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The recommended dosing regimen of zoledronic acid in Chinese osteoporosis patients is completely in accordance with the one of 5 mg per year abroad that based on the dosing regimen in Paget's disease. This dosing regimen lacks the actual supportive clinical data of Chinese patients. In addition, the overall incidence of acute phase response, the main adverse event after the first infusion, in Chinese patients is higher than that in Caucasian patients population. Moreover, the results of the similar drug clinical study in the Japanese patients shown that the purpose of effective treatment for osteoporosis could be achieved with half of the dosage in Caucasian population. Thus, it could be inferred from these that the dosing regimen of zoledronic acid might be inappropriate in Chinese osteoporosis patients. Therefore, the main purpose of this clinical trail is to compare the zoledronic acid pharmacokinetic and pharmacodynamic characteristic of different doses in Chinese postmenopausal subjects with low bone mass or osteoporosis and explore the best dosing regimen in Chinese patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| zoledronic acid 1mg | Experimental | Add 20 mL of Zoledronic acid injection (100mL : 5mg) with 80 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once. |
|
| zoledronic acid 2.5mg | Experimental | Add 50 mL of Zoledronic acid injection (100mL : 5mg) with 50 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once. |
|
| zoledronic acid 5mg | Experimental | Infusion 100 mL of Zoledronic acid injection (100mL : 5mg) with constant speed in 20 minutes. Administration only once. |
|
| placebo | Placebo Comparator | Infusion 100 mL of normal saline with constant speed in 20 minutes. Administration only once. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Zoledronic Acid Injection | Drug | Infusion 1mg zoledronic acid once. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Concentration of Zoledronic acid | Zoledronic acid concentration in plasma and urine. | Predose, 30 minutes, 2 hours, 24 hours, day 7, day 29, 3 months, 6 months, 12 months, 24 months, and 36 months post dose |
| Maximum concentration of Zoledronic acid | The observed maximum concentration following administration (Cmax) in plasma after zoledronic acid infusion. | 0-36 months |
| Time to reach maximum concentration of Zoledronic acid | The time to reach the maximum concentration after administration (Tmax) in plasma after zoledronic acid infusion. | 0-36 months |
| AUC of Zoledronic acid | The area under the concentration-time curve (AUC) in plasma after zoledronic acid infusion. | 0-36 months |
| terminal half-life of Zoledronic acid | The terminal half-life (t1/2) of zoledronic acid after administration. | 0-36 months |
| apparent clearance of Zoledronic acid | The apparent clearance (CL/F) of zoledronic acid after administration. | 0-36 months |
| apparent volume of distribution of Zoledronic acid | The apparent volume of distribution of zoledronic acid after administration. | 0-36 months |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of adverse event | The occurrence time and severity of fracture. The occurrence time and severity of acute phase response. The occurrence time and severity of other adverse event. | 0-36 months |
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Inclusion Criteria:
Exclusion Criteria:
(1) intravenous biphosphonates or denosumab. (2) oral biphosphonates, parathyroid hormone or its analogues, strontium, or fluoride within 12 months.
(3) glucocorticoid, steroids, immunosuppressive agents, calcitonin, calcitriol or its analogues, thiazides diuretics, long-acting estrogen/progesterone, or statins within 3 months.
4. Combine other diseases affect bone metabolism: osteogenesis imperfecta, hyperthyroidism, malignant tumors, Paget's disease, rheumatoid arthritis, osteomalacia, osteopetrosis, ankylosing spondylitis, liver failure, or renal failure.
5. Hyperthyroidism or hypothyroidism during screening.
6. Treatment with any investigational drug within the past 3 months.
7. Creatinine clearance < 35 mL/min.
8. 25(OH)D level< 20 ng/mL.
