About

Gina Woods is a Clinical Professor in the Department of Medicine at UC San Diego. Her research focuses on osteoporosis, bone marrow adiposity, and rare bone diseases. She has contributed to the understanding of metabolic bone disease in special populations, utilizing advanced imaging techniques such as ultrashort echo time magnetic resonance imaging to detect changes in collagen, pore water, and bone microstructure. Her work also explores the effects of lipids on bone density and fracture risk, as well as the relationship between bone marrow adiposity and bone loss in older adults. Dr. Woods has been involved in studies examining calcium metabolism, hormone therapy, and the impact of aging on bone health, contributing valuable insights into the pathophysiology and potential therapeutic approaches for osteoporosis and related conditions.

Research topics

• Internal medicine
• Medicine
• Endocrinology
• Family medicine
• Chemistry
• Gerontology
• Nuclear medicine
• Physical therapy
• Emergency medicine

Selected publications

• MON-792 Extended Teriparatide Therapy: A Case Study of Continued Bone Density Improvement in Postmenopausal Osteoporosis

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: J. Hansen: None. G. Woods: Corcept Therapeutics, Alexion Pharmaceuticals, Inc.. Teriparatide is a PTH-analog initially FDA approved in 2002 for the treatment of osteoporosis. Due to a signal of increased risk of osteosarcoma in rat models, initial human trials limited exposure to an average of 19 months, and the drug was then approved with a 24-month lifetime use limit. Post-marketing surveillance studies did not show an increased risk of osteosarcoma, and in November 2020 the 2-year limit was lifted. In the absence of clinical trial efficacy data, the question remains if extending treatment will continue to improve bone mineral density (BMD), reduce fracture risk, and/or demonstrate an increase in side effects. We present a case of continued improvement in BMD in a postmenopausal woman with osteoporosis with >4 years of continuous treatment with teriparatide. A 66 year old woman presented to endocrinology clinic following an L1 spinal compression fracture after a ground level fall. Her DXA bone density scan was notable for L2-L4 BMD of 0.66g/cm2 (T-score -4.2). Clinical risk factors for osteoporosis include maternal history of osteoporosis. Laboratory evaluation for secondary causes of osteoporosis was unrevealing. She started teriparatide 20 mcg daily in August 2020. Her bone density improved over the course of 2 years, but T-scores remained < -2.5. Due to her strong preference to continue teriparatide rather than transition to another treatment, she has continued teriparatide for 4 years and 5 months to date. At 3 years 10 months of treatment, her lumbar spine bone density improved to 0.883 g/cm2 (T-score -2.6) and procollagen I intact N-terminal propeptide (P1NP) remains elevated at 214 ug/L. Trabecular bone score (TBS) did not improve . She has not sustained any fractures since starting teriparatide. Side effects have included minor injection site bleeding. This case demonstrates continued improvement in bone density with extended teriparatide use beyond two years in a postmenopausal woman with osteoporosis complicated by vertebral fracture. After nearly four years of treatment, the patient's lumbar spine BMD improved by 22.4% (T-score improved from -4.2 to -2.6) and left total hip improved by 11.0% (T-score -2.5 to -2.0) without significant adverse effects. These findings suggest potential benefits of extended teriparatide therapy, highlighting the need for additional studies to further define the safety and efficacy of extended use. Presentation: Monday, July 14, 2025

  PublisherOA PDFDOI

• SAT-799 Significant One-Year Bone Mineral Density Gains Following a Single Dose of Romosozumab: Insights from Two Case Studies

  Journal of the Endocrine Society · 2025-10-01

  articleOpen accessSenior author

  Abstract Disclosure: H.L. Hofflich: None. M. Soliman: None. L. Eger: None. G. Woods: None. Introduction: Romosozumab is an anabolic medication that treats osteoporosis by increasing bone formation by inhibiting sclerostin. It is given once monthly for twelve months (FDA 2019). Here we report the one-year bone mineral density (BMD) gains following one dose of Romosozumab in two anabolic-naive patients. Case Presentation Patient 1 is a 76-year-old female diagnosed with osteoporosis in August 2023 and treated with Alendronate 70 mg daily for four months, followed by one dose of Romosozumab in April 2024, with no subsequent treatment. Between August 2023 and September 2024, she had statistically significant improvements in BMD at the lumbar spine (13.9%), right femur (7.9%), and left femur (9.6%). Patient 2 is a 67 year old female with osteoporosis treated with one dose of Romosozumab in January 2024 followed by one dose of Zoledronic acid in February 2024. Between September 2023 and December 2024, she had statistically significant improvements in BMD at the lumbar spine (17.1%) and the left femur (10.3%). Discussion: These two cases demonstrate significant one-year BMD improvements with just one dose of Romosozumab. These results are comparable to the BMD changes seen in the FRAME trial, which showed significant gains in BMD of the lumbar spine (13.3%), total hip (6.9%), and femoral neck (5.9%) after 12 doses (Cosman 2016). Considering the biological, histological, and clinical timeline that has been noted in the clinical trials for Romosozumab, it is plausible that rapid improvement in BMD may occur with fewer that twelve doses. In the FRAME and ARCH trials, the markers of bone formation peaked in month 1-2, and returned to baseline by month 9, offering a possible mechanism for a rapid anabolic response. (McClung 2014, Cosman 2016, Erikson 2022). Our cases are limited by a short follow-up period and confounded by the use of bisphosphonate medications in the time period studied. Learning Points 1. Our patients’ one-year BMD improvement after one dose of Romosozumab was similar to the one-year BMD improvement of clinical trial patients after twelve doses of Romosozumab. 2.There is a need for further research to determine whether shorter treatment courses could reduce fractures effectively, minimize side effects, and lower the cost of osteoporosis care. Presentation: Saturday, July 12, 2025

