Denosumab Allergy, Zoledronic Acid Allergy
Conditions
Brief summary
Osteoporotic vertebral compression fracture (OVCF) patients had a proportion of secondary fractures after percutaneous vertebroplasty (PVP). Denosumab and zoledronate acid is both effective to prevent bone loss for OVCF postmenopausal women. However, trial evidence comparing effect of denosumab vs zoledronate after PVP was unknown. The study aims to assess the efficiency of denosumab vs zoledronate for OVCF patients bone mineral density (BMD), bone turnover markers (BTMs), secondary fracture and adverse events after PVP.
Detailed description
Whether denosumab was non-inferior than zoledronate in improving bone mineral density (BMD), bone turnover markers (BTMs), functional status questionnaires, and secondary fracture in elderly patients with OVCF after PVP remains unknown. A prospective, randomized, placebo-controlled clinical trial in OVCF patients with PVP was performed. This study aimed to investigate the efficiency of denosumab vs zoledronate on BMD, BTMs, functional status, secondary fracture rate, and adverse events in OVCF patients after PVP during a 12-month follow-up period.
Interventions
1 ml (60 mg) of denosumab (Prolia; Amgen, Inc) subcutaneous injection plus intravenous placebo every 6 months (Q6M)
DRUGZoledronate
Intravenous zoledronic acid 5 mg plus subcutaneous placebo every 12 months
Sponsors
Shenzhen People's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Participants were randomized using a block randomization model (block size 5). Computer-generated, random-number sequences were prepared by an experienced statistician. Consecutive treatment allocations were stored in sealed opaque envelopes and assigned to doctors. Patients and doctors were blinded to the assignments; all researchers and data analysts were blinded as to the allocation during the 12-month follow-up period.
Eligibility
Sex/Gender
ALL
Age
50 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Must be age between 50 and 90 years old * X-ray diagnosis of 1 or 2 segment vertebral compression fractures from T4 to L5 * Bone mineral density T value less than -1 via dual-energy X-ray * A recent fracture history less than 6 weeks * MRI show bone marrow edema of fractured vertebrae * low back pain, local paravertebral tenderness
Exclusion criteria
* Must be able to have no intervertebral fissure * Must be able to have no infection * Must be able to have no malignancy * Must be able to have no neurological dysfunction * Must be able to have no previous use of anti-osteoporosis drugs * Must be able to have no inability to perform magnetic resonance imaging * Must be able to have no prior back open surgery * Must be able to have no other established contraindications for elective surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analog scale (VAS) back | up to 12 months | The VAS score for back pain were determined at baseline, 6 and 12 month. Use a ruler about 10cm long, one side is marked with 0 and the other 10 respectively. A score of 0 indicates no pain, 10 indicates the most unbearable pain. |
| Lumbar bone mineral density(BMD) | up to 12 months | Lumbar vertebral (L1 to L4, except the surgery segment) BMD were determined at baseline, 6 and 12 months via dual- energy X-ray |
| Total hip BMD | up to 12 months | Total hip BMD were determined at baseline, 6 and 12 months via dual-energy X-ray. |
| Femoral neck BMD | up to 12 months | Femoral neck BMD were determined at baseline, 6 and 12 month via dual-energy X-ray |
| Procollagen type 1 n-terminal propeptide (P1NP) | up to 12 months | Bone formation marker, P1NP were determined at baseline, 6 and 12 months after surgery. |
| C-terminal cross-linked type 1 collagen terminal peptide (CTX) | up to 12 months | Bone resorption marker, CTX were determined at baseline, 6 and 12 months after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The QUALEFFO-31 Questionnaire | up to 12 month | The Quality of Life Questionnaire of the European Foundation for Osteoporosis-31 (QUALEFFO-31), which contains three domains including pain, physical function, and mental function. This scale is assessed on a scale of 0 to 100, with 0 indicating the highest QoL and 100 the lowest. |
| The EQ-5D Questionnaire | up to 12 month | The EuroQol five-dimension (EQ-5D) questionnaire evaluates health status consisting five dimensions: mobility, self-care, performance of usual activities, pain or discomfort, and anxiety or depression. After conversion, the index was between 0 and 1.0 (minimum score: 0, indicating worst health state; full score:1.0, indicating full health). |
| Secondary fracture rate | up to 12 month | Secondary fracture rate containing vertebral fracture and non-vertebral fracture was assessed at 12 month after surgery. The lowest score was 0, the highest score was 100%. The lower score 0 represents no secondary fracture. |
| Adverse events | up to 12 month | The main adverse events including deep venous thrombosis, pneumonia, acute renal failure, pulmonary embolism, myocardial infarction, influenza, transfer to intensive care unit, joint pain, headache, nausea, osteonecrosis of the jaw, atypical femoral fracture and rash. |
| The Roland-Morris Disability Questionnaire | up to 12 month | The Roland-Morris Disability Questionnaire is scored by 24 adding up the number of items checked yes on different low back pain-related daily activity disabilities. Total scores range from 0 to 24, with higher scores 24 indicating a higher level of disability related to low back pain and lowest 0 represents no back pain. |
Countries
China
Outcome results
None listed