Combined Administration of Teripapartide and Antiresorptive Agents in Postmenopausal Osteoporosis (Confors)

Phase IV Study Teriparatide and Antiresorptive Combination Treatment Subsequent to 9 Months of Teriparatide Monotherapy

Increased bone formation in the absence of accelerated resorption is resulting in a marked anabolic response to teriparatide (TPTD) during the early phase after treatment initiation. Months later, due to coupling mechanism, the sustained increase of bone formation and ongoing anabolic effects are accompanied by significantly increased bone resorption as well. Antiresorptives influence the balance of bone formation and resorption. Therefore the investigators aim is to investigate the effects of the addition of antiresorptives to the second half of TPTD cycle when resorption is already also markedly elevated.

Study Overview

• Status: Completed
• Conditions: Osteoporosis
• Intervention / Treatment: Drug: teriparatide; Drug: teriparatide and raloxifene; Drug: teriparatide and alendronate

Detailed Description

We prospectively randomize 125 postmenopausal women after 9 months of TPTD treatment into three different open-label groups for another 9 months: either alendronate (ALN, 70 mg/week), raloxifene (RAL, 60 mg/day) or no medication (TPTD mono) on top of ongoing TPTD treatment.

All subjects receive daily supplementation of 1000mg calcium and 800 IU vitamin D.

Serum level of intact amino terminal propeptide of type I procollagen (PINP) and type 1 collagen cross-linked C-telopeptide (CTX) as well as DXA measurement at the spine, total hip and femoral neck BMD are evaluated at TPTD treatment initiation, at baseline of randomization to antiresorptive therapy as well as at 3 and 9 months during the combination treatment.Volumetric BMD values will be also determined.

• Study Type: Interventional
• Enrollment (Actual): 125
• Phase: Phase 4

Contacts and Locations

Study Locations

• Austria
  • Vienna, Austria, 1060
    • Medical University of Vienna

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years to 88 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Ambulatory postmenopausal women at least 55 years of age
• Patients with "unsatisfactory clinical response to previous antiresorptive therapy" according to the national reimbursement criteria of Austria (either new clinical or radiographic fragility fracture on ≥ 2 years and/or accelerated bone loss of ≥ 3.5%/year on antiresorptive treatment; discontinuation of oral antiresorptive treatment due to side-effects and substantial risk for osteoporotic fracture defined by a T-Score ≤ -2.5 or ≥ 2 clinical risk factors according to the FRAX™-algorithm)and consequently started with teriparatide treatment
• Patients treated with teriparatide (20 ug/day) currently and since 9 months for postmenopausal osteoporosis
• Lumbar spine, femoral neck, and total hip evaluable by dual energy x ray absorptiometry (DXA)
• Normal or clinically non-significant abnormal laboratory values (as defined by the investigator)
• Without language barrier, cooperative, expected to return for all follow-up procedures, and who give informed consent before entering the study and after being informed of the medications and procedures to be used in this study

Exclusion Criteria:

• History of bone metabolic diseases, Paget's disease, renal osteodystrophy, osteomalacia, any secondary causes of osteoporosis, hyperparathyroidism (uncorrected), and intestinal malabsorption
• History of malignant neoplasms in the prior 5 years, with the exception of superficial basal cell carcinoma or squamous cell carcinoma of the skin that has been definitively treated. If malignant neoplasm was ever diagnosed, patient must presently be free of disease
• History of nephrolithiasis or urolithiasis in the prior 2 years. Patients with any documented history of nephro- or uro-lithiasis must have had an appropriate imaging procedure within the prior 6 months, such as, an intravenous pyleogram (IVP), supine radiograph of the kidney ureter bladder, or renal ultrasound, which must document the absence of stones
• Abnormal thyroid function at any time in the prior 6 months. Patients with chronic hypothyreosis and adequate substitution therapy are permitted
• Active liver disease (liver enzymes more than three times the upper limit of normal) or clinical jaundice
• Significantly impaired renal function. This is defined as serum creatinine >1.8 mg/dL
• Treatment with bone active agent other than teriparatide in the prior 9 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Teriparatide; 18 months of daily 20 ug sc. teriparatide monotherapy (TPTD)	Drug: teriparatide; teriparatide 20 ug/day, sc.; Other Names: Forteo
Active Comparator: Teriparatide and Raloxifene; 9 months teriparatide 20 ug/day sc. monotherapy (TPTD) continued by combination therapy of raloxifene 60 mg/day orally(RAL)and TPTD for another 9 months	Drug: teriparatide and raloxifene; teriparatide 20 ug/day sc. raloxifene 60mg oral daily; Other Names: Forteo; Evista
Active Comparator: Teriparatide and Alendronate; 9 months teriparatide monotherapy 20 ug/day sc.(TPTD) continued by combination therapy of alendronate 70 mg/week orally(ALN)and TPTD for another 9 months	Drug: teriparatide and alendronate; teriparatide 20 ug/day sc. alendronate 70mg oral weekly; Other Names: Forteo; Fosamax

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Differences in changes of areal lumbar spine BMD between the three treatment groups	Primary objective To investigate the changes in lumbar spine BMD of patients among the three treatment groups	Evaluation after 9, 12 and 18 months of TPTD

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Differences in changes of BMDs and markers of bone turnover among the three treatment groups after 18 months TPTD treatment	Secondary objectives; Differences in change of biochemical markers of bone turnover (serum CTX and serum PINP) between treatment groups; Differences in change of the additional DXA results in the hip scan (neck, upper neck, nape, Wards, Troch, shaft, total hip [g/cm²]) of patients between treatment groups; To investigate the volumetric changes of vertebral and hip BMD by quantitative computertomography of patients between treatment groups; To investigate safety and tolerability of the treatments	Evaluation after 9, 12 and 18 months of TPTD treatment

Collaborators and Investigators

• Sponsor: Medical University of Vienna
• Investigators: Principal Investigator: Christian Muschitz, M.D., Medical University of Vienna

Publications and helpful links

General Publications

• Muschitz C, Kocijan R, Fahrleitner-Pammer A, Pavo I, Haschka J, Schima W, Kapiotis S, Resch H. Overlapping and continued alendronate or raloxifene administration in patients on teriparatide: effects on areal and volumetric bone mineral density--the CONFORS Study. J Bone Miner Res. 2014 Aug;29(8):1777-85. doi: 10.1002/jbmr.2216.

Helpful Links

• Homepage of Medical Department II, Vienna (German)

Study record dates

Study Major Dates

• Study Start: March 1, 2006
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: December 20, 2011
• First Submitted That Met QC Criteria: February 14, 2012
• First Posted (Estimate): February 17, 2012

Study Record Updates

• Last Update Posted (Estimate): January 3, 2013
• Last Update Submitted That Met QC Criteria: December 30, 2012
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: bone mineral density; alendronate; teriparatide; raloxifene
• Additional Relevant MeSH Terms: Metabolic Diseases; Musculoskeletal Diseases; Bone Diseases; Bone Diseases, Metabolic; Osteoporosis; Physiological Effects of Drugs; Hormones, Hormone Substitutes, and Hormone Antagonists; Hormone Antagonists; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Estrogen Antagonists; Selective Estrogen Receptor Modulators; Estrogen Receptor Modulators; Alendronate; Raloxifene Hydrochloride; Teriparatide
• Other Study ID Numbers: Vinforce-003