  PublisherOA PDFDOI

• Ultrashort echo time magnetization transfer (UTE-MT) MRI detects non-enzymatic crosslinking of collagen in ex vivo rat bones

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2025-09-16

  article

  Motivation: Type 2 diabetes (T2D) patients suffer from increased bone fracture risk despite preserved or even elevated bone mineral density (BMD). A better diagnostic tool that accurately reports the bone health of T2D patients is urgently needed. Goal(s): To develop an MRI method that can probe non-enzymatic crosslinking of bone collagen and compromise of bone mechanical properties. Approach: We used ultrashort echo time magnetization transfer (UTE-MT) MRI for measuring the degree of collagen crosslinking in ex vivo rat bones with ribosylation. Results: The UTE-MT showed sensitivity to bone collagen crosslinking via ribosylation and subsequent compromise of bone mechanical properties. Impact: The UTE-MT technique showed significant sensitivity to non-enzymatic crosslinking of bone collagen, a key mechanism that explains the increased fracture risk of T2D patients. The UTE-MT can be an accurate noninvasive diagnostic tool for probing bone health of T2D patients.

  PublisherDOI

• Ultrashort echo time quantitative magnetization transfer MRI detects non-enzymatic crosslinking of collagen in ex vivo rat bones

  JBMR Plus · 2025-11-23

  articleOpen access

  Abstract Increased bone fragility despite preserved or elevated BMD in type 2 diabetes mellitus (T2DM) is linked to nonenzymatic collagen crosslinking via advanced glycation end-products (AGEs). However, there is no noninvasive method clinically available to probe these collagen alterations in the bone. We examined the potential of ultrashort echo time quantitative magnetization transfer (UTE-qMT) MRI for detecting AGE-induced collagen crosslinking in bones. Rat tibial bones were subject to ribosylation ex vivo to induce AGE accumulation. UTE-qMT MRI was performed to quantify the magnetization exchange rate (kba) and macromolecular fraction (MMF), which were compared to mechanical properties from 3-point bending tests and AGE concentrations from fluorometric assays. Ribosylation significantly increased AGE crosslinking, confirmed by a 3-fold rise in AGE fluorescence intensity. UTE-qMT MRI revealed a significantly higher kba and MMF in ribosylated bones, whereas BMD did not show significant differences. A 3-point bending test showed that ribosylation reduced post-yield displacement, fracture displacement, and work-to-fracture from load–displacement curves, indicating reduced bone ductility and toughness. Importantly, kba and MMF correlated significantly with these mechanical properties, whereas BMD showed no significant correlations. These findings demonstrate that UTE-qMT MRI is a novel noninvasive tool sensitive to AGE-mediated collagen crosslinking and its critical role in predicting bone fragility.

  PublisherDOI

• Bone health ECHO case report: Normocalcemic hyperparathyroidism in a patient with osteoporosis referred for pre-operative bone health evaluation before spine surgery

  Journal of Clinical Densitometry · 2025-06-16

  articleSenior author
  PublisherDOI

• Subgroup differences in calcium metabolism in response to dietary sodium: Rationale, design, and methods of a randomized, controlled, crossover dietary intervention in healthy adults

