- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02753283
Preventing Osteoporosis Using Denosumab (PROUD)
Sustaining Skeletal Health in Frail Elderly
Study Overview
Status
Intervention / Treatment
Detailed Description
Objective:
The long term goal is to improve health, well-being and quality of life in the frail long-term care (LTC) elderly population by reducing fractures. The short term goal is to demonstrate efficacy of the non-bisphosphonate denosumab to improve bone mineral density (BMD), a necessary (but not sufficient) pre-condition of a large fracture reduction trial. The investigators propose to conduct a 2-year, randomized, double-blind, calcium-vitamin D controlled trial to test the efficacy and predictability of the antiresorptive RANK ligand inhibitor, denosumab (60 mg), among a cohort of 212 institutionalized, under-served, frail men and women ≥65 years old in LTC.
Specific Aims:
Aim 1: To evaluate efficacy of denosumab in improving/maintaining bone mineral density. The investigators will measure conventional hip and spine bone mineral density (BMD).
Primary Hypothesis: After 2 years, women and men on denosumab will have greater hip and spine BMD increases.
Zoledronic Acid Infusion Safety Treatment and Follow-up Extension:
After the trial was started, case reports suggested a potential increase in fracture risk with disuse. A post hoc analysis that combined the pivotal denosumab trial and extension trial data suggested there was an increase in multiple vertebral fractures when patients discontinued therapy. Following discontinuation of denosumab/placebo, all patients will be offered treatment with 1 dose of intravenous zoledronic acid 5 mg. For those consenting to receive end of study treatment, the zoledronic acid will be given at month 27 for an individual patient.
Zoledronic Acid Safety Infusion Extension Specific Aims:
Aim 1: To evaluate maintenance of bone mineral density (BMD). Zoledronic acid will be administered intravenously at 9 months post-denosumab (month 27) and assess BMD by DXA at months 33 and 39 (6 months and 12 months after zoledronic acid infusion).
Primary Hypothesis: Zoledronic acid will prevent BMD loss at the spine and hip following denosumab discontinuation.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15213
- UPMC Senior Communities
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Ambulatory male and female residents with osteoporosis or low bone mass (at risk for fracture) ages 65 and older will be considered if:
- Reside in long-term care institution (nursing home or assisted living facility); and
- HaveOsteoporosis: (1) by bone density [spine, hip or forearm Bone Mineral Density (BMD) T-score ≤ -2.5]; (2) A previous adult fragility fracture of the spine or hip; or (3) Would be treated based on FRAX® and the National Osteoporosis Foundation (NOF) treatment thresholds of a 10 year risk of ≥ 20% for a major fracture or ≥ 3% for hip fracture suing femoral neck BMD.
Exclusion Criteria:
- Institutionalized residents with subacute illnesses who are not expected to survive or who will be discharged in < 2 years.
- Non-ambulatory residents (those who cannot stand and pivot with assistance in order to transfer to the DXA table).
- Those currently on therapy (including bisphosphonate, denosumab, or teriparatide) or who have been on a bisphosphonate for > 1year during the previous 2 years because some bisphosphonates are long acting.
- Those with a history of hypocalcemia or contraindication for treatment. We will screen for these conditions by detailed history, chart review, and baseline laboratory analyses.
- Those with vitamin D levels < 25ng/mL will be treated with vitamin D 50,000 IU/wk for 8 weeks; they will be enrolled if the follow-up vitamin D level is 25 ng/mL or more (if after 2 rounds of vitamin D repletion their vitamin D level is not at least 25 ng/mL, they will not be eligible to be randomized into the study).
- Those on dialysis or with stage 5 chronic kidney disease (eGFR<15ml/min) will be excluded at screening.
- Those requiring tooth extraction or oral surgery will not be enrolled until cleared by a dentist.
- Patients will be allowed to continue on glucocorticoids and anticonvulsants because their use is common in this population.
- Those on glucocorticoids and anticonvulsants will be allowed to continue in the study because their use is common in this population.
- Those on hormone replacement therapy (HRT), raloxifene, or prescribed protective hip pads by their Primary Care Physician (PCP) will be allowed to participate and continue on these therapies.
