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A Transiliac Crest Bone Histology and Histomorphometry Study in Postmenopausal Women With Low Bone Mass or Osteoporosis Previously Treated With Denosumab

Primary Purpose

Low Bone Mass, Low Bone Mineral Density, Osteoporosis

Status
Completed
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Previous denosumab
Sponsored by
Amgen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Low Bone Mass focused on measuring Low Bone Mass, Low Bone Mineral Density, Osteoporosis, Postmenopausal Osteoporosis, Bone Biopsy, Transiliac Crest Bone Histology, Histomorphometry

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Ambulatory postmenopausal women
  • Received denosumab and completed study 20050179 (NCT00293813), completed study 20050141 (NCT00330460), completed study 20060237 (NCT00515463), completed study 20030216 (NCT00089791) but did not enroll in study 20060289 (NCT00523341). Patients who will participate in the off-treatment imaging study for 20080747 (NCT00890981) also are eligible.
  • Completed participation in eligible studies ≥ 12 and ≤ 36 months prior to screening
  • Provide signed informed consent

Exclusion Criteria:

  • Did not receive denosumab in studies 20050141, 20060237, 20030216, or 20050179.
  • Discontinued investigational product before end of study visit for studies 20050141, 20060237, 20030216, or 20050179.
  • Received > 1 month osteoporosis treatment since having completed studies 20050141, 20060237, 20030216, or 20050179.
  • Received zoledronic acid at any time after ending study participation in parent studies 20050141, 20050179, 20030216, or 20060237.
  • Newly diagnosed with any of the following conditions during the intervening period since completing studies 20050141, 20060237, 20030216, or 20050179:
  • Hyperthyroidism (stable on anti-thyroid therapy or post-ablation is allowed, if the Thyroid Stimulating Hormone is within the normal range)
  • Hypothyroidism (stable on thyroid replacement therapy is allowed, if the Thyroid Stimulating Hormone is within the normal range)
  • Hyper- or hypoparathyroidism
  • Osteomalacia
  • Paget's disease of bone
  • Other bone diseases which affect bone metabolism (eg, osteopetrosis, osteogenesis imperfecta)
  • Malignancy within the last 5 years (except cervical carcinoma in situ or basal cell carcinoma).
  • Self-reported alcohol or drug abuse within the previous 12 months.
  • Permanently non-ambulatory subjects (use of assistive device eg cane, walker is permitted).
  • Has known or suspected sensitivity or contraindication to tetracycline derivatives.
  • Received any investigational product other than denosumab.
  • Current use of the following osteoporosis agents: bisphosphonates, calcitonin, fluoride, parathyroid hormone analogue, selective estrogen receptor modulators, systemic oral or transdermal estrogen (except vaginal preparations and estrogen creams which are acceptable), strontium or tibolone.
  • Has undergone bilateral transiliac crest bone biopsy in the past.
  • Current use of medications that, in the opinion of the investigator, cannot be discontinued and may compromise the safety of the subject when undergoing the bone biopsy procedure (eg, aspirin, warfarin, high-dose heparin).
  • Current use of systemic glucocorticoid therapy (topical or nasal steroids are permitted).
  • Evidence of coagulopathy that in the opinion of the investigator, may compromise patient safety when subjected to the bone biopsy procedure.
  • Any disorder that, in the opinion of the investigator, may compromise the ability of the participant to give written informed consent and/or comply with study procedures.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Other

    Arm Label

    Previous denosumab

    Arm Description

    Participants who had previously received denosumab received a transiliac crest bone biopsy performed following standard labeling procedures with tetracycline or tetracycline derivative.

    Outcomes

    Primary Outcome Measures

    Number of Participants With Normal/Abnormal Bone Histology
    The number of participants with normal/abnormal bone histology as assessed by bone biopsy samples at the central histomorphometric facility. Normal bone histology is characterized by: - normal lamellar bone, - normal mineralization or - osteoid (the organic matrix of bone; young bone that has not undergone calcification). Biopsies with abnormal bone histology are characterized by: - osteomalacia, - marrow fibrosis, - clinically significant marrow abnormality or - woven bone.

