebre, A., Zhu, K., Lim, W., Teh, R., Kiel, DP., Schousboe, JT., Levinger, I., Von Haehling , S., Woodman, R., Coats, AJ., Prince, RL., Lewis, J. (2024). Extent of abdominal aortic calcification is associated with incident rapid weight loss over five years: the Perth Longitudinal Study of Ageing Women. Arteriosclerosis, Thrombosis and Vascular Biology, 44(2), 54-64. https://doi.org/10.1161/ATVBAHA.123.320118.

Neumann, JT., Twerenbold, R., Weimann, J., Ballantyne, CM., Benjamin, EJ., Costanzo, S., De Lemos, JA., Defilippi, CR., Di Castelnuovo, A., Donfrancesco, C., Dörr, M., Eggers, KM., Engström, G., Felix, SB., Ferrario, MM., Gansevoort, RT., Giampaoli, S., Giedraitis, V., Hedberg, P., Iacoviello, L., Jørgensen, T., Kee, F., Koenig, W., Kuulasmaa, K., Lewis, J., Lorenz, T., Lyngbakken, MN., Magnussen, C., Melander, O., Nauck, M., Niiranen, TJ., Nilsson, PM., Olsen, MH., Omland, T., Oskarsson, V., Palmieri, L., Peters, A., Prince, RL., Qaderi, V., Vasan, RS., Salomaa, V., Sans, S., Smith, JG., Söderberg, S., Thorand, B., Tonkin, AM., Tunstall-Pedoe, H., Veronesi, G., Watanabe, T., Watanabe, M., Zeiher, AM., Zeller, T., Blankenberg, S., Ojeda, F. (2024). Prognostic Value of Cardiovascular Biomarkers in the Population. JAMA: Journal of the American Medical Association, 331(22), 1898-1909. https://doi.org/10.1001/jama.2024.5596.

Schultz, CJ., Dalgaard, F., Bellinge, JW., Murray, K., Sim, M., Connolly, E., Blekkenhorst, L., Bondonno, C., Lewis, J., Gislason, GH., Tjønneland, A., Overvad, K., Hodgson, J., Bondonno, N. (2024). Dietary Vitamin K1Intake and Incident Aortic Valve Stenosis. Arteriosclerosis, Thrombosis and Vascular Biology, 44(2), 513-521. https://doi.org/10.1161/ATVBAHA.123.320271.

Gebre, A., Lewis, J., Leow, K., Szulc, P., Scott, D., Sim, M., Ebeling, P., Wong , G., Lim, WH., Schousboe, JT., Kiel, DP., Prince, RL., Rodriguez, A. (2023). Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis of observational studies. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 78(7), 1147-1154. https://doi.org/10.1093/gerona/glac171.

Sharif, N., Gilani, Z., Suter, D., Reid, S., Szulc, P., Kimelman, D., Monchka, B., Jozani, M., Hodgson, J., Sim, M., Zhu, K., Harvey, N., Kiel, D., Prince, R., Schousboe , J., Leslie, W., Lewis, J. (2023). Machine Learning for Abdominal Aortic Calcification Assessment from Bone Density Machine-Derived Lateral Spine Images. EBioMedicine, 94(August 2023), Article number 104676. https://doi.org/10.1016/j.ebiom.2023.104676.

Zanker, J., Sim, M., Anderson, K., Balogun, S., Brennan-Olsen, S., Dent, E., Duque, G., Girgis, C., Grossmann, M., Hayes, A., Henwood, T., Hirani, V., Inderjeeth, C., Iuliano, S., Keogh, J., Lewis, J., Lynch, G., Pasco, J., Phu, S., Reijnierse, E., Russell, N., Vlietstra, L., Visvanathan, R., Walker, T., Waters, D., Yu, S., Maier, A., Daly, R., Scott, D. (2023). Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand. Journal of Cachexia, Sarcopenia and Muscle, 14(1), 142-156. https://doi.org/10.1002/jcsm.13115.

Key publications

Selected Journal Articles:

Gebre AK, Sim M, Rodríguez AJ, Hodgson JM, Blekkenhorst LC, Szulc P, Bondonno, NP, Zhu K, Bondonno CP, Kiel DP, Schousbe JT, Prince RL, Lewis JR. Abdominal aortic calcification is associated with increased risk of injurious fall-related hospitalizations in older Australian women. Atherosclerosis (2021) In-press.

Lewis J, Voortman T, Ioannidis JPA. Perspective: Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground? The Journal of Bone and Mineral Research. 2021; 36 (2), 219-226.

Leow K, Szulc P, Schousboe JT, Kiel DP, Teixeira‐Pinto A, Shaikh H, Sawang M, Sim M, Bondonno N, Hodgson JM, Sharma A, Thompson PL, Prince RL, Craig JC, Lim WH, Wong G, and Lewis JR. Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta‐Analysis of Observational Studies. Journal of the American Heart Association. 2021 Jan 19;10(2):e017205.

