Abaloparatide vs. Placebo in Post-Menopausal Women and Abaloparatide in Men Receiving Initial Spinal Fusion Surgery

NCT ID: NCT03841058

Last Updated: 2025-07-25

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 96 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-08-14
• Study Completion Date: 2026-09-30

Brief Summary

This is a prospective randomized, double-blinded, placebo-controlled, phase 2, 12-month pilot to study the efficacy of abaloparatide in postmenopausal women needing lumbar spinal fusion surgery. A total of 72 women with low bone mass who are scheduled to undergo spinal fusion surgery will be randomized 2:1 in a blinded fashion to receive either 80 mcg of abaloparatide subcutaneously (SC) every day or an identical-appearing placebo SC for 6 months. As well as a total of 24 men in an open-label design will be enrolled as an extension to this study. The total anticipated enrollment updated to 97. Outcomes include surgical outcomes at one year, pain, and fusion bone mass volume (FBMV) as a marker of bone union at 6 months and 1 year.

Detailed Description

This is a prospective randomized, double-blinded, placebo-controlled, phase 2, 12-month pilot to study the efficacy of abaloparatide in postmenopausal women needing lumbar spinal fusion surgery. Seventy-two women with low bone mass who are scheduled to undergo spinal fusion surgery will be randomized 2:1 in a blinded fashion to receive either 80 mcg of abaloparatide subcutaneously (SC) every day or an identical-appearing placebo SC for 6 months. In addition, as Tymlos is now approved for treatment in men, the investigators will enroll 24 men aged 55 and over who will treat in an open-label design. Their responses to teriparatide will be compared to those of untreated men in an ongoing observational study, as well as to the postmenopausal women. This study has 3 objectives:

1. In this pilot study the investigators will evaluate surgical outcomes at one year and the primary outcome will be fusion based on CT exam with categories of Fusion/ Indeterminate/ Not fused and this will be compared between groups receiving 6 months of abaloparatide vs. placebo. Secondary outcomes for surgical success will be evidence of pedicle screw loosening, adjacent segment fracture and proximal junctional kyphosis. This data will be used to determine effect sizes and variance to power the next larger clinical trial.

2. To determine if abaloparatide/Tymlos versus placebo leads to a faster reduction in pain as assessed by both the Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) for low back pain at 6 months.

3. As an exploratory proof of concept objective the investigators will determine if abaloparatide/Tymlos versus placebo results in greater fusion bone mass volume (FBMV) as a marker of bone union at 6 months and 1 year to see whether at one year post lumbar spinal fusion surgery, greater FBMV is associated with improved spinal surgery outcomes including: enhanced bone union, reduced pedicle screw loosening, adjacent segment fracture and proximal junctional kyphosis. This would serve as evidence that FBMV can be used as an early validated marker of fusion surgery success.

All analyses will be two-sided and the alpha level will be set at 0.05. FBMV, pain and function will be compared by drug (Abaloparatide vs. placebo) at 6 months. Compliance will be considered as taking 80% of the study drug. For the primary analysis the investigators will evaluate bone union and reduced pedicle screw loosening, adjacent segment fracture, and proximal junctional kyphosis as dichotomous variables at 12 months using logistic regression and comparing the placebo group to the abaloparatide group. The investigators will also evaluate FBMV as a continuous variable and evaluate differences in this outcome between abaloparatide and placebo groups at 6 months as an exploratory outcome variable. The investigators will determine if FBMV differs in those with or without markers of surgical success for validity of FBMV, regardless of prior treatment group. In addition, these data will be used to determine effect sizes and variance to power the next larger clinical trial.

The investigators will evaluate NRS and ODI score by using repeated measures of these variables over time by treatment group and evaluate NRS at 6 months in the placebo versus abaloparatide group. Comorbidity, age, prior fracture, prior use of bisphosphonates and other covariates will be evaluated, via multivariable regression, as to whether they lead to a change in the estimate of effect in order to be considered for inclusion in the models.

If abaloparatide can improve outcomes following lumbar spine fusion surgery, this pilot study could lead to the requisite two year trial that may have an impact on the treatment of fusion surgery patients.

Conditions

Spinal Fusion

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Abaloparatide (PM Women)

Abaloparatide 80 mcg dose administered subcutaneously with a pen once daily for 6 months

Group Type: ACTIVE_COMPARATOR

Abaloparatide

Intervention Type: DRUG

80 mcg delivered SC by a pen

Placebo (PM Women)

Placebo administered subcutaneously with a pen once daily for 6 months

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

A pen to deliver a SC dose of placebo

Abaloparatide (Men)

Open-label treatment with Abaloparatide 80 mcg dose administered subcutaneously with a pen once daily for 6 months

Group Type: EXPERIMENTAL

Abaloparatide

Intervention Type: DRUG

80 mcg delivered SC by a pen

Interventions

Abaloparatide

80 mcg delivered SC by a pen

Intervention Type: DRUG

Placebo

A pen to deliver a SC dose of placebo

Intervention Type: DRUG

Other Intervention Names

Tymlos; placebo pen

Eligibility Criteria

Inclusion Criteria

• Postmenopausal women (defined as >12 months since last menstrual cycle) OR men
• Age of 50 years or older
• Requiring posterolateral lumbar spine fusion surgery (L1-2; L2-3; L3-4; L4-5, L5-S1) with single or multi-level fusion for degenerative conditions of the lumbar spine (including lumbar degenerative disk disease, severe instability, high grade spondylolisthesis, deformity, degenerative scoliosis, pseudoarthrosis, and spinal stenosis) under the care of spine surgeons at the Hospital for Special Surgery.

Exclusion Criteria

1. Hypersensitivity to abaloparatide

2. Patients with increased risk of osteosarcoma: Paget's disease, prior radiation therapy

3. Patients with active hypercalcemia or current diagnosis of hyperparathyroidism

4. History of multiple renal calculi or renal calculus within 2 years

5. Unexplained elevations in alkaline phosphatase

6. Evidence of metastatic cancer or multiple myeloma.

7. Patients unwilling to take placebo or abaloparatide.

8. Patients whose surgery is for a revision to a prior lumbar spinal fusion surgery

9. Chronic oral steroids (>= 7.5 mg prednisone/d currently and for more than 1 month) for an inflammatory comorbid diagnosis

10. Patients who cannot understand and sign the informed consent

11. Patients who are unable to meet the proposed follow-up schedule

12. Patients with >1 year of prior cumulative treatment with Forteo and/or Tymlos, or any use of Forteo or Tymlos within the 6 months prior to enrollment.

13. Patients who have received bisphosphonate treatment of >1 year in past 5 years

14. Patients who are current smokers

• Minimum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hospital for Special Surgery, New York

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Emily Stein, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital for Special Surgery, New York

Locations

Hospital for Special Surgery

New York, New York, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Giavanna D'Erasmo

Role: CONTACT

derasmogi@hss.edu

(646) 797-8797

Facility Contacts

Giavanna D'Erasmo

Role: primary

derasmogi@hss.edu

(646) 797-8797

Other Identifiers

2018-0287

Identifier Type: -

Identifier Source: org_study_id