Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| University of Aarhus | OTHER |
Not provided
Not provided
Not provided
Not provided
The study is a cohort study comprising 136 patients with osteoporosis stopping treatment with alendronate. The study will contribute with new knowledge about biochemical markers of bone turnover as predictors of bone loss after stopping treatment with alendronate.
Background:
Osteoporosis increases the risk of fractures. Alendronate reduces the risk of both vertebral- and hip fractures by approximately 50%. It has, however, become evident that long-term anti-resorptive may lead to serious side effects such as atypical femoral fractures or osteonecrosis of the jaw. The alendronate extension study (FLEX) showed that despite stopping treatment after five years the anti-fracture efficacy regarding non-vertebral and radiological vertebral fractures persists for an additional five years in patients with bone mineral density (BMD) T-score > -2.5 at the femoral neck, no fractures during treatment, and no previous vertebral fracture. It is therefore now clinical practice, that treatment is discontinued after five years in patients that fulfil these criteria. Based on the alendronate extension study it was assumed, that bone turnover monitored by biochemical markers would stay suppressed for years after stopping treatment, however, other studies have demonstrated that there is a great variability in the change in bone turnover markers seen after stopping treatment with alendronate in a real-life setting.
Aim:
To investigate the predictive value of markers of bone turnover on bone loss 12 months after stopping alendronate therapy.
Methods:
The study is a cohort study comprising 136 patients with osteoporosis stopping treatment with alendronate.
Perspectives:
The study will contribute with new knowledge about biochemical markers of bone turnover as predictors of bone loss after stopping treatment with alendronate. It will thus be possible to identify patients who will experience a decrease in BMD during treatment break, and for this particular group of patients treatment can be re-initiated earlier so further loss of bone will be avoided. On the other hand, the biochemical markers of bone turnover could also shed light on who can tolerate treatment break, thereby avoid long-term treatment with alendronate, which may be associated with serious side effects. Finally, the use of blood samples rather than DXA will reduce the use of X-rays.
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Discontinue alendronate | Drug | 136 patients with osteoporosis stopping treatment with alendronate. |
| Measure | Description | Time Frame |
|---|---|---|
| If Carboxy-terminal Collagen Crosslinks (CTX) Three and Six Months After Stopping Alendronate Predicted TH BMD (Total Hip BMD) Loss Above the Least Significant Change at Month 12 at the Individual Level. | We constructed receiver operating characteristic (ROC) curves to evaluate if carboxy-terminal collagen crosslinks (CTX) three and six months after stopping alendronate predicted TH BMD loss above the least significant change (LSC) at month 12 at the individual level. | Baseline and one year after baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Percent Change in Bone Turnover Markers Measured Three and Six Months After Stopping Alendronate Treatment and BMD After One and Two Years | We constructed receiver operating characteristic (ROC) curves to evaluate if changes in p-CTX or p-PINP measured three and six months after stopping alendronate predicted TH BMD loss above the least significant change at month 12 and/or month 24 at the individual level. |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
140 patients with osteoporosis stopping treatment with alendronate.
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Bente L Langdahl, MD PhD DMSc | Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Endocrinology and Internal Medicine, Aarhus University Hospital | Aarhus | 8000 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 8950879 | Background | Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996 Dec 7;348(9041):1535-41. doi: 10.1016/s0140-6736(96)07088-2. | |
| 7477143 |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| FG000 | Study Population | Postmenopausal women (postmenopausal for at least 2 years) and men above 50 years, who had been treated with alendronate for at least five years and had a total hip bone mineral density (BMD) T-score > -2.5 and lumbar spine BMD (L1-L4) T-score > -4. We excluded patients with any low-energy fracture within the previous 5 years during alendronate treatment (not including fingers, toes, or skull), low-energy vertebral fracture or hip fracture at any time, on-going treatment with systemic glucocorticoids, metabolic bone disease, hormone replacement therapy, cancer and other conditions affecting bone metabolism. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | Study Population | Postmenopausal women and men |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | If Carboxy-terminal Collagen Crosslinks (CTX) Three and Six Months After Stopping Alendronate Predicted TH BMD (Total Hip BMD) Loss Above the Least Significant Change at Month 12 at the Individual Level. | We constructed receiver operating characteristic (ROC) curves to evaluate if carboxy-terminal collagen crosslinks (CTX) three and six months after stopping alendronate predicted TH BMD loss above the least significant change (LSC) at month 12 at the individual level. | None of the ROC curves investigating the ability of change in CTX to predict BMD loss beyond LSC at any site at month 12 at the individual level had AUC above 60% meaning that it was not possible to identify a specific cut-off value that could predict significant bone loss at the individual level. | Posted | Mean | Standard Deviation | percentage change | Baseline and one year after baseline |
|
From baseline to month 24
Not provided
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Study Population | Postmenopausal women (postmenopausal for at least 2 years) and men above 50 years, who had been treated with ALN for at least five years and had a THBMD T-score > -2.5 and LSBMD (L1-L4) T-score > -4. We excluded patients with any low-energy fracture within the previous 5 years during ALN treatment (not including fingers, toes, or skull), low-energy VFx or hip fracture at any time, on-going treatment with systemic glucocorticoids, metabolic bone disease, hormone replacement therapy, cancer and other conditions affecting bone metabolism. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Cancer | Investigations | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Fracture | Musculoskeletal and connective tissue disorders | Systematic Assessment |
