Bone, Exercise, Alendronate, and Caloric Restriction

NCT ID: NCT05764733

Last Updated: 2025-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

900 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-08

Study Completion Date

2027-09-30

Brief Summary

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The purpose of this research is to identify strategies that minimize bone loss that occurs when older adults lose weight. Participation in this research will involve up to nine assessment visits and last up to two years.

Detailed Description

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The main objective of this study is to compare the independent and combined effects of a 12-month intervention of resistance training (RT) plus bone-loading exercises and bisphosphonate use on dietary weight loss (WL)-associated bone loss among older adults, with an indication for WL, and low bone density to explore lasting treatment efficacy. All participants will receive the same group-mediated dietary WL intervention and be randomized to one of four groups. Due to its robust change following dietary WL and clinical utility in predicting fracture, the study's primary outcome is change in total hip areal bone mineral density (aBMD) measured via dual x-ray absorptiometry (DXA). This will be complemented by DXA assessment at other skeletal sites, as well as high resolution peripheral quantitative computed tomography (HR-pQCT) derived compartmental volumetric (v)BMD, trabecular bone microarchitecture, cortical thickness/porosity, and strength at the distal radius and tibia allowing for assessment of intervention effectiveness on novel measures of bone quality.

Conditions

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Bone Loss

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

This is a 2x2 factorial design.
Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Masking applies to drug only. All assessments will be conducted by trained and blinded assessors.

Study Groups

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Resistance Training (RT) + Bisphosphonate (BIS)

Progressive Resistance Training (RT) and Bone-Loading Exercise

\+ 70 mg/weekly dose alendronate

Group Type EXPERIMENTAL

Bisphosphonate

Intervention Type DRUG

Medicine used to treat bone problems, called osteopenia or osteoporosis.

Resistance Training/Bone-Loading Exercise

Intervention Type BEHAVIORAL

Exercise in small groups three days per week under the supervision of exercise physiologists. Heart rate and blood pressure will be measured before and after each session and participants will warm-up by walking or cycling for five minutes at a slow pace. All RT exercises will be conducted on machines which accommodate different body sizes and allow small increments in resistance, both important considerations for low functioning older adults with obesity.

No RT + BIS

No Resistance Training

\+ 70 mg/weekly dose alendronate

Group Type EXPERIMENTAL

Bisphosphonate

Intervention Type DRUG

Medicine used to treat bone problems, called osteopenia or osteoporosis.

No RT + Placebo (PL)

No Resistance Training + Weekly Placebo

Group Type ACTIVE_COMPARATOR

Placebo

Intervention Type OTHER

Capsules identical to the active alendronate capsules without any active ingredients with the same dosing and follow up as BIS treatment group.

RT + PL

Progressive RT and Bone-Loading Exercise + Weekly Placebo

Group Type ACTIVE_COMPARATOR

Resistance Training/Bone-Loading Exercise

Intervention Type BEHAVIORAL

Exercise in small groups three days per week under the supervision of exercise physiologists. Heart rate and blood pressure will be measured before and after each session and participants will warm-up by walking or cycling for five minutes at a slow pace. All RT exercises will be conducted on machines which accommodate different body sizes and allow small increments in resistance, both important considerations for low functioning older adults with obesity.

Placebo

Intervention Type OTHER

Capsules identical to the active alendronate capsules without any active ingredients with the same dosing and follow up as BIS treatment group.

Interventions

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Bisphosphonate

Medicine used to treat bone problems, called osteopenia or osteoporosis.

Intervention Type DRUG

Resistance Training/Bone-Loading Exercise

Exercise in small groups three days per week under the supervision of exercise physiologists. Heart rate and blood pressure will be measured before and after each session and participants will warm-up by walking or cycling for five minutes at a slow pace. All RT exercises will be conducted on machines which accommodate different body sizes and allow small increments in resistance, both important considerations for low functioning older adults with obesity.