    Secondary Outcome Measures

    Bone Histomorphometry: Cancellous Bone Volume
    Cancellous (trabecular) bone volume (Tb.V) is the relative volume of total cancellous bone measured (TV), expressed as percentage, that is occupied by trabeculae. Cancellous bone volume was measured using Fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Bone Histomorphometry: Trabecular Number
    Trabecular number (Tb.N) is the number of trabeculae present per lineal mm and is calculated as trabecular bone volume/trabecular thickness. Tb.N is a measure of trabecular connectivity and decreases with bone loss.
    Bone Histomorphometry: Trabecular Separation
    Trabecular separation (Tb.Sp) is the mean distance in mm between trabeculae (measured by integrated computer graphics). Tb.Sp increases with trabecular bone loss.
    Bone Histomorphometry: Trabecular Thickness
    Mean trabecular thickness (Tb.Th) is a measure of trabecular structure and is calculated as the reciprocal of total bone (trabecular) surfaces. Tb.Th is reduced by aging and osteoporosis.
    Bone Histomorphometry: Cortical Width
    Cortical width correlates with dual photon absorptiometric (DPX) measurements of bone density.
    Bone Histomorphometry: Surface Density
    Surface density is calculated by total bone (trabecular) surfaces / total tissue volume.
    Bone Histomorphometry: Osteoblast - Osteoid Interface
    Osteoblast - osteoid interface is calculated as osteoblast surface / osteoid surface * 100.
    Bone Histomorphometry: Osteoid Surface
    Osteoid surface is expressed as a percentage total bone surface.
    Bone Histomorphometry: Osteoid Width
    Osteoid thickness (width; O.Th) is the mean thickness of osteoid seams on cancellous surfaces. O.Th is normally <12.5 µm. Increased O.Th suggests abnormal mineralization (osteomalacia).
    Bone Histomorphometry: Wall Thickness
    Wall thickness is the average thickness of trabecular bone structural units (BSU) and is used to assess the overall balance between resorption and formation.
    Bone Histomorphometry: Eroded Surface/Bone Surface
    Eroded surface is expressed as a percentage of total bone surface.
    Bone Histomorphometry: Osteoclast Number - Length Based
    Osteoclast number expressed per mm of bone. Osteoclast number was measured using fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Bone Histomorphometry: Osteoclast Number - Surface Based
    Osteoclast number expressed per bone surface area. Osteoclast number was measured using fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Bone Histomorphometry: Single-label Surface
    Single-label surface is expressed as a percentage of total bone surface. The presence of a single label indicates that mineralization was occurring during only one labeling period.
    Bone Histomorphometry: Double-label Surface
    Double-label surface is expressed as a percentage of total bone surface. The presence of double labels indicates that normal bone mineralization was actively occurring over the labeling interval.
    Bone Histomorphometry: Total Mineralizing Surface
    Total mineralizing surfaces (MS) include all double and half of single-labeled surfaces. MS is expressed as a percentage of total bone surface.
    Bone Histomorphometry: Mineral Apposition Rate
    The mineral apposition rate (MAR) is the avarage rate at which new bone mineral is being added on any actively forming surface. MAR is calculated as the average distance between visible labels, divided by the labeling interval.
    Bone Histomorphometry: Adjusted Mineral Apposition Rate
    The mineral apposition rate (MAR) is the avarage rate at which new bone mineral is being added on any actively forming surface. Adjusted MAR is calculated as: (average distance between visible labels / labeling interval) * (total mineralizing surface/total bone surface).
    Bone Histomorphometry: Bone Formation Rate - Surface Based
    Bone formation rate - surface based (BFR/BS) is the calculated rate at which cancellous bone surface is being replaced annually. BFR/BS is derived from the Mineral Appositional Rate * 365 * (relative mineralizing surface /total bone surface).
    Bone Histomorphometry: Bone Formation Rate - Volume Based
    Bone formation rate - volume based (BFR/BV) is the calculated rate at which cancellous bone volume is being replaced annually. BFR/BV is derived from the Mineral Appositional Rate * 365 * (relative mineralizing surface / total bone volume).
    Bone Histomorphometry: Formation Period
    The formation period is the duration of an interval when a place on the bone surface is actively forming bone. The formation period is calculated as the wall width (thickness of new bone made in one cycle) divided by the mineral apposition rate.
    Bone Histomorphometry: Activation Frequency
    The average time that it takes for a new remodeling cycle to begin on any point on a cancellous surface is called the activation frequency (Ac.f). Activation frequency is calculated as the bone formation rate / wall width.
    Bone Histomorphometry: Osteoid Volume
    Osteoid volume is expressed as a percentage of total bone volume.
    Bone Histomorphometry: Mineralization Lag Time
    The mineralization lag time is the time interval between osteoid secretion and its subsequent mineralization, in days.
    C-Telopeptide (CTX-1)
    C-Telopeptide is a biochemical marker for bone turnover. Blood samples were drawn for assessment of CTX-1 levels on either Day 3 or Day 20, within 24 hours of the last dose of the respective tetracycline cycle.
    Procollagen Type 1 N-terminal Peptide (P1NP)
    Procollagen Type 1 N-terminal Peptide is a biochemical marker of bone turnover. Blood samples were drawn for assessment of P1NP levels on either Day 3 or Day 20, within 24 hours of the last dose of the respective tetracycline cycle.

