Study Results
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Basic Information
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UNKNOWN
PHASE2
140 participants
INTERVENTIONAL
2005-09-30
2017-11-30
Brief Summary
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Detailed Description
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All participants have completed a parent study of two years that included a screening visit with a physical exam, blood draw, x-rays, EKG, and distribution of calcium and vitamin D supplements. Participants will be separated into two groups according to the treatment they have undergone over the year prior to study entry. Participants who have taken alendronate for at least 1 year prior to study entry will be assigned to Protocol 1. Participants who have not previously taken alendronate will be assigned to Protocol 2. Participants in both protocols will be randomly assigned to one of the following three biopsy groups: pre-treatment; early; or late. Participants in the pre-treatment biopsy group will have a bone biopsy before treatment begins. Those participants in the early biopsy group will have a biopsy at Week 7 of treatment, and those in the late group will have a biopsy at Month 7.5 of treatment.
Participants will also be randomly assigned to one of three treatment schedules. Participants in Protocol 1 may be assigned to receive alendronate alone for 24 months; teriparatide daily plus alendronate for 24 months; or teriparatide daily on and off for 3 months at a time plus alendronate for 24 months. Participants in Protocol 2 may be assigned to receive only the supplements they were given during the screening visit; teriparatide daily plus alendronate for 24 months; or teriparatide daily on and off for 3 months at a time for 24 months. Participants will attend assessment visits at Weeks 4 and 7 and Months 3, 5, 6, 7.5, 9, 12, 15, 18, 21, and 24. Visits may include bone turnover measurements, bone mass scans, walking tests, questionnaires, CT scans, and blood draws.
A recently funded extension study will extend the treatment period from 24 to 48 months for all consenting. If the individual was assigned to teriparatide daily (with or without alendronate), they will be given alendronate for the 24 to 48 month time period. If the individual was assigned to cyclic teriparatide, they will continue cyclic therapy foro the 24-48 month period (with or without alendronate).
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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1
Participants in this group will have been treated with alendronate for at least 1 year prior to study entry. Upon study entry, they will receive a continuous regimen of daily teriparatide (20 mcg subcutaneously) for 48 months, in addition to alendronate. Biopsies will be performed at Week 7 or Month 7.5. The participants will then have the option to be followed while taking alendronate alone for 24-48 months.
Teriparatide
Teriparatide will be given subcutaneously in 20-mcg doses either continuously or cyclically.
Alendronate
Participants will take 70 mg per week of alendronate for 48 months.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
2
Participants in this group will have been treated with alendronate for at least 1 year prior to study entry. Upon study entry, they will receive a cyclical regimen of teriparatide, in addition to alendronate. Teriparatide will be administered subcutaneously in 20-mcg doses daily for 3 months. They will receive no teriparatide for the following 3 months, and then teriparatide treatment will continue for the 3 months after that. This schedule will continue for 24 months with an aption to all participants to continue cyclic teriparatide for another 24 months. Biopsies will be performed at Week 7 or Month 7.5.
Teriparatide
Teriparatide will be given subcutaneously in 20-mcg doses either continuously or cyclically.
Alendronate
Participants will take 70 mg per week of alendronate for 48 months.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
3
Participants in this group will have been treated with alendronate for at least 1 year prior to study entry. Upon study entry, they will continue taking alendronate alone. Biopsies will be performed at Week 7 and then participants in this group will be offered teriparatide as part of Group 2 or 3.
Alendronate
Participants will take 70 mg per week of alendronate for 48 months.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
4
Participants in this group will receive a continuous regimen of teriparatide (20 mcg delivered subcutaneously) daily for 48 months. Biopsies will be performed at Week 7 or Month 7.5. At 24 months the participants will then have the option of taking alendronate and remaining in the study for another 24 months.
Teriparatide
Teriparatide will be given subcutaneously in 20-mcg doses either continuously or cyclically.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
5
Participants in this group will receive a cyclical regimen of teriparatide. Teriparatide will be administered subcutaneously in 20-mcg doses daily for 3 months. They will receive no teriparatide for the following 3 months, and then teriparatide treatment will continue for the 3 months after that. This schedule will continue for 24 months with an option to all participants to continue cyclic teriparatide for another 24 months. Biopsies will be performed at Week 7 or Month 7.5.
Teriparatide
Teriparatide will be given subcutaneously in 20-mcg doses either continuously or cyclically.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
6
Participants in this group will take only calcium and vitamin D supplements. Biopsies will be performed at Week 7. Participants will then be offered the standard care for osteoporosis or they may enter the study in Group 4 or 5.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
Interventions
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Teriparatide
Teriparatide will be given subcutaneously in 20-mcg doses either continuously or cyclically.
Alendronate
Participants will take 70 mg per week of alendronate for 48 months.
Calcium
Calcium supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily calcium intake to 1,200 mg.
Vitamin D3
Vitamin D3 supplements will be administered in varied amounts for all participants, but each participant will take enough to bring her total daily intake to 1,200 mg.
Eligibility Criteria
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Inclusion Criteria
* Two measurable vertebrae between L1 and L4
* Willing to undergo a single iliac crest biopsy after administration of 4 tetracycline labels
Exclusion Criteria
* Uses drugs likely to affect skeletal or calcium homeostasis
* Multiple vertebral fractures or severe degenerative changes with fewer than two evaluable vertebrae
* Unwilling to undergo a single iliac crest biopsy
* History of allergy to tetracyclines, exposure to tetracyclines within the last year, or any remote long term use of tetracyclines
* Current use of anti-resorptive medicines (other than alendronate for half the female participants)
* Use of hormone therapy, estrogen therapy, raloxifene, or calcitonin within 6 months before study entry
* Use of any bisphosphonate for more than 3 months within 2 years before study entry (only applies to participants in Groups 4, 5, and 6)
* History of a kidney stone within 5 years before study entry or any history of multiple kidney stones
* Hypercalcemia, hypercalciuria, or elevated parathyroid hormone (reduced 25-hydroxyvitamin D will be corrected prior to admission)
* Esophageal ulceration or stricture or known hypersensitivity to bisphosphonates
* History of external radiation therapy
* Unlikely or unable to complete the study, as determined by the investigators
* Illicit drug use or excessive alcohol consumption
45 Years
85 Years
FEMALE
Yes
Sponsors
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
NIH
Health Research, Inc.
OTHER
Helen Hayes Hospital
OTHER
Responsible Party
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Robert Lindsay
Professor of Clinical Medicine
Principal Investigators
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Robert Lindsay, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Helen Hayes Hospital
Locations
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Helen Hayes Hospital
West Haverstraw, New York, United States
Countries
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References
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Ganapathy A, Nieves JW, Keaveny TM, Cosman F. Effects of four-year cyclic versus two-year daily teriparatide treatment on volumetric bone density and bone strength in postmenopausal women with osteoporosis. Bone. 2023 Feb;167:116618. doi: 10.1016/j.bone.2022.116618. Epub 2022 Nov 21.
Cosman F, Nieves JW, Roimisher C, Neubort S, McMahon DJ, Dempster DW, Lindsay R. Administration of teriparatide for four years cyclically compared to two years daily in treatment Naive and alendronate treated women. Bone. 2019 Mar;120:246-253. doi: 10.1016/j.bone.2018.10.020. Epub 2018 Oct 21.
Other Identifiers
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R01 AR056651-01A2, 5RO1 ARO5
Identifier Type: -
Identifier Source: org_study_id
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