Smith C, Lewis JR, Sim M, Wai HL, Lim EM, Blekkenhorst LB, Brennan-Speranza, Adams L, Brynes E, Duque G, Levinger I, Prince. Higher undercarboxylated to total osteocalcin ratio is associated with reduced physical function and increased 15-year falls-related hospitalizations: The Perth Longitudinal Study of Ageing Women. Journal of Bone and Mineral Research 2020 36(3):523-530.

Sim M, Lewis JR, Prince RL, Levinger I, Brennan-Speranza TC, Palmer C, et al. (2020) The effects of vitamin K-rich green leafy vegetables on bone metabolism: A 4-week randomised controlled trial in middle-aged and older individuals. Bone Reports. 2020:100274.

Sim M, Blekkenhorst LC, Bondonno NP, Radavelli-Bagatini S, Peeling P, Bondonno CP, Magliano DJ, Shaw JE, Woodman R, Murray K, Lewis JR, Daly RM, Hodgson JM. (2020) Dietary nitrate intake is positively associated with muscle function in men and women independent of physical activity levels. Journal of Nutrition. 2021; 151(5):1222-1230.

Chong JJH, Prince RL, Thompson PL, Thavapalachandran S, Ooi E, Devine A, Lim EEM, Byrnes E, Wong G, Lim WH, Lewis J. Association Between Plasma Neutrophil Gelatinase-Associated Lipocalin and Cardiac Disease Hospitalizations and Deaths in Older Women. Journal of the American Heart association (2019); Jan 8;8(1):e011028.

Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, Zhu K, Woodman RJ, Hodgson JM, Lewis JR. (2019). Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women. Osteoporosis International: 30(1)167

Lewis, J., Eggermont, C., Schousboe, J., Lim, W., Wong, G., Khoo, B., Sim, M., Yu, M., Ueland, T., Bollerslev , J., Hodgson, J., Zhu, K., Wilson, K., Kiel, D., Prince, R., (2019), Association between abdominal aortic calcification, bone mineral density and fracture in older women. Journal of Bone and Mineral Research, 34(11), 2052-2060, DOI: 10.1002/jbmr.3830.

Zhu K, Lewis JR, Sim M, Richard RL (2019) Low vitamin D status is associated with impaired bone quality and increased risk of fracture-related hospitalization in older Australian women. Journal of Bone and Mineral Research 34(11):2019-2027.

Sim M, Lewis JR, Blekkenhorst LC, Bondonno CP, Devine A, Zhu K, Peeling P, Prince RL, Hodgson JM (2019) Higher dietary nitrate intake is associated with better muscle function in older women. Journal of Cachexia Sarcopenia and Muscle 10(3):601-610.

Rodríguez AJ, Leow K, Szulc P, Scott D, Ebeling P, Sim M, Wong G, Lim WH, Schousboe JT, Kiel DP, Prince RL, R Lewis J. Abdominal aortic calcification, bone mineral density and fractures: a systematic review and meta-analysis protocol. BMJ Open. 2019;9(4):e026232.

Blekkenhorst LC, Lewis J, Prince RL, Devine A, Bondonno NP, Bondonno CP, Wood LG, Puddey IB, Ward NC, Croft KD, Woodman RJ, Beilin LJ, Hodgson JM. Nitrate-rich vegetables do not lower blood pressure in individuals with mildly elevated blood pressure: a 4-week randomised controlled crossover trial. The American Journal of Clinical Nutrition (2018) Jun 1;107(6):894-908.

Sim M, Blekkenhorst LC, Lewis JR, Bondonno CP, Devine A, Zhu K, Woodman RJ, Prince RL, Hodgson JM. (2018) Vegetable diversity, injurious falls and fracture risk in older women: a prospective cohort study. Nutrients: 10(8), 1081

Alonso N, Estrada K, Albagha OME, Herrera L, Reppe S, Olsta OK, Gautvik KM , Ryan N, Evans K, C Nielson C, Hsu HY, Kiel D, Masi L, Brandi ML, Riches P, Daroszewska1 A, Olmos JM, Sañudo C, Riancho JA, Husted LB, Langdahl BL, Brown MA, Duncan EL, Sims M, Kaptoge S, Reeve J, Usategui R, del Pino J, Gonzalez-Sarmiento R, Lewis J, Prince RL, D’Amelio P, Garcia-Giralt N, Nogues X, Mencej-Bedrac S, Marc J, Wolstein O, Eisman J, Oei L, Medina-Gomez MC, Feenstra B, Melbye M, Schraut K, Navarro P, Wilson J, Davies G, Starr J, Deary I, Tanaka T, Ferrucci L, Gianfrancesco F, Gennari L, Lucas G, Elosua R, Uitterlinden AG, Rivadeneira F, Ralston SH. Identification of a novel locus on chromosome 2q13 which predisposes to clinical vertebral fractures independently of bone density. Annals of Rheumatic disease (2018) Mar;77(3):378-385

Lewis, J., Schousboe, J., Lim, W., Wong, G., Wilson, K., Zhu, K., Thompson, P., Kiel, D., Prince, R., (2018), Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study. Journal of Bone and Mineral Research, 33(6), 1001–1010, United States, Wiley-Blackwell Publishing, Inc., DOI: 10.1002/jbmr.3405.