    Full Information

    First Posted
    April 23, 2009
    Last Updated
    October 23, 2013
    Sponsor
    Amgen
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00887965
    Brief Title
    A Transiliac Crest Bone Histology and Histomorphometry Study in Postmenopausal Women With Low Bone Mass or Osteoporosis Previously Treated With Denosumab
    Official Title
    A Transiliac Crest Bone Histology and Histomorphometry Study in Postmenopausal Women With Low Bone Mass or Osteoporosis Previously Treated With Denosumab
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2013
    Overall Recruitment Status
    Completed
    Study Start Date
    June 2009 (undefined)
    Primary Completion Date
    June 2010 (Actual)
    Study Completion Date
    August 2010 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Amgen

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    To characterize the effects of discontinuation of denosumab therapy on variables of bone histology in postmenopausal women with low bone mass or osteoporosis. Patients who have received denosumab and completed study 20050179 (NCT00293813), completed study 20050141 (NCT00330460), completed study 20060237 (NCT00515463), completed study 20030216 (NCT00089791) but did not enroll in study 20060289 (NCT00523341) will be included in this study. Patients who will participate in the off-treatment imaging study for 20080747 (NCT00890981) are also eligible.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Low Bone Mass, Low Bone Mineral Density, Osteoporosis, Postmenopausal Osteoporosis
    Keywords
    Low Bone Mass, Low Bone Mineral Density, Osteoporosis, Postmenopausal Osteoporosis, Bone Biopsy, Transiliac Crest Bone Histology, Histomorphometry