9. Serum calcium level < 2.0 mmol/L (8 mg/dL), or >2.8 mmol/L (11.0 mg/dL).
10. Fever, severe infections, severe injuries, or major surgical operation within 30 days.
11. ECG corrected QT interval (QTc) > 480 ms.
12. Pending invasive dental procedure or in progress.
13. History of smoking within 6 months.
14. Diabetes with fasting blood glucose ≥ 7.0 mmol/L, or glycated hemoglobin (HbA1c) >6.3%.
15. History of drug or alcohol abuse.
16. History of stroke, cerebral ischemic stroke, or cerebral hemorrhage.
17. Any physiological or medical condition which, in the opinion of the investigator, would preclude the participant from this trail.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Qi Liu, Ph. D. | Contact | +8615501060136 | liuqicpu@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Chunli Song, M.D.; Ph. D. | Peking University Third Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25182228 | Background | Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. doi: 10.1007/s00198-014-2794-2. Epub 2014 Aug 15. | |
| 12730746 | Background | Shiraki M, Fukunaga M, Kushida K, Kishimoto H, Taketani Y, Minaguchi H, Inoue T, Morita R, Morii H, Yamamoto K, Ohashi Y, Orimo H. A double-blind dose-ranging study of risedronate in Japanese patients with osteoporosis (a study by the Risedronate Late Phase II Research Group). Osteoporos Int. 2003 May;14(3):225-34. doi: 10.1007/s00198-002-1369-9. Epub 2003 Apr 10. |
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| ID | Term |
|---|---|
| D015663 | Osteoporosis, Postmenopausal |
| ID | Term |
|---|---|
| D010024 | Osteoporosis |
| D001851 | Bone Diseases, Metabolic |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D000077211 | Zoledronic Acid |
| ID | Term |
|---|---|
| D004164 | Diphosphonates |
| D063065 | Organophosphonates |
| D009943 | Organophosphorus Compounds |
| D009930 | Organic Chemicals |
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| Zoledronic Acid Injection | Drug | Infusion 2.5mg zoledronic acid once. |
|
|
| Zoledronic Acid Injection | Drug | Infusion 5mg zoledronic acid once. |
|
|
| Placebo | Drug | Infusion normal saline once. |
|
|
| Concentration of bone turnover markers |
Concentration-time profile of procollagen type 1 N-propeptide (P1NP), bone-specific alkaline phosphatase (ALP), osteocalcin (OCN), C-telopeptide (CTx), and tartrate-resistant acid phosphatase 5b (TRACP-5b) with unit of ng/mL. |
| 0-36 months |
| Concentration of 25(OH)D and FGF23 | Concentration determination of 25(OH)D and fibroblast growth factor 23 (FGF23) with unit of ng/mL | 0-36 months |
| PTH concentration determination | Assessment of the profile of parathyroid hormone (PTH) | 0-36 months |
| Serum sclerostin concentration determination | Concentration-time profile of sclerostin (SOST) after zoledronic acid infusion. | 0-36 months |
| Pharmacodynamic of zoledronic acid | Assessment of lipid metabolism markers, such as low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol, and triglycerides. | 0-36 months |
| Pharmacodynamic of zoledronic acid | Assessment of fibroblast growth factor 19 (FGF19). | 0-36 months |
| Pharmacodynamic of zoledronic acid | Assessment of total bile acid. | 0-36 months |
| Pharmacodynamic of zoledronic acid | Assessment of bone mineral density at the lumbar spine, neck of femur, and total hip. | 0-36 months |
| Change of immune indicator | Changes in white blood cells(WBC) | 0-36 months |
| Change of immune indicator | Changes in C reaction protein (CRP) | 0-36 months |
| Change of immune indicator | Changes in interferon-γ (IFN-γ) | 0-36 months |
| Change of immune indicator | Changes in interleukin-6 (IL-6) | 0-36 months |
| Change of immune indicator | Changes in γδT cells activation | 0-36 months |
| 28960821 | Background | Ding Y, Zeng JC, Yin F, Zhang CL, Zhang Y, Li SX, Liu X, Zhang C, Xue QY, Lin H, Pei FX. Multicenter Study on Observation of Acute-phase Responses After Infusion of Zoledronic Acid 5 mg in Chinese Women with Postmenopausal Osteoporosis. Orthop Surg. 2017 Aug;9(3):284-289. doi: 10.1111/os.12338. |
| D008659 |
| Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D007093 |
| Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |