Zoledronic Acid for Prevention of Bone Loss After BAriatric Surgery (ZABAS)

NCT ID: NCT04742010

Last Updated: 2022-06-10

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE2
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-02-20
• Study Completion Date: 2024-06-30

Brief Summary

In a randomised placebo-controlled trial assess effects of zoledronic acid for prevention of bone and muscle loss after bariatric surgery.

Detailed Description

In individuals with severe obesity, bariatric surgery effectively reduces body weight, improves obesity related diseases and lowers mortality. A loss of bone and muscle mass and an increase in bone fracture risk are however seen after surgery. In this study it is examined if treatment with zoledronic acid (a drug used to treat osteoporosis) can prevent the bone and muscle loss after bariatric surgery. A single infusion of zoledronic acid or placebo is given before surgery. The study is blinded and randomized for methodological reasons. Bone and muscle scans, tests of muscle strength and physical performance and blood samples (for analysis of markers related to bone and muscle metabolism) are performed at inclusion and 12 and 24 months after surgery. A total of 60 adult individuals will participate. Results will be important for the evidence-based care of patients undergoing bariatric surgery and zoledronic acid.

Study design This is a single center randomized double-blind placebo-controlled study of zoledronic acid for prevention of bone and muscle loss after bariatric surgery. Routine bariatric surgery (RYGB or gastric sleeve) will be performed. The end of study is 24 months after surgery.

Study Population Patients referred for bariatric surgery at The Hospital South West Jutland, Esbjerg will be invited to participate.

Randomization After inclusion and baseline assessment, patients will be randomly assigned to either zoledronic acid or placebo with a 1:1 allocation. A randomization code stratifying an equal number of participants having RYGB or SG into each study arm will be applied.

Conditions

Bone Loss; Muscle Atrophy; Bariatric Surgery

Study Design

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

Study Groups

Zoledronic Acid

Active treatment

Group Type: EXPERIMENTAL

Zoledronic Acid

Intervention Type: DRUG

• A single treatment 21 days before bariatric surgery with Zoledronic acid 5 mg or placebo (an interval of 5 to 180 days is accepted)
• Pharmaceutical form: Solution for infusion (100 ml normal saline containing 5 mg zoledronic acid or placebo)
• Administration: slow intravenous infusion with a duration of at least 15 minutes

Placebo

Placebo

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

as above

Interventions

Zoledronic Acid

• A single treatment 21 days before bariatric surgery with Zoledronic acid 5 mg or placebo (an interval of 5 to 180 days is accepted)
• Pharmaceutical form: Solution for infusion (100 ml normal saline containing 5 mg zoledronic acid or placebo)
• Administration: slow intravenous infusion with a duration of at least 15 minutes

Intervention Type: DRUG

Placebo

as above

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• 35 years old or older
• Eligible for bariatric surgery (BMI>35 kg/m2 with obesity-related comorbidity)

Exclusion Criteria

• Pregnancy or breastfeeding.
• Chronic kidney disease with estimated GFR<45 ml/min.
• Hypocalcemia .
• Hypersensitivity to bisphosphonates, mannitol, sodium citrate or water.
• Metabolic bone disease (osteoporosis is allowed).
• Prior treatment with anti-osteoporotic agents.
• Treatment with oral glucocorticoids
• Other diseases with known effects on bone metabolism

• Minimum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Research Unit of Health Sciences, Hospital of South West Jutland

UNKNOWN

Sponsor Role: collaborator

Department of Regional Health Research, University of Southern Denmark

UNKNOWN

Sponsor Role: collaborator

OPEN - Odense Patient data Explorative Network, The University of Southern Denmark, Odense, Denmark

UNKNOWN

Sponsor Role: collaborator

Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, 6700 Esbjerg, Denmark

UNKNOWN

Sponsor Role: collaborator

Odense University Hospital

OTHER

Sponsor Role: collaborator

Stinus Gadegaard Hansen

OTHER

Sponsor Role: lead

Responsible Party

Stinus Gadegaard Hansen

Endocrinologist, Associate professor, PhD

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

Hospital South West Jutland

Esbjerg, , Denmark

Site Status: RECRUITING

Countries

Denmark

Central Contacts

Stinus Gadegaard Hansen, MD, PhD

Role: CONTACT

Stinus.Gadegaard.Hansen@rsyd.dk

+45 27594121

Facility Contacts

Stinus Gadegaard Hansen, Medical Doctor

Role: primary

Stinus.Gadegaard.Hansen@rsyd.dk

Søren Gam, Master of Sports Science

Role: backup

soren.gam@rsyd.dk

References

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Aug 30;384(9945):766-81. doi: 10.1016/S0140-6736(14)60460-8. Epub 2014 May 29.

Reference Type: BACKGROUND

PMID: 24880830 (View on PubMed)

Arterburn D, Gupta A. Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity. JAMA. 2018 Jan 16;319(3):235-237. doi: 10.1001/jama.2017.20449. No abstract available.