    7. Study Design

    Primary Purpose
    Supportive Care
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    15 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Previous denosumab
    Arm Type
    Other
    Arm Description
    Participants who had previously received denosumab received a transiliac crest bone biopsy performed following standard labeling procedures with tetracycline or tetracycline derivative.
    Intervention Type
    Drug
    Intervention Name(s)
    Previous denosumab
    Intervention Description
    Participants who had previously received denosumab received a transiliac crest bone biopsy performed following standard labeling procedures with tetracycline or tetracycline derivative.
    Primary Outcome Measure Information:
    Title
    Number of Participants With Normal/Abnormal Bone Histology
    Description
    The number of participants with normal/abnormal bone histology as assessed by bone biopsy samples at the central histomorphometric facility. Normal bone histology is characterized by: - normal lamellar bone, - normal mineralization or - osteoid (the organic matrix of bone; young bone that has not undergone calcification). Biopsies with abnormal bone histology are characterized by: - osteomalacia, - marrow fibrosis, - clinically significant marrow abnormality or - woven bone.
    Time Frame
    25-34 days post-Day 1
    Secondary Outcome Measure Information:
    Title
    Bone Histomorphometry: Cancellous Bone Volume
    Description
    Cancellous (trabecular) bone volume (Tb.V) is the relative volume of total cancellous bone measured (TV), expressed as percentage, that is occupied by trabeculae. Cancellous bone volume was measured using Fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Trabecular Number
    Description
    Trabecular number (Tb.N) is the number of trabeculae present per lineal mm and is calculated as trabecular bone volume/trabecular thickness. Tb.N is a measure of trabecular connectivity and decreases with bone loss.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Trabecular Separation
    Description
    Trabecular separation (Tb.Sp) is the mean distance in mm between trabeculae (measured by integrated computer graphics). Tb.Sp increases with trabecular bone loss.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Trabecular Thickness
    Description
    Mean trabecular thickness (Tb.Th) is a measure of trabecular structure and is calculated as the reciprocal of total bone (trabecular) surfaces. Tb.Th is reduced by aging and osteoporosis.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Cortical Width
    Description
    Cortical width correlates with dual photon absorptiometric (DPX) measurements of bone density.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Surface Density
    Description
    Surface density is calculated by total bone (trabecular) surfaces / total tissue volume.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoblast - Osteoid Interface
    Description
    Osteoblast - osteoid interface is calculated as osteoblast surface / osteoid surface * 100.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoid Surface
    Description
    Osteoid surface is expressed as a percentage total bone surface.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoid Width
    Description
    Osteoid thickness (width; O.Th) is the mean thickness of osteoid seams on cancellous surfaces. O.Th is normally <12.5 µm. Increased O.Th suggests abnormal mineralization (osteomalacia).
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Wall Thickness
    Description
    Wall thickness is the average thickness of trabecular bone structural units (BSU) and is used to assess the overall balance between resorption and formation.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Eroded Surface/Bone Surface
    Description
    Eroded surface is expressed as a percentage of total bone surface.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoclast Number - Length Based
    Description
    Osteoclast number expressed per mm of bone. Osteoclast number was measured using fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoclast Number - Surface Based
    Description
    Osteoclast number expressed per bone surface area. Osteoclast number was measured using fluorochrome labeling with tetracyclene and tartrate-resistant acid phosphatase stain (TRAP) staining techniques.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Single-label Surface
    Description
    Single-label surface is expressed as a percentage of total bone surface. The presence of a single label indicates that mineralization was occurring during only one labeling period.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Double-label Surface
    Description
    Double-label surface is expressed as a percentage of total bone surface. The presence of double labels indicates that normal bone mineralization was actively occurring over the labeling interval.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Total Mineralizing Surface
    Description
    Total mineralizing surfaces (MS) include all double and half of single-labeled surfaces. MS is expressed as a percentage of total bone surface.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Mineral Apposition Rate
    Description
    The mineral apposition rate (MAR) is the avarage rate at which new bone mineral is being added on any actively forming surface. MAR is calculated as the average distance between visible labels, divided by the labeling interval.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Adjusted Mineral Apposition Rate
    Description
    The mineral apposition rate (MAR) is the avarage rate at which new bone mineral is being added on any actively forming surface. Adjusted MAR is calculated as: (average distance between visible labels / labeling interval) * (total mineralizing surface/total bone surface).
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Bone Formation Rate - Surface Based
    Description
    Bone formation rate - surface based (BFR/BS) is the calculated rate at which cancellous bone surface is being replaced annually. BFR/BS is derived from the Mineral Appositional Rate * 365 * (relative mineralizing surface /total bone surface).
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Bone Formation Rate - Volume Based
    Description
    Bone formation rate - volume based (BFR/BV) is the calculated rate at which cancellous bone volume is being replaced annually. BFR/BV is derived from the Mineral Appositional Rate * 365 * (relative mineralizing surface / total bone volume).
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Formation Period
    Description
    The formation period is the duration of an interval when a place on the bone surface is actively forming bone. The formation period is calculated as the wall width (thickness of new bone made in one cycle) divided by the mineral apposition rate.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Activation Frequency
    Description
    The average time that it takes for a new remodeling cycle to begin on any point on a cancellous surface is called the activation frequency (Ac.f). Activation frequency is calculated as the bone formation rate / wall width.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Osteoid Volume
    Description
    Osteoid volume is expressed as a percentage of total bone volume.
    Time Frame
    25-34 days post-Day 1
    Title
    Bone Histomorphometry: Mineralization Lag Time
    Description
    The mineralization lag time is the time interval between osteoid secretion and its subsequent mineralization, in days.
    Time Frame
    25-34 days post-Day 1
    Title
    C-Telopeptide (CTX-1)
    Description
    C-Telopeptide is a biochemical marker for bone turnover. Blood samples were drawn for assessment of CTX-1 levels on either Day 3 or Day 20, within 24 hours of the last dose of the respective tetracycline cycle.
    Time Frame
    Day 3 or Day 20
    Title
    Procollagen Type 1 N-terminal Peptide (P1NP)
    Description
    Procollagen Type 1 N-terminal Peptide is a biochemical marker of bone turnover. Blood samples were drawn for assessment of P1NP levels on either Day 3 or Day 20, within 24 hours of the last dose of the respective tetracycline cycle.
    Time Frame
    Day 3 or Day 20

