Osteopenia, Type 2 Diabetes
Conditions
Brief summary
The hypothesis for this study is that oral Semaglutide, a GLP-1Ra, has a positive effect on the balance between build-up and degradation as well as the strength of the bones in men and women aged 50-85 years with type 2 diabetes and an increased risk of bone fractures. Treatment involves once daily oral GLP-1Ra semaglutide or matching placebo for 52 weeks. The effect will be measured by bone markers in blood samples, bone scans, bone tissue and bone marrow tests (bone marrow aspiration and biopsy), physical activity assessed by a questionnaire, and direct bone strength measured by microindentation at the start and end of the study.
Interventions
DRUGoral Semaglutide/Rybelsus
Weeks 1-4: 3 mg of oral semaglutide once daily. Weeks 5-52: 7 mg of semaglutide once daily as maintenance dose. Dose may be increased to 14 mg of semaglutide once daily as maintenance dose after 2 months if glucose levels are out of range.
DRUGPlacebo
Weeks 1-4: 3 mg of oral placebo once daily. Weeks 5-52: 7 mg of placebo once daily as maintenance dose. Dose may be increased to 14 mg of placebo once daily as maintenance dose after 2 months if glucose levels are out of range.
Sponsors
Odense University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
50 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Type 2 diabetes and glycosylated haemoglobin (HbA1C) of 48-91 mmol/mol (6.5-10.5%) and * T-score \<-1 in hip or lower back, assessed by DXA scan and / or * Low-energy fracture within the last 3 years
Exclusion criteria
* T-score \<-2.5 in hip or lower back, assessed by DXA scan, although these individuals may be included if they are not candidates for conventional osteoporosis therapy, e.g., due to allergies and renal impairment, or if they prefer to participate in the trial. * Type 1 diabetes mellitus * Severe NPDR (non-proliferative diabetic retinopathy) or PDR (proliferative diabetic retinopathy) assessed within the last year. If a recent assessment is unavailable, a new retinal photo test will be performed. * Congestive heart failure (NYHA Class IV) * Primary hyperparathyroidism * Vitamin D deficiency (\<25 nM) (re-test after substitution acceptable) * Known disorders affecting bone metabolism, e.g., uncontrolled thyrotoxicosis, severe renal impairment (eGFR \<30) or liver dysfunction (baseline phosphatase higher than twice upper limit (105 U/L)), rheumatism, celiac disease, hypogonadism, severe COPD, hypopituitarism, Cushing's disease * Clinically significant concomitant diseases or disorders (e.g., cancer) or clinically significant abnormal values in laboratory screening tests, including increased Choriogonadotropin (hCG) in women. * History of gastrointestinal surgery (except uncomplicated surgical procedures such as hernia surgery and appendectomy) * Antiresorptive or bone anabolic drugs for the last 12 months * Use of anabolic steroids in the previous year * Use of GLP-1Ras within 90 days * Stable therapy with DPP4 inhibitors (unless the patient is willing to discontinue the treatment) * History of pancreatitis * Allergy or hypersensitivity to the active substance or to any of the ingredients * Inability to give informed consent * Previous bariatric surgery * BMI \<20 kg/m2 or BMI\>37 kg/m2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Procollagen type 1 N-terminal propeptide (P1NP) | Baseline and 52 weeks | Percentage changes in bone formation marker P1NP from baseline and after 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bone formation rate | 52 weeks | Changes in bone formation rate (BRF/BS, µm\^3/µm\^2 per day), the volume of mineralized bone made per unit surface of bone per year, based on dynamic histomorphometry of bone tissue |
| Fat tissue distribution | Baseline and 52 weeks | Change in fat tissue distribution, assessed by DXA |
| Lean tissue distribution | Baseline and 52 weeks | Change in lean tissue distribution, assessed by DXA |
| Glycosylated haemoglobin (HbA1C) | Baseline and 52 weeks | Change in HbA1c from baseline and after 12 months |
| Physical activity | Baseline and 52 weeks | Change in physical activity based on analysis of International Physical Activity Questionnaire Short Form (IPAQ-SF) from baseline and after 12 months |
| Body mass index (BMI) | Baseline and 52 weeks | Change in BMI from baseline and after 12 months |
| Collagen 1 cross link C-terminal telopeptide (CTX) | Baseline and 52 weeks | Changes in bone resorption marker CTX from baseline and after 12 months |
| Osteocalcin | Baseline and 52 weeks | Changes in bone formation marker osteocalcin from baseline and after 12 months |
| Bone specific alkaline phosphatase (BALP) | Baseline and 52 weeks | Changes in bone formation marker BALP from baseline and after 12 months |
| Bone mineral density (BMD) | Baseline and 52 weeks | Changes in BMD (total hip, femoral neck and lumbar spine (L1-4)) assessed by DXA scans from baseline and after 12 months |
| Estimated bone strength | Baseline and 52 weeks | Changes in estimated bone strength assessed by finite elemental analysis (HR-pQCT scan) from baseline and after 12 months |
| Total volumetric BMD | Baseline and 52 weeks | Changes in total volumetric BMD (mg/cm\^3) assessed by HR-pQCT scan of distal tibia and radius |
| Trabecular volumetric BMD | Baseline and 52 weeks | Changes in trabecular volumetric BMD (mg/cm\^3) assessed by HR-pQCT scan of distal tibia and radius |
| Cortical volumetric BMD | Baseline and 52 weeks | Changes in cortical volumetric BMD (mg/cm\^3) assessed by HR-pQCT scan of distal tibia and radius |
| Bone volume | Baseline and 52 weeks | Changes in trabecular bone volume pr total volume (BV/TV) assessed by HR-pQCT scan of distal tibia and radius |
| Trabecular thickness | Baseline and 52 weeks | Changes in trabecular thickness (mm) assessed by HR-pQCT scan of distal tibia and radius |
| Cortical porosity | Baseline and 52 weeks | Changes in cortical porosity assessed by HR-pQCT scan of tibia and radius |
| Cortical thickness | Baseline and 52 weeks | Changes in cortical thickness (mm) assessed by HR-pQCT scan of distal tibia and radius |
Countries
Denmark
Outcome results
None listed