Hypercalciuria, Hypercalciuria, Familial Idiopathic, Osteopenia, Osteoporosis
Conditions
Keywords
Hypercalciuria, Familial Idiopathic, Hypercalciuria, Osteopenia, Osteoporosis, Postmenopausal women
Brief summary
The purpose of this study is to assess if estrogen replacement normalizes urinary calcium excretion in postmenopausal women with hypercalciuria and low bone mass and to assess for differences in response to estrogen replacement in women with familial hypercalciuria compared to nonfamilial hypercalciuria.
Detailed description
Subjects will primarily be recruited from the subjects of protocol 12-1421. Subjects may also be identified through chart review of patients seen by Dr. Favus in the Bone Clinic at the University of Chicago. These subjects will be mailed a letter describing the study and a request to contact us if they are willing to participate in the study. We plan to enroll 20 subjects to obtain complete data on 16 subjects. We aim to have 10 subjects who will have confirmed familial idiopathic hypercalciuria (IH) and 10 subjects who will have no family history of hypercalciuria. Subjects will be brought into the Clinical Research Center at the University of Chicago where blood samples will be collected by phlebotomy to obtain the following screening tests: complete metabolic panel; including calcium, phosphate, magnesium, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin; parathyroid hormone, 25-hydroxyvitamin D, follicle stimulating hormone (FSH), and estradiol. A twenty-four hour urine collection starting with second void of the day will be collected for calcium, phosphate, magnesium, citrate, oxalate, sodium, ammonia, sulfate, and creatinine. Subjects on diuretics will be screened after a 2 week washout period, provided this can be discontinued safely. If subjects have participated in study protocol number 12-1421, these screening tests do not have to be repeated and the results from protocol number 12-1421 will be used to determine eligibility. Screening subjects who meet inclusion criteria can proceed to the observational study. Screening subjects who are vitamin D depleted (serum 25-hydroxyvitamin D less than 35 ng/mL) may be rescreened after repletion of vitamin D. A letter describing the study aims, protocols, and risks and benefits will be sent to their primary care physicians and gynecologists. Upon completion of the study, a summary letter will be sent as well. Prior to the baseline visit a twenty-four hour urine collection starting with the second void of the day will be collected for calcium, phosphate, magnesium, citrate, oxalate, sodium, ammonia, sulfate, and creatinine. Subjects on diuretics will require a 2 week washout period, provided this can be discontinued safely. During the baseline visit a medical history will be taken and a physical exam will be performed. Venous blood will be collected for 1,25-dihydroxyvitamin D3, osteocalcin, bone-specific alkaline phosphatase, C-telopeptides of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP), bone morphogenetic protein 2 (BMP-2), and sclerostin. If the subject has had these blood tests performed in the preceding four months for protocol 12-1421, the blood tests will not be repeated. 18F sodium fluoride PET/CT bone scan will be performed. The protocol for the radionuclide imaging is attached. All subjects will be started on transdermal 17-beta-estradiol 0.05 mg/d, which is equivalent to the standard dose of conjugated estrogen dose of 0.625 mg, for 4 weeks and increased to 0.1 mg for subsequent 4 weeks. Given the short duration of this study, progesterone will not be provided, as 8 weeks is not of sufficient duration to significantly increase the risk of endometrial cancer (Strom, Schinnar et al. 2006). For the entire study, diuretics will be discontinued if it has been deemed safe to do so by the principle investigator or prescribing physician. Throughout the study, subject will maintain 900-1200 mg of dietary calcium daily. To monitor dietary calcium intake, a 5 day diet diary will be kept from Sunday to Thursday of the fourth week of each medication dose. Compliance of the study medication will be assessed by estrogen patch counts. The following blood tests will be repeated 4 and 8 weeks after starting estradiol patch: complete metabolic panel (including calcium, phosphate, potassium, bicarbonate, chloride, magnesium, creatinine, and albumin), 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D3, parathyroid hormone, estradiol, osteocalcin, bone-specific alkaline phosphatase, C-telopeptides of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP), bone morphogenetic protein 2 (BMP-2), and sclerostin. In addition, 4 and 8 weeks after starting estradiol patch, 24 hour urine collection will be performed for calcium, phosphate, magnesium, citrate, oxalate, sodium, ammonia, sulfate, and creatinine.