  Contemporary Clinical Trials · 2025-05-18

  article
  PublisherDOI

• UTE MRI technical developments and applications in osteoporosis: a review

  Frontiers in Endocrinology · 2025-02-06 · 7 citations

  reviewOpen access

  Osteoporosis (OP) is a metabolic bone disease that affects more than 10 million people in the USA and leads to over two million fractures every year. The disease results in serious long-term disability and death in a large number of patients. Bone mineral density (BMD) measurement is the current standard in assessing fracture risk; however, the majority of fractures cannot be explained by BMD alone. Bone is a composite material of mineral, organic matrix, and water. While bone mineral provides stiffness and strength, collagen provides ductility and the ability to absorb energy before fracturing, and water provides viscoelasticity and poroelasticity. These bone components are arranged in a complex hierarchical structure. Both material composition and physical structure contribute to the unique strength of bone. The contribution of mineral to bone's mechanical properties has dominated scientific thinking for decades, partly because collagen and water are inaccessible using X-ray based techniques. Accurate evaluation of bone requires information about its components (mineral, collagen, water) and structure (cortical porosity, trabecular microstructure), which are all important in maintaining the mechanical integrity of bone. Magnetic resonance imaging (MRI) is routinely used to diagnose soft tissue diseases, but bone is "invisible" with clinical MRI due to its short transverse relaxation time. This review article discusses using ultrashort echo time (UTE) sequences to evaluate bone composition and structure. Both morphological and quantitative UTE MRI techniques are introduced. Their applications in osteoporosis are also briefly discussed. These UTE-MRI advancements hold great potential for improving the diagnosis and management of osteoporosis and other metabolic bone diseases by providing a more comprehensive assessment of bone quantity and quality.

  PublisherDOI

• Leave no bone unturned: metabolic bone disease in special populations

  Therapeutic Advances in Endocrinology and Metabolism · 2025-12-01

  articleOpen accessSenior author
  PublisherDOI

• MRI-based porosity index and suppression ratio in the tibial cortex: significant differences in normal, osteopenic, and osteoporotic subjects

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2024-08-14

  article

  The porosity index (PI) and the suppression ratio (SR) are two rapid MRI-based techniques developed using ultrashort echo time (UTE) sequences to evaluate the cortical bone microstructure. We have investigated the performance of PI and SR in detecting tibial bone quality differences between osteoporosis (OPo) patients, osteopenia (OPe) patients, and healthy volunteers with normal bone (Normal). We also investigated the correlations of PI and SR with DEXA T-score performed at the hip in patients. PI and SR were significantly higher in the OPo group compared with the Normal and OPe groups. DEXA T-score was significantly correlated with PI and SR.

  PublisherDOI

• Risk Factors for Bone Microarchitecture Impairments in Older Men With Type 2 Diabetes—The MrOS Study

  The Journal of Clinical Endocrinology & Metabolism · 2024-07-12 · 10 citations

  articleOpen access

  CONTEXT: Impaired bone microarchitecture, assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT), may contribute to bone fragility in type 2 diabetes (T2DM) but data on men are lacking. OBJECTIVE: To investigate the association between T2DM and HR-pQCT parameters in older men. METHODS: HR-pQCT scans were acquired on 1794 participants in the Osteoporotic Fractures in Men study. T2DM was ascertained by self-report or medication use. Linear regression models, adjusted for age, race, body mass index, limb length, clinic site, and oral corticosteroid use, were used to compare HR-pQCT parameters by diabetes status. RESULTS: Among 1777 men, 290 had T2DM (mean age, 84.4 years). T2DM men had smaller total cross-sectional area at the distal tibia (P = .028) and diaphyseal tibia (P = .025), and smaller cortical area at the distal (P = .009) and diaphyseal tibia (P = .023). Trabecular indices and cortical porosity were similar between T2DM and non-T2DM. Among men with T2DM, in a model including HbA1c, diabetes duration, and insulin use, diabetes duration ≥ 10 years, compared with <10 years, was significantly associated with higher cortical porosity but with higher trabecular thickness at the distal radius. Insulin use was significantly associated with lower cortical area and thickness at the distal radius and diaphyseal tibia and lower failure load at all 3 scan sites. Lower cortical area, cortical thickness, total bone mineral density, cortical bone mineral density, and failure load of the distal sites were associated with increased risk of incident nonvertebral fracture in T2DM. CONCLUSION: Older men with T2DM have smaller bone size compared to those without T2DM, which may contribute to diabetic skeletal fragility. Longer diabetes duration was associated with higher cortical porosity and insulin use with cortical bone deficits and lower failure load.

  PublisherOA PDFDOI

Frequent coauthors

• Deborah M. Kado

  VA Palo Alto Health Care System

  23 shared

• Vilmundur Guðnason

  University of Iceland

  22 shared

• Clifford J. Rosen

  MaineHealth

  17 shared

• John T. Schousboe

  HealthPartners

  14 shared

• Christine B. Chung

  14 shared

• Thomas Rutledge

  VA San Diego Healthcare System

  13 shared

• Ann V. Schwartz

  University of California, San Francisco

  13 shared

• Thomas Lang

  University of California, San Francisco

  12 shared

Labs

• UCSD School of Bone DensitometryPI

Education

• MD

  Drexel University School of Medicine

  2001

• BS, Chemical Engineering

  Johns Hopkins University

  1996