Reference Type: BACKGROUND

PMID: 29340659 (View on PubMed)

Yu EW. Bone metabolism after bariatric surgery. J Bone Miner Res. 2014 Jul;29(7):1507-18. doi: 10.1002/jbmr.2226.

Reference Type: BACKGROUND

PMID: 24677277 (View on PubMed)

Rousseau C, Jean S, Gamache P, Lebel S, Mac-Way F, Biertho L, Michou L, Gagnon C. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ. 2016 Jul 27;354:i3794. doi: 10.1136/bmj.i3794.

Reference Type: BACKGROUND

PMID: 27814663 (View on PubMed)

Yu EW, Lee MP, Landon JE, Lindeman KG, Kim SC. Fracture Risk After Bariatric Surgery: Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding. J Bone Miner Res. 2017 Jun;32(6):1229-1236. doi: 10.1002/jbmr.3101. Epub 2017 Mar 20.

Reference Type: BACKGROUND

PMID: 28251687 (View on PubMed)

Lalmohamed A, de Vries F, Bazelier MT, Cooper A, van Staa TP, Cooper C, Harvey NC. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2012 Aug 3;345:e5085. doi: 10.1136/bmj.e5085.

Reference Type: BACKGROUND

PMID: 22867649 (View on PubMed)

Lu CW, Chang YK, Chang HH, Kuo CS, Huang CT, Hsu CC, Huang KC. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore). 2015 Dec;94(48):e2087. doi: 10.1097/MD.0000000000002087.

Reference Type: BACKGROUND

PMID: 26632892 (View on PubMed)

Nakamura KM, Haglind EG, Clowes JA, Achenbach SJ, Atkinson EJ, Melton LJ 3rd, Kennel KA. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int. 2014 Jan;25(1):151-8. doi: 10.1007/s00198-013-2463-x. Epub 2013 Aug 3.

Reference Type: BACKGROUND

PMID: 23912559 (View on PubMed)

Axelsson KF, Werling M, Eliasson B, Szabo E, Naslund I, Wedel H, Lundh D, Lorentzon M. Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. J Bone Miner Res. 2018 Dec;33(12):2122-2131. doi: 10.1002/jbmr.3553. Epub 2018 Aug 13.

Reference Type: BACKGROUND

PMID: 30011091 (View on PubMed)

Frederiksen KD, Hanson S, Hansen S, Brixen K, Gram J, Jorgensen NR, Stoving RK. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT. Calcif Tissue Int. 2016 Mar;98(3):253-62. doi: 10.1007/s00223-015-0091-5. Epub 2015 Dec 12.

Reference Type: BACKGROUND

PMID: 26661530 (View on PubMed)

Andersen S, Frederiksen KD, Hansen S, Brixen K, Gram J, Stoving RK. Bone structure and estimated bone strength in obese patients evaluated by high-resolution peripheral quantitative computed tomography. Calcif Tissue Int. 2014 Jul;95(1):19-28. doi: 10.1007/s00223-014-9857-4. Epub 2014 Apr 17.

Reference Type: BACKGROUND

PMID: 24736885 (View on PubMed)

Shanbhogue VV, Stoving RK, Frederiksen KH, Hanson S, Brixen K, Gram J, Jorgensen NR, Hansen S. Bone structural changes after gastric bypass surgery evaluated by HR-pQCT: a two-year longitudinal study. Eur J Endocrinol. 2017 Jun;176(6):685-693. doi: 10.1530/EJE-17-0014. Epub 2017 Mar 13.

Reference Type: BACKGROUND

PMID: 28289103 (View on PubMed)

Lindeman KG, Greenblatt LB, Rourke C, Bouxsein ML, Finkelstein JS, Yu EW. Longitudinal 5-Year Evaluation of Bone Density and Microarchitecture After Roux-en-Y Gastric Bypass Surgery. J Clin Endocrinol Metab. 2018 Nov 1;103(11):4104-4112. doi: 10.1210/jc.2018-01496.

Reference Type: BACKGROUND

PMID: 30219833 (View on PubMed)

Muschitz C, Kocijan R, Marterer C, Nia AR, Muschitz GK, Resch H, Pietschmann P. Sclerostin levels and changes in bone metabolism after bariatric surgery. J Clin Endocrinol Metab. 2015 Mar;100(3):891-901. doi: 10.1210/jc.2014-3367. Epub 2014 Dec 9.

Reference Type: BACKGROUND

PMID: 25490275 (View on PubMed)

Gagnon C, Schafer AL. Bone Health After Bariatric Surgery. JBMR Plus. 2018 May 1;2(3):121-133. doi: 10.1002/jbm4.10048. eCollection 2018 May.

Reference Type: BACKGROUND

PMID: 30283897 (View on PubMed)

Schafer AL, Weaver CM, Black DM, Wheeler AL, Chang H, Szefc GV, Stewart L, Rogers SJ, Carter JT, Posselt AM, Shoback DM, Sellmeyer DE. Intestinal Calcium Absorption Decreases Dramatically After Gastric Bypass Surgery Despite Optimization of Vitamin D Status. J Bone Miner Res. 2015 Aug;30(8):1377-85. doi: 10.1002/jbmr.2467. Epub 2015 May 21.