Intervention Type BEHAVIORAL

Placebo

Capsules identical to the active alendronate capsules without any active ingredients with the same dosing and follow up as BIS treatment group.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Community-dwelling
* BMI\>30 kg/m\^2 or BMI 25.0 to \<30 kg/m\^2 plus one risk factor
* Currently receiving routine (annual) dental care
* Pre-existing low bone mass (T-score ≤-1.1 to \>-2.5 at the hip, femoral neck, or lumbar spine (L1-L4))

Exclusion Criteria

* Weight greater than 450 lbs (DXA limit)
* Resides with someone who is currently participating in BEACON
* Dependent on quad cane or walker; inability to walk independently
* History of mild cognitive impairment or dementia or evidence of cognitive impairment ((score \<20) on Montreal Cognitive Assessment (MoCA))
* Excessive alcohol use (\>21 drinks/week) in the past month; any non-cannabis illicit drug use
* Weight change ≥5% in past 3 months
* Regular participation (\>60 mins per day on \> 3 days/week) in structured strength training program for \>6 months
* Severe arthritis, fracture, chronic injury, or other musculoskeletal disorder that prevents safe exercise participation; joint replacement or other orthopedic surgery in past 6 months or planned in next 12 months; invasive dental procedure (i.e. extraction/implant) in past 6 month or planned in next 12 months
* Osteoporosis (any of the following): Self-reported and on prescription osteoporosis medication; self-reported prior spine, hip, wrist, or shoulder fracture after age 40 (except when caused by trauma or fall from height), including atypical femoral fractures (AFF); or ≥20% for major osteoporotic fracture at screening
* Uncontrolled hypertension (systolic \>180 OR diastolic \>110 mmHg) upon repeated assessments (up to 3 times)
* Uncontrolled type 2 diabetes (HbA1c \>8%); dialysis or abnormal kidney function (eGFR \<45 mL/min/1.73 m2); liver disease or abnormal liver function (ALT levels 2 times above normal); anemia (Hb\<LLN); calcium above or below normal limit; uncontrolled thyroid disease (hypo/hyper) or requiring recent (past 3 months) adjustments in thyroid hormone supplementation or thyroid-stimulating hormone \<LLN or \>10 mIU/ml; vitamin D deficiency (\<20 ng/mL).
* Stroke, heart attack, heart failure hospitalization, or revascularization procedure within the past 6 months; chronic respiratory disease requiring oxygen; PAD diagnosis within the last 12 months; uncontrolled angina; progressive neurological disease; malabsorption disorder; any disease suggesting a life-expectancy \<3 years; bilateral hip replacement; past or planned bariatric surgery; cancer requiring initial treatment within the last 12 months (except non-melanoma skin cancers); major vision or hearing loss; unstable gastric reflux; esophageal stricture, achalasia, or Barrett's esophagus
* Daily use of growth hormones, weight loss medications, oral steroids, or diabetes prescriptions (such as insulin, thiazolidinediones, or canagliflozin); known allergy to bisphosphonates; prior use of oral bisphosphonates for \>3 months within the past 3 years; zoledronic acid within the past 5 years; denosumab use within the past year; anabolic agents for \>3 months in the last year; current use of biotin or strontium; history of 3+ years of antiresorptive therapy
* Unable/unwilling to: provide own transportation to study visits, commit to study protocol (including random assignment), or adhere to data collection visits
* Current participation in another intervention research study; planned out-of-town trip greater than 1 month at a time during the first 6 months of the study; unwilling to provide informed consent, including consent to access personal electronic health records; judged unsuitable for the trial for any reason by research team
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kristen Beavers, PhD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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University of Colorado Anschutz Medical Campus

Aurora, Colorado, United States

Site Status RECRUITING

Atrium Health Wake Forest Baptist Medical Center

Winston-Salem, North Carolina, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Christa Todoroff Calderone, M.S.

Role: CONTACT

336-758-5019

Facility Contacts

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Sarah Wherry, PhD

Role: primary

Kristen Beavers, PhD

Role: primary

336-758-5855

Christa Todoroff Calderone, M.S.

Role: backup

336-758-5019

References

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Beavers KM, Wolle BR, Ard JD, Beavers DP, Biehl O, Brubaker PH, Burghardt AJ, Calderone CT, Carballido-Gamio J, Fanning J, Kohrt WM, Love M, MacLean CM, Nicklas BJ, Stapleton J, Swanson CM, Weaver AA, Worden M, Wherry SJ. The Bone, Exercise, Alendronate, and Caloric Restriction (BEACON) trial design and methods. Contemp Clin Trials. 2024 Nov;146:107692. doi: 10.1016/j.cct.2024.107692. Epub 2024 Sep 17.

Reference Type BACKGROUND
PMID: 39293778 (View on PubMed)

Other Identifiers

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R01AG074979

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB00077185

Identifier Type: -

Identifier Source: org_study_id