Prevention of early menopausal bone loss may reduce the future burden of osteoporosis. In this modelling exercise, an osteoporosis prevention strategy involving 5-year infusions of zoledronic acid, beginning early in menopause, reduced long-term fracture risk and the proportion of aging women with femoral neck densitometric osteoporosis. This strategy warrants further evaluation.
Introduction
Preventing early menopausal bone loss may substantially reduce the future burden of osteoporosis. We modelled the effects of infrequent zoledronic acid infusions on long-term fracture risk.
Methods
Data from the Canadian Multicentre Osteoporosis Study (CaMos) were used to determine the expected natural history of femoral neck areal bone mineral density (BMD) and fracture risk (using FRAX®) from ages 50-80 for women with no antiresorptive drug exposures. We modelled the effects of three infusions of zoledronic acid (at ages 50, 55, 60) on long-term fracture risk, assuming this intervention would preserve BMD until age 65 years, followed by losses mirroring early menopausal BMD loss.
Results
At age 65, untreated women and zoledronic acid recipients had expected mean (SD) femoral neck T-scores of - 1.5(1.0) and - 0.8(1.0), 10-year major osteoporotic fracture (MOF) risks of 9.8%(5.0) and 8.0%(3.7) and hip fracture risks of 1.7%(2.4) and 0.8%(1.2), respectively. At age 80, untreated women and zoledronic acid recipients had expected femoral neck T-scores of - 1.9(0.9) and - 1.4(0.9), MOF risks of 17.9%(8.2) and 14.9%(6.4) and hip fracture risks of 6.3%(6.2) and 4.4%(4.5), respectively. The expected proportion of women with femoral neck T-score ≤ - 2.5 was 14.9% for untreated women and 3.8% for zoledronic acid recipients at age 65, increasing to 28.1% and 12.0%, respectively, at age 80. Numbers-needed-to-treat to prevent one case of densitometric osteoporosis were 9 at age 65 and 5 at age 80.
Conclusion
Infrequent infusions of zoledronic acid, initiated early in menopause, are expected to reduce long-term fracture risk and result in a substantial reduction in the proportion of women with densitometric osteoporosis after age 65.
Prior JC early menopausal bone loss prevention zoledronic acid, menopausal bone mineral density preservation long-term fracture risk, zoledronic acid infusion early menopause osteoporosis prevention modelling, CaMos Canadian Multicentre Osteoporosis Study femoral neck BMD, FRAX fracture risk assessment menopause bone density simulation, bisphosphonate prevention early menopause densitometric osteoporosis, Billington Leslie Prior menopausal bone loss prevention, infrequent zoledronic acid osteoporosis prevention postmenopausal women, femoral neck T-score menopause fracture risk modelling, number needed to treat osteoporosis prevention menopause
PMID 33438038 33438038 DOI 10.1007/s00198-021-05826-5 10.1007/s00198-021-05826-5
Cite this article
E O Billington, W D Leslie, J P Brown, J C Prior, S N Morin, C S Kovacs, S M Kaiser, B C Lentle, T Anastassiades, T Towheed, & G A Kline (2021). Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 32(7), 1313-1320. https://doi.org/10.1007/s00198-021-05826-5
E O Billington, W D Leslie, J P Brown, J C Prior, S N Morin, C S Kovacs, et al. Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study. Osteoporos Int. 2021;32(7):1313-1320. doi:10.1007/s00198-021-05826-5
E O Billington, et al. "Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study." Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 32, no. 7, 2021, pp. 1313-1320.
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