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Effects of Denosumab on Periprosthetic Bone After Total Hip Arthroplasty

Primary Purpose

Osteoarthritis, Hip, Ambulation Difficulty

Status
Completed
Phase
Phase 2
Locations
Sweden
Study Type
Interventional
Intervention
denosumab
Sponsored by
Hans Mallmin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Osteoarthritis, Hip focused on measuring Osteoarthritis of the hip, Uncemented Total Hip Arthroplasty, DXA, BMD, PET, CT, Biochemical bone markers

Eligibility Criteria

35 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. male or female patient 35-65 years of age with an unilateral OAH requiring a THA and a healthy contralateral hip
  2. body weight ≤110 kg or body mass index (BMI) ≤35 kg/m2
  3. living in the Uppsala County
  4. the eligible patients should have been given oral information, a written Patient Information and signed an Informed Consent

Exclusion Criteria:

  1. on or previously have had bone-specific treatment, e.g. bisphosphonates, raloxifene, parathyroid hormone, strontium ranelate, during the last five years
  2. patients on systemical corticosteroid for more than 3 months should not be considered
  3. patients with diagnosed malignant disease during the last five years or known to have metastasis from malignant disease should be excluded
  4. patients with compromised general conditions and an American Society of Anesthesiologists, ASA-score >31 should not be regarded eligible
  5. patients with known drug or alcohol abuse or regarded as socially dysfunctional, as judged by the investigator, should not be considered for the study
  6. pregnant women or women planning for pregnancy or fertile women (premenopausal) without contraceptives should not be accepted for the study
  7. patients that have been exposed frequently and/or have had large irradiation doses, as judged by the investigator, must not be included in the study.
  8. enrolled in either another investigational drug study, in another investigational device study, or in another investigational study of an approved drug within 30 days prior to Visit 1 of the current study
  9. any condition or laboratory findings which in the opinion of the Investigator makes the patient unsuitable for inclusion (for example claustrophobia)

Sites / Locations

  • Department of Orthopedics

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Denosumab

saline

Arm Description

1 ml (60 mg) subcutaneous injection Denosumab give in the posterior part of the upper arm after surgery followed by another injection 6 months later

1 ml subcutaneous injection 0.9% saline give in the posterior part of the upper arm after surgery followed by another injection 6 months later

Outcomes

Primary Outcome Measures

Bone Mineral Density
Bone mineral density by DXA in Gruen Zone 7 and a sum of Gruen zone 1-7

Secondary Outcome Measures

Bone mineral Density
BMD, g/cm2, adjacent to the femur implant for Gruen Zone 1-7, 3, 6, and 24 months after surgery
Standardised Uptake value
fluoride isotope uptake, measured as (SUV), adjacent to the femoral stem, 3 and 6 months after surgery.
Standardised Uptake value
fluoride isotope uptake, measured as SUV adjacent to the acetabular cup 3 and 6 months after surgery
Bone Mineral density
BMD adjacent to the acetabular cup during the follow up period, i.e. after 3, 6, 12 and 24 months
Bone Mineral Density
BMD at the lumbar spine and at the contra lateral nonoperated hip 6, 12 and 24 months after surgery
Standardised Uptake Value
Fluoride isotope uptake measured as SUV at the lumbar spine and at the contra lateral nonoperated hip after 3 and 6 months
Biochemical markers for bone metabolism
biochemical markers for bone turnover and the relation to SUV and BMD findings at the proximal femur and acetabulum during the follow up period, i.e. 3, 6, 12 and 24 months after surgery
Biochemical markers for bone metabolism in relation to Bone Mineral Density and Standardised Uptake Value
biochemical markers for bone turnover and the relation to SUV and BMD findings at anatomical sites not exposed to surgery, i.e. the lumbar spine and the contra lateral hip 3 and 6 months after surgery
Biochemical markers for bone metabolism in relation to Bone Mineral Density and Standardised Uptake Value
to evaluate the natural course of an uncemented THA on BMD, i.e. the placebo group 3, 6, 12 and 24 months after surgery, SUV i.e. the placebo group 3 and 6 months after surgery and on biochemical markers, i.e. the placebo group 3, 6, 12 and 24 months after surgery
Clinical outcome evaluation
to evaluate the patients Quality of Life, measured by Harris Hip score and EQ-5D questionnaires
Adverse events
incidence and severity of adverse events (AEs) during the study period

Full Information

First Posted
June 26, 2012
Last Updated
April 4, 2017
Sponsor
Hans Mallmin
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1. Study Identification

Unique Protocol Identification Number
NCT01630941
Brief Title
Effects of Denosumab on Periprosthetic Bone After Total Hip Arthroplasty
Official Title
Uncemented Total Hip Implant and Subcutaneous Injections of Denosumab for Patients With Osteoarthritis of the Hip. A Randomized Double Blind Placebo Controlled Study on the Effects on Bone Evaluated With DXA, PET/CT and Biochemical Markers
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
August 7, 2012 (Actual)
Primary Completion Date
January 16, 2017 (Actual)
Study Completion Date
March 30, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Hans Mallmin

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective is to study the effect of Denosumab on Bone Mineral Density, Standardised Uptake Value and bone metabolism in patients with total hip arthroplasty. The primary hypothesis is to demonstrate that Denosumab is superior to placebo.
Detailed Description
A clinical study with 64 patients, age 35-65 years, with unilateral osteoarthritis of the hip, randomised to two groups of patients, either receiving Denosumab or placebo The patients will operated with an uncemented total hip arthroplasty with a Continuum acetabular cup with trabecular surface (Tantalum) and longevity Highly Cross-linked Polyethylene liner, Zimmer, Warsaw, IN, USA, and a CFP femoral stem with Titanium surface and a chrome cobalt 28 mm head, Waldemar Link, Hamburg, Germany. Clinical outcome evaluated by Harris Hip Score and EQ-5D, Bone Mineral Density by DXA, Standardised Uptake Value of Fluoride tracer, by PET/CT and biochemical markers for bone formation and bone resorption will be analyzed together with conventional radiology for implant position and fixation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis, Hip, Ambulation Difficulty
Keywords
Osteoarthritis of the hip, Uncemented Total Hip Arthroplasty, DXA, BMD, PET, CT, Biochemical bone markers

