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
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
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
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
Learn more about this trial
A Transiliac Crest Bone Histology and Histomorphometry Study in Postmenopausal Women With Low Bone Mass or Osteoporosis Previously Treated With Denosumab
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