Changes in BMD over 6 months of elagolix treatment at either dose were less than has been observed with GnRH agonists (−3.2% to −4.3%).47–49 Over a short-term assessment period (12 weeks) in a phase 2 study, decreases in BMD were lower with elagolix 150 or 250 mg once daily compared with leuprolide acetate 3.75 mg.25 Patients with risk factors for bone loss or osteoporosis (e.g., history of low-trauma fracture, family history of osteoporosis, and lifestyle risk factors) should undergo BMD assessment before starting elagolix. The gene discussed is GNRH1; the disease is osteoporosis.