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Anne Sophie Sølling | Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark | +45 78 45 54 75 | annesoel@rm.dk |
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 23, 2018 | Nov 26, 2020 | Prot_SAP_000.pdf |
Not provided
| ID | Term |
|---|---|
| D010024 | Osteoporosis |
| ID | Term |
|---|---|
| D001851 | Bone Diseases, Metabolic |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D008659 | Metabolic Diseases |
Not provided
Not provided
Not provided
Not provided
Not provided
| one and two years after baseline |
| Number of Participants in Which CTX Increased Above the Least Significant Change | Number of participants in which CTX increased above the least significant change. The Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark provided the the least significant change for p-CTX > 30%. | From baseline to month 24 |
| The Number of Participants Who Lost BMD Beyond the Least Significant Change (LSC) at the Lumbar Spine and Total Hip. | the number of patients who lost BMD beyond the LSC at the lumbar spine (>3%) and total hip (>5%) | from baseline to month 24 |
| If Baseline Bone Turnover Markers at the Time of Alendronate Discontinuation Predict Changes in BMD After One and Two Years. | We constructed receiver operating characteristic (ROC) curves to evaluate if baseline p-CTX or baseline p-PINP at the time of alendronate discontinuation predicted TH BMD loss above the least significant change at month 12 and/or month 24 at the individual level. | Changes in TH BMD after one and two years. |
| Background |
| Liberman UA, Weiss SR, Broll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 1995 Nov 30;333(22):1437-43. doi: 10.1056/NEJM199511303332201. |
| 20842676 | Background | Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster D, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Koval K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O'Keefe R, Papapoulos S, Sen HT, van der Meulen MC, Weinstein RS, Whyte M; American Society for Bone and Mineral Research. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010 Nov;25(11):2267-94. doi: 10.1002/jbmr.253. |
| 17663640 | Background | Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E; American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007 Oct;22(10):1479-91. doi: 10.1359/jbmr.0707onj. |
| 17190893 | Background | Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR; FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006 Dec 27;296(24):2927-38. doi: 10.1001/jama.296.24.2927. |
| 20200926 | Background | Schwartz AV, Bauer DC, Cummings SR, Cauley JA, Ensrud KE, Palermo L, Wallace RB, Hochberg MC, Feldstein AC, Lombardi A, Black DM; FLEX Research Group. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res. 2010 May;25(5):976-82. doi: 10.1002/jbmr.11. |
| 33517477 | Derived | Solling AS, Harslof T, Bruun NH, Langdahl B. The predictive value of bone turnover markers during discontinuation of alendronate: the PROSA study. Osteoporos Int. 2021 Aug;32(8):1557-1566. doi: 10.1007/s00198-021-05835-4. Epub 2021 Jan 30. |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Bone mineral density (BMD) lumbar spine | Mean | Standard Deviation | g/cm3 |
|
| Bone mineral density (BMD) total hip | Mean | Standard Deviation | g/cm3 |
|
| Baseline CTX | Mean | Standard Deviation | ug/L |
|
| Baseline PINP | Mean | Standard Deviation | ug/L |
|
Study population
|
|
| Secondary | Percent Change in Bone Turnover Markers Measured Three and Six Months After Stopping Alendronate Treatment and BMD After One and Two Years | We constructed receiver operating characteristic (ROC) curves to evaluate if changes in p-CTX or p-PINP measured three and six months after stopping alendronate predicted TH BMD loss above the least significant change at month 12 and/or month 24 at the individual level. | None of the ROC curves investigating the ability of change in bone turnover markers to predict BMD loss beyond LSC at any site at month 12 or month 24 at the individual level had AUC above 60% meaning that it was not possible to identify a specific cut-off value that could predict significant bone loss at the individual level. | Posted | Mean | Standard Deviation | percentage change | one and two years after baseline |
|
|
|
| Secondary | Number of Participants in Which CTX Increased Above the Least Significant Change | Number of participants in which CTX increased above the least significant change. The Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark provided the the least significant change for p-CTX > 30%. | Posted | Number | participants | From baseline to month 24 |
|
|
|
| Secondary | The Number of Participants Who Lost BMD Beyond the Least Significant Change (LSC) at the Lumbar Spine and Total Hip. | the number of patients who lost BMD beyond the LSC at the lumbar spine (>3%) and total hip (>5%) | Posted | Number | participants | from baseline to month 24 |
|
|
|
| Secondary | If Baseline Bone Turnover Markers at the Time of Alendronate Discontinuation Predict Changes in BMD After One and Two Years. | We constructed receiver operating characteristic (ROC) curves to evaluate if baseline p-CTX or baseline p-PINP at the time of alendronate discontinuation predicted TH BMD loss above the least significant change at month 12 and/or month 24 at the individual level. | None of the ROC curves investigating the ability of baseline bone turnover markers to predict BMD loss beyond LSC at any site at month 12 or month 24 at the individual level had AUC above 60% meaning that it was not possible to identify a specific cut-off value that could predict significant bone loss at the individual level. | Posted | Mean | Standard Deviation | percentage change | Changes in TH BMD after one and two years. |
|
|
|
| 0 |
| 142 |
| 7 |
| 142 |
| 68 |
| 142 |
| Arrhythmia, acute myocardial infarction, hypertension | Cardiac disorders | Systematic Assessment |
|
| Cataract, glaucoma | Eye disorders | Systematic Assessment |
|
| Lower urinary symptoms, infection and kidney stones | Renal and urinary disorders | Systematic Assessment |
|
| Arthralgia, osteoarthritis, back pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Upper and lower respiratory tract infection, pneumonia, bronchitis | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
Not provided
Not provided
Not provided
| D009750 |
| Nutritional and Metabolic Diseases |
|
| Mean change in TH BMD from baseline to month 24 |
|