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Bisphosphonates for Prevention of Post-Denosumab Bone Loss

Primary Purpose

IOP, Osteoporosis

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Alendronate
Zoledronic Acid
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for IOP focused on measuring premenopausal women

Eligibility Criteria

20 Years - 55 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • All women completing at least 12 months of Forteo treatment and at least 12 months of denosumab under previous research studies who remain without a diagnosis of an excluded medical condition and medication exposures as detailed below, will be offered enrollment into this study.

Exclusion Criteria:

  • Known intolerance to calcium supplements
  • Contraindications to bisphosphonate treatment:

    1. Hypocalcemia
    2. Pregnancy
    3. Known hypersensitivity to bisphosphonates
  • History of osteomalacia
  • History of osteonecrosis of the jaw
  • History of dental extraction or other invasive dental surgery within the prior 4 weeks
  • Invasive dental work planned in the next 12 months
  • Any condition or illness (acute, chronic, or history), which in the opinion of the Investigator might interfere with the evaluation of efficacy and safety during the study or may otherwise compromise the safety of the subject
  • Self-reported or known alcohol or drug abuse within the previous 12 months
  • Current or recent (within 1 year of enrollment) inflammatory bowel disease or malabsorption
  • Abnormal laboratory tests performed during Visit 1

    1. Renal insufficiency or liver disease: estimated glomerular filtration rate (eGFR) < 35 ml/min, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >50% above upper limit of normal
    2. Hypercalcemia, hypocalcemia
    3. Vitamin D deficiency: 25-Hydroxyvitamin D (25-OHD) < 30 ng/mL
  • Subjects must be willing to participate voluntarily. Specifically excluded are the following: 1) women less than 20 (or 35 in the case of those who wish to participate because they have low BMD); 2) protected individuals (institutionalized); 3) prisoners; 4) any other prospective participant who, for any reason, might not be able to give voluntary informed consent.

Sites / Locations

  • Creighton University
  • Columbia University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

alendronate

zoledronic acid

Arm Description

Subjects will receive oral alendronate

Subjects will receive zoledronic acid

Outcomes

Primary Outcome Measures

Difference in BMD at the Lumbar spine (L1-4) within group
Within-group difference (percent change) in BMD at the lumbar spine (L1-4) will be measured by Dual-energy X-ray absorptiometry (DXA) and calculated.

Secondary Outcome Measures

Full Information

First Posted
January 5, 2018
Last Updated
May 24, 2023
Sponsor
Columbia University
Collaborators
Amgen
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1. Study Identification

Unique Protocol Identification Number
NCT03396315
Brief Title
Bisphosphonates for Prevention of Post-Denosumab Bone Loss
Official Title
Bisphosphonates for Prevention of Post-Denosumab Bone Loss in Premenopausal Women With Idiopathic Osteoporosis
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
January 29, 2018 (Actual)
Primary Completion Date
January 1, 2024 (Anticipated)
Study Completion Date
January 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Columbia University
Collaborators
Amgen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary goal of the study is to assess the extent to which bisphosphonate therapy will prevent decreases in bone mass that may occur after cessation of denosumab in premenopausal women with idiopathic osteoporosis (IOP) enrolled in AAAN0161 (FD05114) "Denosumab for the prevention of post-teriparatide bone loss in premenopausal women with idiopathic osteoporosis". In addition, the investigator will observe participants for a second year off bisphosphonate therapy to assess duration of response. The hypothesis is that bisphosphonate therapy with alendronate or zoledronic acid, initiated after recovery of bone remodeling activity, will prevent significant bone loss after discontinuing denosumab.
Detailed Description
Osteoporosis in premenopausal women with normal menstrual function and no specific cause is termed idiopathic osteoporosis (IOP). IOP is a rare disease with an estimated prevalence of <200,000 affected premenopausal women in the United States. Women with IOP completing at least one year and up to three years of denosumab (Protocol AAAN0161) will be offered participation in this open-label study in which they would choose whether to take oral alendronate 70 mg weekly for 12 months or a single intravenous dose of zoledronic acid 5 mg. Subjects and study personnel will be blinded to BMD outcomes until 12 months. Discontinuation of denosumab is followed by substantial increases in bone turnover markers to well above baseline, bone resorption reaching twice baseline levels for about 6 months. Over the first 12 months off therapy, all the bone density gained on treatment is lost. Studies done at the institution has demonstrated the occurrence of multiple vertebral fractures in some patients who have stopped denosumab. Based upon these new fracture data, the Prolia label is currently recommending that consideration should be given to transition to another antiresorptive drug in patients stopping denosumab. The main goals of this extension study are to determine rates of bone loss and incidence of radiographic vertebral fractures during one year of bisphosphonate therapy (oral alendronate or intravenous zoledronic acid) initiated after completing denosumab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
IOP, Osteoporosis
Keywords
premenopausal women