Reference Type: BACKGROUND

PMID: 25640580 (View on PubMed)

Yu EW, Wewalka M, Ding SA, Simonson DC, Foster K, Holst JJ, Vernon A, Goldfine AB, Halperin F. Effects of Gastric Bypass and Gastric Banding on Bone Remodeling in Obese Patients With Type 2 Diabetes. J Clin Endocrinol Metab. 2016 Feb;101(2):714-22. doi: 10.1210/jc.2015-3437. Epub 2015 Nov 24.

Reference Type: BACKGROUND

PMID: 26600045 (View on PubMed)

Muschitz C, Kocijan R, Haschka J, Zendeli A, Pirker T, Geiger C, Muller A, Tschinder B, Kocijan A, Marterer C, Nia A, Muschitz GK, Resch H, Pietschmann P. The Impact of Vitamin D, Calcium, Protein Supplementation, and Physical Exercise on Bone Metabolism After Bariatric Surgery: The BABS Study. J Bone Miner Res. 2016 Mar;31(3):672-82. doi: 10.1002/jbmr.2707. Epub 2015 Sep 30.

Reference Type: BACKGROUND

PMID: 26350034 (View on PubMed)

Mundbjerg LH, Stolberg CR, Bladbjerg EM, Funch-Jensen P, Juhl CB, Gram B. Effects of 6 months supervised physical training on muscle strength and aerobic capacity in patients undergoing Roux-en-Y gastric bypass surgery: a randomized controlled trial. Clin Obes. 2018 Aug;8(4):227-235. doi: 10.1111/cob.12256. Epub 2018 Jun 12.

Reference Type: BACKGROUND

PMID: 29896844 (View on PubMed)

Frost HM. Bone's mechanostat: a 2003 update. Anat Rec A Discov Mol Cell Evol Biol. 2003 Dec;275(2):1081-101. doi: 10.1002/ar.a.10119.

Reference Type: BACKGROUND

PMID: 14613308 (View on PubMed)

Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V. Muscle and bone, two interconnected tissues. Ageing Res Rev. 2015 May;21:55-70. doi: 10.1016/j.arr.2015.03.002. Epub 2015 Mar 21.

Reference Type: BACKGROUND

PMID: 25804855 (View on PubMed)

Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR; HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007 May 3;356(18):1809-22. doi: 10.1056/NEJMoa067312.

Reference Type: BACKGROUND

PMID: 17476007 (View on PubMed)

Boonen S, Reginster JY, Kaufman JM, Lippuner K, Zanchetta J, Langdahl B, Rizzoli R, Lipschitz S, Dimai HP, Witvrouw R, Eriksen E, Brixen K, Russo L, Claessens F, Papanastasiou P, Antunez O, Su G, Bucci-Rechtweg C, Hruska J, Incera E, Vanderschueren D, Orwoll E. Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med. 2012 Nov 1;367(18):1714-23. doi: 10.1056/NEJMoa1204061.

Reference Type: BACKGROUND

PMID: 23113482 (View on PubMed)

Deas CM, Murphy P, Iranikhah M, Freeman MK. Retained Skeletal Effects of Zoledronic Acid Following Discontinuation of Treatment: A Review of the Literature. Consult Pharm. 2017 Mar 1;32(3):144-155. doi: 10.4140/TCP.n.2017.144.

Reference Type: BACKGROUND

PMID: 28270269 (View on PubMed)

Watanabe R, Fujita N, Takeda S, Sato Y, Kobayashi T, Morita M, Oike T, Miyamoto K, Matsumoto Y, Matsumoto M, Nakamura M, Miyamoto T. Ibandronate concomitantly blocks immobilization-induced bone and muscle atrophy. Biochem Biophys Res Commun. 2016 Nov 25;480(4):662-668. doi: 10.1016/j.bbrc.2016.10.112. Epub 2016 Oct 27.

Reference Type: BACKGROUND

PMID: 27983979 (View on PubMed)

Borsheim E, Herndon DN, Hawkins HK, Suman OE, Cotter M, Klein GL. Pamidronate attenuates muscle loss after pediatric burn injury. J Bone Miner Res. 2014 Jun;29(6):1369-72. doi: 10.1002/jbmr.2162.

Reference Type: BACKGROUND

PMID: 24347438 (View on PubMed)

Gam S, Gram B, Juhl CB, Hermann AP, Hansen SG. Zoledronic Acid for prevention of bone and muscle loss after BAriatric Surgery (ZABAS)-a study protocol for a randomized controlled trial. Trials. 2022 Oct 8;23(1):861. doi: 10.1186/s13063-022-06766-z.

Reference Type: DERIVED

PMID: 36209245 (View on PubMed)

Other Identifiers

20/41068

Identifier Type: -

Identifier Source: org_study_id