Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women
Abstract Decline of bone mineral density (BMD) during menopause is related to increased risk of fractures in postmenopausal women, however, this relationship in premenopausal women has not been established. To quantify this relationship, real‐world data (RWD) from the National Health and Nutrition E...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-07-01
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| Series: | Clinical and Translational Science |
| Online Access: | https://doi.org/10.1111/cts.13006 |
| _version_ | 1818923859285377024 |
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| author | Denise Beck Insa Winzenborg Wei Gao Nael M. Mostafa Peter Noertersheuser Stephanie E. Chiuve Charlotte Owens Mohamad Shebley |
| author_facet | Denise Beck Insa Winzenborg Wei Gao Nael M. Mostafa Peter Noertersheuser Stephanie E. Chiuve Charlotte Owens Mohamad Shebley |
| author_sort | Denise Beck |
| collection | DOAJ |
| description | Abstract Decline of bone mineral density (BMD) during menopause is related to increased risk of fractures in postmenopausal women, however, this relationship in premenopausal women has not been established. To quantify this relationship, real‐world data (RWD) from the National Health and Nutrition Examination Survey (NHANES), and longitudinal data from the elagolix phase III clinical trials were modeled across a wide age range, and covariates were evaluated. The natural changes in femoral neck BMD (FN‐BMD) were well‐described by a bi‐exponential relationship with first‐order BMD formation (k1) and resorption (k2) rate constants. Body mass index (BMI) and race (i.e., Black) were significant predictors indicating that patients with high BMI or Black race experience a relatively lower BMD loss. Simulations suggest that untreated premenopausal women with uterine fibroids (UFs) from elagolix phase III clinical trials (median age 43 years [minimum 25–maximum 53]) lose 0.6% FN‐BMD each year up to menopausal age. For clinical relevance, the epidemiological FRAX model was informed by the simulation results to predict the 10‐year risk of major osteoporotic fracture (MOF). Premenopausal women with UFs, who received placebo only in the elagolix phase III trials, have a projected FN‐BMD of 0.975 g/cm2 at menopause, associated with a 10‐year risk of MOF of 2.3%. Integration of modeling, RWD, and clinical trials data provides a quantitative framework for projecting long‐term postmenopausal risk of fractures, based on natural history of BMD changes in premenopausal women. This framework enables quantitative evaluation of the future risk of MOF for women receiving medical therapies (i.e., GnRH modulators) that adversely affect BMD. |
| first_indexed | 2024-12-20T02:16:08Z |
| format | Article |
| id | doaj.art-668fcd1e2bf94365ac22a86e6bc82dc7 |
| institution | Directory Open Access Journal |
| issn | 1752-8054 1752-8062 |
| language | English |
| last_indexed | 2024-12-20T02:16:08Z |
| publishDate | 2021-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Science |
| spelling | doaj.art-668fcd1e2bf94365ac22a86e6bc82dc72022-12-21T19:56:56ZengWileyClinical and Translational Science1752-80541752-80622021-07-011441452146310.1111/cts.13006Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal womenDenise Beck0Insa Winzenborg1Wei Gao2Nael M. Mostafa3Peter Noertersheuser4Stephanie E. Chiuve5Charlotte Owens6Mohamad Shebley7Clinical Pharmacology and Pharmacometrics AbbVie Deutschland GmbH & Co. KG Ludwigshafen am Rhein GermanyClinical Pharmacology and Pharmacometrics AbbVie Deutschland GmbH & Co. KG Ludwigshafen am Rhein GermanyAnalysis Group Boston Massachusetts USAClinical Pharmacology and Pharmacometrics AbbVie North Chicago Illinois USAClinical Pharmacology and Pharmacometrics AbbVie Deutschland GmbH & Co. KG Ludwigshafen am Rhein GermanyGlobal Epidemiology AbbVie North Chicago Illinois USAClinical Development, General Medicine AbbVie North Chicago Illinois USAClinical Pharmacology and Pharmacometrics AbbVie North Chicago Illinois USAAbstract Decline of bone mineral density (BMD) during menopause is related to increased risk of fractures in postmenopausal women, however, this relationship in premenopausal women has not been established. To quantify this relationship, real‐world data (RWD) from the National Health and Nutrition Examination Survey (NHANES), and longitudinal data from the elagolix phase III clinical trials were modeled across a wide age range, and covariates were evaluated. The natural changes in femoral neck BMD (FN‐BMD) were well‐described by a bi‐exponential relationship with first‐order BMD formation (k1) and resorption (k2) rate constants. Body mass index (BMI) and race (i.e., Black) were significant predictors indicating that patients with high BMI or Black race experience a relatively lower BMD loss. Simulations suggest that untreated premenopausal women with uterine fibroids (UFs) from elagolix phase III clinical trials (median age 43 years [minimum 25–maximum 53]) lose 0.6% FN‐BMD each year up to menopausal age. For clinical relevance, the epidemiological FRAX model was informed by the simulation results to predict the 10‐year risk of major osteoporotic fracture (MOF). Premenopausal women with UFs, who received placebo only in the elagolix phase III trials, have a projected FN‐BMD of 0.975 g/cm2 at menopause, associated with a 10‐year risk of MOF of 2.3%. Integration of modeling, RWD, and clinical trials data provides a quantitative framework for projecting long‐term postmenopausal risk of fractures, based on natural history of BMD changes in premenopausal women. This framework enables quantitative evaluation of the future risk of MOF for women receiving medical therapies (i.e., GnRH modulators) that adversely affect BMD.https://doi.org/10.1111/cts.13006 |
| spellingShingle | Denise Beck Insa Winzenborg Wei Gao Nael M. Mostafa Peter Noertersheuser Stephanie E. Chiuve Charlotte Owens Mohamad Shebley Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women Clinical and Translational Science |
| title | Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| title_full | Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| title_fullStr | Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| title_full_unstemmed | Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| title_short | Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| title_sort | integrating real world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women |
| url | https://doi.org/10.1111/cts.13006 |
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