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
64 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Denosumab
Arm Type
Active Comparator
Arm Description
1 ml (60 mg) subcutaneous injection Denosumab give in the posterior part of the upper arm after surgery followed by another injection 6 months later
Arm Title
saline
Arm Type
Placebo Comparator
Arm Description
1 ml subcutaneous injection 0.9% saline give in the posterior part of the upper arm after surgery followed by another injection 6 months later
Intervention Type
Drug
Intervention Name(s)
denosumab
Other Intervention Name(s)
Prolia
Intervention Description
Two doses of 60 mg in a solution of 1 ml, given as an subcutaneous injection with a 6 month interval
Primary Outcome Measure Information:
Title
Bone Mineral Density
Description
Bone mineral density by DXA in Gruen Zone 7 and a sum of Gruen zone 1-7
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Bone mineral Density
Description
BMD, g/cm2, adjacent to the femur implant for Gruen Zone 1-7, 3, 6, and 24 months after surgery
Time Frame
24 months
Title
Standardised Uptake value
Description
fluoride isotope uptake, measured as (SUV), adjacent to the femoral stem, 3 and 6 months after surgery.
Time Frame
6 months
Title
Standardised Uptake value
Description
fluoride isotope uptake, measured as SUV adjacent to the acetabular cup 3 and 6 months after surgery
Time Frame
6 months
Title
Bone Mineral density
Description
BMD adjacent to the acetabular cup during the follow up period, i.e. after 3, 6, 12 and 24 months
Time Frame
24 months
Title
Bone Mineral Density
Description
BMD at the lumbar spine and at the contra lateral nonoperated hip 6, 12 and 24 months after surgery
Time Frame
24 months
Title
Standardised Uptake Value
Description
Fluoride isotope uptake measured as SUV at the lumbar spine and at the contra lateral nonoperated hip after 3 and 6 months
Time Frame
6 months
Title
Biochemical markers for bone metabolism
Description
biochemical markers for bone turnover and the relation to SUV and BMD findings at the proximal femur and acetabulum during the follow up period, i.e. 3, 6, 12 and 24 months after surgery
Time Frame
24 months
Title
Biochemical markers for bone metabolism in relation to Bone Mineral Density and Standardised Uptake Value
Description
biochemical markers for bone turnover and the relation to SUV and BMD findings at anatomical sites not exposed to surgery, i.e. the lumbar spine and the contra lateral hip 3 and 6 months after surgery
Time Frame
24
Title
Biochemical markers for bone metabolism in relation to Bone Mineral Density and Standardised Uptake Value
Description
to evaluate the natural course of an uncemented THA on BMD, i.e. the placebo group 3, 6, 12 and 24 months after surgery, SUV i.e. the placebo group 3 and 6 months after surgery and on biochemical markers, i.e. the placebo group 3, 6, 12 and 24 months after surgery
Time Frame
24
Title
Clinical outcome evaluation
Description
to evaluate the patients Quality of Life, measured by Harris Hip score and EQ-5D questionnaires
Time Frame
24 months
Title
Adverse events
Description
incidence and severity of adverse events (AEs) during the study period
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: male or female patient 35-65 years of age with an unilateral OAH requiring a THA and a healthy contralateral hip body weight ≤110 kg or body mass index (BMI) ≤35 kg/m2 living in the Uppsala County the eligible patients should have been given oral information, a written Patient Information and signed an Informed Consent Exclusion Criteria: on or previously have had bone-specific treatment, e.g. bisphosphonates, raloxifene, parathyroid hormone, strontium ranelate, during the last five years patients on systemical corticosteroid for more than 3 months should not be considered patients with diagnosed malignant disease during the last five years or known to have metastasis from malignant disease should be excluded patients with compromised general conditions and an American Society of Anesthesiologists, ASA-score >31 should not be regarded eligible patients with known drug or alcohol abuse or regarded as socially dysfunctional, as judged by the investigator, should not be considered for the study pregnant women or women planning for pregnancy or fertile women (premenopausal) without contraceptives should not be accepted for the study patients that have been exposed frequently and/or have had large irradiation doses, as judged by the investigator, must not be included in the study. enrolled in either another investigational drug study, in another investigational device study, or in another investigational study of an approved drug within 30 days prior to Visit 1 of the current study any condition or laboratory findings which in the opinion of the Investigator makes the patient unsuitable for inclusion (for example claustrophobia)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hans Mallmin, MD, PhD
Organizational Affiliation
Uppsala University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Nils Hailer, MD, PhD
Organizational Affiliation
Uppsala University
Official's Role
Study Chair
Facility Information:
Facility Name
Department of Orthopedics
City
Uppsala
Country
Sweden

12. IPD Sharing Statement

Citations:
PubMed Identifier
31589776
Citation
Nystrom A, Kiritopoulos D, Ullmark G, Sorensen J, Petren-Mallmin M, Milbrink J, Hailer NP, Mallmin H. Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial. J Bone Miner Res. 2020 Feb;35(2):239-247. doi: 10.1002/jbmr.3883. Epub 2019 Nov 4.
Results Reference
derived

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Effects of Denosumab on Periprosthetic Bone After Total Hip Arthroplasty

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