Interventions
4 weeks of Vivelle-Dot 0.05 mg/day followed by 4 weeks of Vivelle-Dot 0.10 mg/day
Sponsors
University of Chicago
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 69 Years
Healthy volunteers
No
Inclusion criteria
* Postmenopausal women * Diagnosis of hypercalciuria * Diagnosis of low bone mass * Vitamin D replete (serum 25-hydroxyvitamin D level \>35 ng/mL)
Exclusion criteria
* Secondary causes of hypercalciuria (primary hyperparathyroidism, sarcoidosis, vitamin D excess, malignant neoplasm, and renal tubular acidosis) * Other metabolic bone disease (primary hyperparathyroidism, hyperthyroidism, hypercortisolemia, severe gastrointestinal disorders, liver cirrhosis, renal failure (Cr \>1.5), active malignancy including multiple myeloma, rheumatological diseases, and Paget's disease of bone) * Use of medications affecting bone and calcium metabolism (corticosteroids in the previous 3 months, suppressive dose of thyroid hormone, calcium channel blockers, anti-convulsants, aromatase inhibitors, thiazolidinediones, and cyclosporine A) * History of coronary artery disease * Breast cancer or suspected estrogen-dependent neoplasia * Previous venous thromboembolic event * Stroke * Active liver disease * Tobacco use within the past 6 months * Negative colonoscopy within the previous 10 years or sigmoidoscopy within the previous 5 years * Negative mammogram within the previous 2 years * Negative Pap smear within the previous 3 years in women \< or = 65 years old with an intact cervix * No vaginal bleeding within the prior 5 months. * Age \> or = 70 * \> or = 20 years since last menstrual period or use of hormone replacement therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Absolute Change in 24 Hour Urinary Calcium Excretion | 4 weeks, 8 weeks | 0 participants were measured because the study was terminated |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum 1,25-dihydroxyvitamin D3 | 4 weeks, 8 weeks | 0 participants were analyzed because the study was terminated |
| Serum Bone Morphogenetic Protein 2 | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Sclerostin | 4 weeks, 8 weeks | Not available because the study was terminated |
Other
| Measure | Time frame | Description |
|---|---|---|
| Serum Estradiol | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Total Calcium | 4 weeks, 8 weeks | Not available because the study was terminated |
| Calculated Serum Ionized Calcium | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Parathyroid Hormone | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Phosphorus | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Osteocalcin | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum C-telopeptides of Type 1 Collagen | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum Procollagen Type 1 N-terminal Propeptide | 4 weeks, 8 weeks | It is not available because the study was terminated |
| Serum Bone-specific Alkaline Phosphatase | 4 weeks, 8 weeks | Not available because the study was terminated |
| Calculated Tubular Resorption of Calcium | 4 weeks, 8 weeks | Not available because the study was terminated |
| Serum 25 Hydroxyvitamin D | 4 weeks, 8 weeks | Not available because the study was terminated |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Transdermal Estradiol Transdermal estradiol 0.05 mg/day for 4 weeks, followed by 0.10 mg/day for 4 weeks
Transdermal estradiol: 4 weeks of Vivelle-Dot 0.05 mg/day followed by 4 weeks of Vivelle-Dot 0.10 mg/day | 0 |
| Total | 0 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Study terminated. | 1 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Absolute Change in 24 Hour Urinary Calcium Excretion
0 participants were measured because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: 0 participants were analyzed because the study was terminated
Secondary
Serum 1,25-dihydroxyvitamin D3
0 participants were analyzed because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: The study was terminated
Secondary
Serum Bone Morphogenetic Protein 2
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: the study was terminated
Secondary
Serum Sclerostin
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Calculated Serum Ionized Calcium
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Calculated Tubular Resorption of Calcium
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum 25 Hydroxyvitamin D
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Bone-specific Alkaline Phosphatase
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum C-telopeptides of Type 1 Collagen
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Estradiol
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Osteocalcin
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Parathyroid Hormone
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Phosphorus
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Procollagen Type 1 N-terminal Propeptide
It is not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated
Other Pre-specified
Serum Total Calcium
Not available because the study was terminated
Time frame: 4 weeks, 8 weeks
Population: Not available because the study was terminated