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
open-label study in which they would choose whether to take oral alendronate 70 mg weekly for 12 months or a single intravenous dose of zoledronic acid 5 mg.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
27 (Actual)

8. Arms, Groups, and Interventions

Arm Title
alendronate
Arm Type
Active Comparator
Arm Description
Subjects will receive oral alendronate
Arm Title
zoledronic acid
Arm Type
Active Comparator
Arm Description
Subjects will receive zoledronic acid
Intervention Type
Drug
Intervention Name(s)
Alendronate
Other Intervention Name(s)
fosamax
Intervention Description
oral alendronate 70 mg weekly for 12 months will be given for the prevention of osteoporosis
Intervention Type
Drug
Intervention Name(s)
Zoledronic Acid
Other Intervention Name(s)
Reclast
Intervention Description
single intravenous dose of zoledronic acid 5 mg will be given for the prevention of osteoporosis
Primary Outcome Measure Information:
Title
Difference in BMD at the Lumbar spine (L1-4) within group
Description
Within-group difference (percent change) in BMD at the lumbar spine (L1-4) will be measured by Dual-energy X-ray absorptiometry (DXA) and calculated.
Time Frame
Baseline, 12 month

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All women completing at least 12 months of Forteo treatment and at least 12 months of denosumab under previous research studies who remain without a diagnosis of an excluded medical condition and medication exposures as detailed below, will be offered enrollment into this study. Exclusion Criteria: Known intolerance to calcium supplements Contraindications to bisphosphonate treatment: Hypocalcemia Pregnancy Known hypersensitivity to bisphosphonates History of osteomalacia History of osteonecrosis of the jaw History of dental extraction or other invasive dental surgery within the prior 4 weeks Invasive dental work planned in the next 12 months Any condition or illness (acute, chronic, or history), which in the opinion of the Investigator might interfere with the evaluation of efficacy and safety during the study or may otherwise compromise the safety of the subject Self-reported or known alcohol or drug abuse within the previous 12 months Current or recent (within 1 year of enrollment) inflammatory bowel disease or malabsorption Abnormal laboratory tests performed during Visit 1 Renal insufficiency or liver disease: estimated glomerular filtration rate (eGFR) < 35 ml/min, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >50% above upper limit of normal Hypercalcemia, hypocalcemia Vitamin D deficiency: 25-Hydroxyvitamin D (25-OHD) < 30 ng/mL Subjects must be willing to participate voluntarily. Specifically excluded are the following: 1) women less than 20 (or 35 in the case of those who wish to participate because they have low BMD); 2) protected individuals (institutionalized); 3) prisoners; 4) any other prospective participant who, for any reason, might not be able to give voluntary informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth Shane, MD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Creighton University
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68131
Country
United States
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
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21365462
Citation
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Links:
URL
http://columbiamedicine.org/divisions/Endo/index.shtml
Description
Department of Endocrinology at Columbia University

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Bisphosphonates for Prevention of Post-Denosumab Bone Loss

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