Lewis, J., Schousboe, JT., Lim, W., Wong, G., Zhu, K., Lim, E., Wilson, K., Thompson, P., Kiel, D., Prince, R., (2016), Abdominal Aortic Calcification Identified on Lateral Spine Images from Bone Densitometers Are a Marker of Generalized Atherosclerosis in Elderly Women. Arteriosclerosis, Thrombosis and Vascular Biology, 36(1), 166-173, USA, Lippincott Williams & Wilkins, DOI: 10.1161/ATVBAHA.115.306383.

Lim, W., Wong, G., Lim, E., Byrnes, E., Zhu, K., Devine, A., Pavlos, N., Prince, R., Lewis, J., (2015), Circulating Lipocalin 2 Levels Predict Fracture-Related Hospitalizations in Elderly Women: A Prospective Cohort Study. Journal of Bone and Mineral Research, 30(11), 2078-2085, Hoboken, USA, John Wiley and Sons Inc., DOI: 10.1002/jbmr.2546.

Zheng, H., Forgetta, V., Hsu, YH., Estrada, K., Rosello-Diez, A., Leo, PJ., Dahia, CL., Park-Min, KH., Tobias, JH., Kooperberg, C., Kleinman, A., Styrkarsdottir, U., Liu, C., Uggla, C., Evans, D., Nielson, CM., Walter, K., Pettersson-Kymmer, U., McCarthy, SE., Eriksson, JA., Kwan, T., Jhamai, M., Trajanoska, K., Memari, Y., Min, J., Huang, J., Danecek, P., Wilmot, B., Li, R., Chou, W., Mokry, LE., Moayyeri, A., Claussnitzer, M., Cheng, C., Cheung, W., Medina-Gomez, C., Ge, B., Chen, S., Choi, K., Oei, L., Fraser, J., Kraaij, R., Hibbs, MA., Gregson, CL., Paquette, D., Hofman, A., Wibom, C., Tranah, GJ., Marshall, M., Gardiner, BB., Cremin, K., Auer, P., Hsu, L., Ring, S., Tung, JY., Thorleifsson, G., Enneman, AW., Van Schoor, NM., De Groot, LC., Van Der Velde, N., Melin, B., Kemp, JP., Christiansen, C., Sayers, A., Zhou, Y., Calderari, S., Van Rooij, J., Carlson, C., Peters, U., Berlivet, S., Dostie, J., Uitterlinden, AG., Williams, SR., Farber, C., Grinberg, D., Lacroix, AZ., Haessler, J., Chasman, DI., Giulianini, F., Rose, LM., Ridker, PM., Eisman, JA., Nguyen, TV., Center, JR., Nogues, X., Garcia-Giralt, N., Launer, LL., Gudnason, V., Mellstrom, D., Vandenput, L., Amin, N., Van Duijn, CM., Karlsson, MK., Ljunggren, O., Svensson, O., Hallmans, G., Rousseau, F., Giroux, S., Bussiere, J., Arp, PP., Koromani, F., Prince, RL., Lewis, J., Langdahl, BL., Hermann, AP., Jensen, J., Kaptoge, S., Khaw, K., Reeve, J., Formosa, M., Xuereb-Anastasi, A., Akesson, K., McGuigan, FE., Garg, G., Olmos, JM., Zarrabeitia, MT., Riancho, JA., Ralston, SH., Alonso, N., Jiang, X., Goltzman, D., Pastinen, T., Grundberg, E., Gauguier, D., Orwoll, ES., Karasik, D., Davey-Smith, G., Aogc Consortium, AC., Smith, AV., Siggeirsdottir, K., Harris, TB., Zillikens, MC., Van Meurs, JB., Thorsteinsdottir, U., Maurano, MT., Timpson, NJ., Soranzo, N., Durbin, R., Wilson, SG., Ntzani, EE., Brown, MA., Stefansson, K., Hinds, DA., Spector, T., Cupples, LA., Ohlsson, C., Greenwood, CM., Uk 10k. Consortium, UK., Jackson, RD., Rowe, DW., Loomis, CA., Evans, DM., Ackert-Bicknell, CL., Joyner, AL., Duncan, EL., Kiel, DP., Rivadeneira, F., Richards, JB., (2015), Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture. Nature, 526(7571), 112-117, UK, Nature Publishing Group, DOI: 10.1038/nature14878.

Blekkenhorst LC, Prince RL, Hodgson JM, Lim WH, Zhu K, Devine A, Thompson PL, Lewis J. Dietary saturated fat intake and the risk of atherosclerotic vascular disease mortality in elderly women: a prospective cohort study. The American Journal of Clinical Nutrition (2015) 101 6 1263 - 1268. PMID: 25948671.

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