    10. Eligibility

    Sex
    Female
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Ambulatory postmenopausal women Received denosumab and completed study 20050179 (NCT00293813), completed study 20050141 (NCT00330460), completed study 20060237 (NCT00515463), completed study 20030216 (NCT00089791) but did not enroll in study 20060289 (NCT00523341). Patients who will participate in the off-treatment imaging study for 20080747 (NCT00890981) also are eligible. Completed participation in eligible studies ≥ 12 and ≤ 36 months prior to screening Provide signed informed consent Exclusion Criteria: Did not receive denosumab in studies 20050141, 20060237, 20030216, or 20050179. Discontinued investigational product before end of study visit for studies 20050141, 20060237, 20030216, or 20050179. Received > 1 month osteoporosis treatment since having completed studies 20050141, 20060237, 20030216, or 20050179. Received zoledronic acid at any time after ending study participation in parent studies 20050141, 20050179, 20030216, or 20060237. Newly diagnosed with any of the following conditions during the intervening period since completing studies 20050141, 20060237, 20030216, or 20050179: Hyperthyroidism (stable on anti-thyroid therapy or post-ablation is allowed, if the Thyroid Stimulating Hormone is within the normal range) Hypothyroidism (stable on thyroid replacement therapy is allowed, if the Thyroid Stimulating Hormone is within the normal range) Hyper- or hypoparathyroidism Osteomalacia Paget's disease of bone Other bone diseases which affect bone metabolism (eg, osteopetrosis, osteogenesis imperfecta) Malignancy within the last 5 years (except cervical carcinoma in situ or basal cell carcinoma). Self-reported alcohol or drug abuse within the previous 12 months. Permanently non-ambulatory subjects (use of assistive device eg cane, walker is permitted). Has known or suspected sensitivity or contraindication to tetracycline derivatives. Received any investigational product other than denosumab. Current use of the following osteoporosis agents: bisphosphonates, calcitonin, fluoride, parathyroid hormone analogue, selective estrogen receptor modulators, systemic oral or transdermal estrogen (except vaginal preparations and estrogen creams which are acceptable), strontium or tibolone. Has undergone bilateral transiliac crest bone biopsy in the past. Current use of medications that, in the opinion of the investigator, cannot be discontinued and may compromise the safety of the subject when undergoing the bone biopsy procedure (eg, aspirin, warfarin, high-dose heparin). Current use of systemic glucocorticoid therapy (topical or nasal steroids are permitted). Evidence of coagulopathy that in the opinion of the investigator, may compromise patient safety when subjected to the bone biopsy procedure. Any disorder that, in the opinion of the investigator, may compromise the ability of the participant to give written informed consent and/or comply with study procedures.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    MD
    Organizational Affiliation
    Amgen
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Links:
    URL
    http://www.amgentrials.com
    Description
    AmgenTrials clinical trials website

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