- We will suggest that participants stop long-term calcitonin as it has been discontinued in Europe due to cancer concerns.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Denosumab, then Zoledronic Acid
Semi-annual dose: denosumab 60 mg semi-annual injection; Vitamin D 800-1000 IU/daily and Calcium approximately 1200 mg/daily (dietary + supplements); Zoledronic acid will be offered to all study participants upon completing the course of Denosumab.
|
Semi-annual dose: 60 mg injection; Vitamin D 800-1000 IU/daily and Calcium approximately 1200 mg/daily (dietary + supplement)
Other Names:
Dietary supplement: Vitamin D 800-1000 IU/daily and Calcium approximately 1200 mg/daily (dietary + supplement)
One time safety treatment dose: 5 mg infusion
Other Names:
|
Placebo Comparator: Placebo Group, then Zoledronic Acid
Semi-annual: placebo saline injection; Vitamin D 800-1000 IU/daily and Calcium approximately1200 mg/daily (dietary + supplements); Zoledronic acid will be offered to all study participants upon completing the course of placebo.
|
Dietary supplement: Vitamin D 800-1000 IU/daily and Calcium approximately 1200 mg/daily (dietary + supplement)
One time safety treatment dose: 5 mg infusion
Other Names:
Semi-annual saline injection
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bone density of the total hip
Time Frame: 24 months
|
Bone Mineral Density (BMD) of the total hip at 24 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
24 months
|
Bone density of the spine
Time Frame: 24 months
|
Bone Mineral Density (BMD) of the spine at 24 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
24 months
|
Extension - Zoledronic Acid Infusion Safety Treatment: Bone density of the total hip
Time Frame: 33 months
|
Bone Mineral Density (BMD) of the total hip at 33 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
33 months
|
Extension - Zoledronic Acid Infusion Safety Treatment: Bone density of the total hip
Time Frame: 39 months
|
Bone Mineral Density (BMD) of the total hip at 39 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
39 months
|
Extension - Zoledronic Acid Infusion Safety Treatment: Bone density of the spine
Time Frame: 33 months
|
Bone Mineral Density (BMD) of the spine at 33 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
33 months
|
Extension - Zoledronic Acid Infusion Safety Treatment: Bone density of the spine
Time Frame: 39 months
|
Bone Mineral Density (BMD) of the spine at 39 months as assessed by dual-energy x-ray absorptiometry (DXA)
|
39 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Susan L Greenspan, MD, University of Pittsburgh
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Metabolic Diseases
- Fractures, Bone
- Wounds and Injuries
- Musculoskeletal Diseases
- Bone Diseases
- Bone Diseases, Metabolic
- Osteoporosis
- Osteoporosis, Postmenopausal
- Osteoporotic Fractures
- Physiological Effects of Drugs
- Micronutrients
- Vitamins
- Bone Density Conservation Agents
- Calcium-Regulating Hormones and Agents
- Vitamin D
- Calcium
- Zoledronic Acid
- Denosumab
Other Study ID Numbers
- STUDY19050268
- 1R01AG052123-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Osteoporosis
-
Radius Health, Inc.CompletedOsteoporosis | Osteoporosis Risk | Osteoporosis, Postmenopausal | Osteoporosis Fracture | Osteoporosis, Age-Related | Osteoporosis Localized to Spine | Osteoporosis Senile | Osteoporosis of Vertebrae | Osteoporosis VertebralUnited States
-
Radius Health, Inc.CompletedOsteoporosis | Age Related Osteoporosis | Osteoporosis, Age-Related | Osteoporosis Localized to Spine | Osteoporosis Senile | Osteoporosis of VertebraeUnited States, Poland, Italy
-
Appalachian State UniversityNorth Carolina Agriculture & Technical State UniversityCompletedPostmenopausal Osteoporosis | Osteoporosis, OsteopeniaUnited States
-
AmgenCompletedPostmenopausal Osteoporosis (PMO)Japan
-
Hoffmann-La RocheCompletedPostmenopausal OsteoporosisPakistan
-
Hoffmann-La RocheCompletedPostmenopausal OsteoporosisBelgium, Luxembourg, Austria, Greece, Ireland
-
Hoffmann-La RocheNo longer availablePostmenopausal OsteoporosisTaiwan
-
Hoffmann-La RocheCompletedPostmenopausal OsteoporosisPoland, Slovakia, Hungary, Russian Federation, Latvia, Romania, Slovenia
-
Hoffmann-La RocheCompletedPostmenopausal OsteoporosisUnited States
-
Hoffmann-La RocheCompletedPost Menopausal OsteoporosisUnited States, Puerto Rico
Clinical Trials on denosumab
-
AmgenCompletedOsteoporosis | Osteopenia | Low Bone Mineral Density | Low Bone Mass | Males With Osteoporosis
-
GlaxoSmithKlineCompletedOsteoporosis, PostmenopausalKorea, Republic of
-
AmgenCompletedHealthy VolunteerUnited States
-
AmgenCompletedPostmenopausal OsteoporosisUnited States, Denmark, Poland, Canada
-
Luye Pharma Group Ltd.ParexelCompleted
-
Samsung Bioepis Co., Ltd.CompletedPostmenopausal OsteoporosisPoland
-
Borstkanker Onderzoek GroepAmgenWithdrawn
-
National Cancer Institute (NCI)TerminatedOvarian CarcinomaUnited States, Israel
-
Swiss Group for Clinical Cancer ResearchActive, not recruitingMetastatic Breast Cancer | Bone Metastases | Metastatic Prostate CancerSwitzerland, Germany, Austria