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Bone Quality Project

Bone Quality Project

Dennis M. Black

University of California, San Francisco

Foundation for NIH (FNIH) will directly raise funds and distribute the funds to UCSF, collaborators, consultants and service vendors. FNIH will execute contracts with each entity that will include multiple payment installments based on achieved milestones described in the Project Plan (see section 4). FNIH will ensure that all contracts include appropriate stipulations regarding data sharing and intellectual property and are consistent with the aims of the project and The Biomarkers Consortium policies.


16 November 2016

Great progress has been made in both the treatment and diagnosis of osteoporosis. Many large randomized trials have shown that osteoporosis treatments can reduce fracture risk and may be one of the factors contributing to the decrease seen in hip fracture incidence. Despite
these advances, there are important limitations to the diagnosis and treatment of osteoporosis,
including limited efficacy for non-spine fractures, limited evidence that anti-osteoporosis drugs prevent fractures among those who do not yet have osteoporosis and lack of data supporting the efficacy of a given treatment beyond 3-4 years. Currently, significant obstacles exist for the
development of new osteoporotic medications. It is challenging, from an ethical standpoint, to
conduct placebo-controlled trials with control subjects who are not taking any osteoporotic drugs. Such ethical problems are circumvented by designing active-control trials and equivalent studies, and also by enrolling lower risk patients. These alternative CT designs require enormous sample sizes for endpoint trials, resulting in infeasibility due to excessive
cost and time required for trial execution. There is an urgent need to develop alternative trial
strategies and/or outcomes that are more efficient than the current ones. The proposed projects will take advantage of the thousands of patients who have already been studied in randomized trials (academic and industry setting) by examining potential biomarkers that reflect the changes in bone strength and fracture risk by utilizing data from: 1) 3D Quantitative
Computed Tomography and 2) biochemical markers of bone turnover, which we expect to
prove useful as endpoints in clinical trials, to aid clinical development generally and, to eventually be adopted in clinical practice. We will pool data from the QCT and BTM sub-studies from a substantial number of these trials. Furthermore, we will apply state-of-the-art methods
to obtain standardized assessments from the QCT scans of bone strength across these multiple
studies. Our overall goal is to maximize the potential of these biomarkers for use in drug development and patient management, using previously collected measurements, and at the same time provide guidance for maximizing their usefulness in future studies. The overall project will be carried out through the execution of two related, but scientifically distinct
projects: 1) Critical evaluation of imaging-derived bone strength measurements for use in drug
development; and
2) Critical evaluation of the utility of serum or urine bone biochemical markers for use in patient management and understanding antifracture efficacy of osteoporosis therapies.
While each of these projects has distinct specific aims, they are inextricably linked. The overarching project will make recommendations for the process of qualification of these biomarkers for use in drug development and/or clinical practice.

[{ "PostingID": 3441, "Title": "GSK-BON103593", "Description": "A one year, parallel, placebo-controlled, double-blind, randomized study to assess the effect of monthly 150mg oral ibandronate dosing versus placebo on bone quality and strength at the proximal femur in women with osteoporosis" }]

Statistical Analysis Plan

Treatment-Related Changes in Bone Turnover and Fracture Risk Reduction in Clinical Trials of Anti-Resorptive Drugs: A Meta-Regression Douglas C Bauer, Dennis M Black, Mary L Bouxsein, Li-Yung Lui, Jane A Cauley, Anne E de Papp, Andreas Grauer, Sundeep Khosla, Charles E McCulloch, and Richard Eastell for the Foundation for the National Institutes of Health (FNIH) Bone Quality Project
Journal of Bone and Mineral Research, Vol. 33, No. 4, April 2018, pp 634-642
DOI: 10.1002/jbmr.3355
Treatment-related changes in bone mineral density as a surrogate biomarker for fracture risk reduction: metaregression analyses of individual patient data from multiple randomised controlled trials Dennis M Black, Douglas C Bauer, Eric Vittinghoff, Li-Yung Lui, Andreas Grauer, Fernando Marin, Sundeep Khosla, Anne de Papp, Bruce Mitlak, Jane A Cauley, Charles E McCulloch, Richard Eastell, Mary L Bouxsein, for the Foundation for the National Institutes of Health Bone Quality
Project Lancet Diabetes Endocrinol 2020; 8: 672-82
doi: 10.1016/S2213-8587(20)30159-5
Change in Bone Density and Reduction in Fracture Risk: A Meta-Regression of Published Trials Mary L Bouxsein, Richard Eastell, Li-Yung Lui, Lucy A Wu, Anne E de Papp, Andreas Grauer, Fernando Marin, Jane A Cauley, Douglas C Bauer, and Dennis M Black; for the FNIH Bone Quality Project Journal of Bone and Mineral Research, Vol. 33, No. xx, Month 2018, pp 1-11
DOI: 10.1002/jbmr.3641
Diabetes Mellitus and the Benefit of Antiresorptive Therapy on Fracture Risk Richard Eastell, Eric Vittinghoff, Li-Yung Lui, Susan K. Ewing, Ann V. Schwartz,
Douglas C. Bauer, Dennis M. Black, and Mary L. Bouxsein Journal of Bone and Mineral Research, Vol. 37, No. 11, November 2022, pp 2121-2131.
DOI: 10.1002/jbmr.4697