Osteopenia Please note this is not a study to investigate the use of the IMP for the treatment of osteopenia but rather to validate a non-invasive imaging technique for measuring early changes in bone in response to therapy. MedDRA version: 12 Level: LLT Classification code 10049088 Term: Osteopenia
Conditions
Interventions
Trade Name: Teriparatide (Forsteo)
Product Name: Teriparatide
Pharmaceutical Form: Injection*
INN or Proposed INN: recombinant human parathyroid hormone (1-34)
CAS Number: 52232-67-4
Concentration uni
Sponsors
King’s College London
Guy's & St Thomas NHS Trust
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Subjects will be eligible for entry into the study if they meet all the following inclusion criterion: • Ambulatory postmenopausal* women. • Aged 50 to 85 years inclusive. • Free of severe or chronically disabling condition. • Without language barrier, cooperative, expected to return for all follow-up visits and who give written informed consent before entering the study. • Lumbar spine, femoral neck and/or total hip BMD between 1 and 2.5 standard deviations below the average bone mineral density for young healthy women (i.e. T-score =-1 to > -2.5) as determined from the manufacturer’s database. • Normal or clinically insignificant abnormal laboratory values. • Normocalcemia Serum Calcium =2.15 mmol/l and =2.55 mmol/l. • Vitamin D 25-(OH) Serum level of =15 ng/ml (37.4 nmol/L) • Otherwise in good health as determined by past medical history, physical examination, vital signs, standard laboratory tests and urinalysis at screening and the opinion of the investigator. • Screening BMI must be >18.5 and =30 and subjects must weigh at least 50 kg. • At Screening vital signs (systolic and diastolic blood pressure and pulse rate) will be assessed after the subject has rested for at least three (3) minutes, and again if clinically indicated after three (3) minutes in standing position. Vital signs should be within the following ranges: o Tympanic (ear) temperature between 35.5 – 37.5 °C o Systolic blood pressure, 90 – 160 mm Hg o Diastolic blood pressure, 50 – 90 mm HG o Pulse rate, 55 – 90 bpm When blood pressure and pulse will be taken again after 3 minutes standing, there shall be no more than a 20 mm Hg drop in systolic or 10 mm Hg drop in diastolic blood pressure and increase in heart rate (>20 bpm) associated with clinical manifestation of postural hypotension. All blood pressure measurements at other time-points should be assessed with the subject seated, unless stated otherwise in the protocol design, and utilizing the same arm for each determination. • Ability to lie still in a PET scanner for 70 minutes Definitions: * Postmenopausal status is defined as: • no vaginal bleeding for at least 12-months prior to enrolment in women with an intact uterus or • a hysterectomy and/or bilateral oophorectomy 12-months after a naturally occurring menopause or • a hysterectomy and/or bilateral oophorectomy prior to menopause and at least 12-months prior to enrolment with postmenopausal status defined biochemically by oestradial 30 IU/L (confirmed prior to dosing). • In women >50 and 30 IU/l (confirmed prior to dosing) Are the trial subjects under 18? no Number of subjects for this age range: F.1.2 Adults (18-64 years) yes F.1.2.1 Number of subjects for this age range F.1.3 Elderly (>=65 years) yes F.1.3.1 Number of subjects for this age range
Exclusion criteria
Exclusion criteria: Subjects will be excluded from the study if they meet any of the following criteria: • Current or recent (within 1 year of enrolment) metabolic bone disorders such as Paget’s disease of bone, Cushing’s Syndrome, acromegaly, osteogenesis imperfecta, renal osteodystrophy, osteomalacia, any secondary causes of osteoporosis and/or bone loss, or serious illness affecting normal bone homeostasis. • Current or recent (within 1 year of enrolment) disease which affects bone metabolism, such as hypoparathyroidism, hyperparathyroidism, or hyperthyroidism. • Subjects with a history of hypothyroidism not on stable replacement therapy with levothyroxine (defined as no change of dose for at least 6-months prior to enrolment) • Subjects with skeletal malignancies or bone metastases • Recent (within 6-months of enrolment) fracture at any skeletal site. • Significant osteoarthritis of the lumbar spine and/or hip(s) precluding a satisfactory DXA or 18F-fluoride PET scan. • History of carcinoma in the previous 5 years or currently suspected carcinoma, with the exception of excised superficial lesions such as basal cell carcinoma and squamous cell carcinoma of the skin. • Current or recent (within 1 year of enrolment) inflammatory bowel disease or malabsorption syndrome. • Pre-existing hypercalcaemia • Unexplained elevations of alkaline phosphatase. • Current or recent (within 2 years of enrolment) nephrolithiasis or urolithiasis. • Clinically significant renal, pancreatic, hepatic or cardiovascular disease, diabetes requiring pharmacotherapy indicated by: o Clinically significant abnormal liver function tests such as SGOT, SGPT, GGT, alkaline phosphatase, or serum bilirubin o Clinically significantly abnormal creatinine or BUN values or abnormal urinary constituents (e.g. albuminuria) o Evidence of urinary obstruction or difficulty in voiding at screening • History of drug or alcohol abuse within the 12 months prior to dosing or evidence of such abuse as indicated by the laboratory tests conducted at screening. • Current or recent treatment (within 1 year of enrolment) with androgens or other anabolic steroids. • Current or recent (within 1 year of enrolment) treatment with oestrogens (with or without progestins) or selective oestrogen receptor modulators (SERMs) • Current or recent (within 1 year of enrolment) treatment with systemic corticosteroids, or orally inhaled or nasally inhaled corticosteroids in doses > 400 µg/day beclomethasone/day or equivalent. • Current or previous treatment with IV or oral bisphosphonates, strontium ranelate, fluorides, calcitonin, teriparatide or PTH 1-84, aluminium supplements. • Patients with 25-(OH) Vitamin D levels less than 15 ng/mL (37.4 nmol/L) prior to randomization • Treatment with vitamin D or calcium supplements started less than one month prior to screening visit. • Current or recent (within 1 year of enrolment) treatment with anticonvulsants. • Subjects with a positive Hepatitis B surface antigen (HBsAg) or hepatitis C test result or a history of immunodeficiency diseases, including a positive HIV test result. • Hypersensitivity to teriparatide or to any of the excipients. • Prior external beam or implant radiation therapy to the skeleton. • Poor medical or psychiatric risk for treatment in the opinion of the investigator. • Subjects with anorexia nervosa, suspected bulimia (by history or physical) or obvious malnutrition • Subjects exhibiting or with a history of any of the following signs or symptoms
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: The aim of this study is to investigate if 18F-fluoride PET can be used to assess the direct effects of treatment on bone turnover at the hip. The primary objective is to compare changes in bone turnover at the hip measured by 18F-fluoride PET in postmenopausal women treated with teriparatide and untreated controls.;Secondary Objective: To compare changes in bone turnover at the hip with changes at the lumbar spine in response to teriparatide treatment. To compare changes in bone turnover at the spine and hip with changes in biochemical markers of bone turnover and changes in bone mineral density. To examine test-retest variability of 18F-fluoride PET measurements at the hip.;Primary end point(s): The primary objective is to demonstrate a significant increase in the rate of bone formation, measured by 18F-fluoride PET, in the hip following 12-weeks of treatment with the anabolic agent teriparatide as compared to controls. | — |
Countries
United Kingdom
Outcome results
None listed