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Adynamic Bone DiseasePhase 4NCT04522622

Treatment of Adynamic Bone Disorder With Parathyroid Hormone in Chronic Kidney Disease

A Phase 4 study testing Teriparatide, DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT and Bone biopsy in people with Adynamic Bone Disease and Chronic Kidney Diseases, run by Ditte Hansen at 4 sites in Denmark.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study is a 1:1 randomized controlled trial with an intervention for 18 months and a follow up period of 12 months. The purpose of the study is to assess the safety and efficacy of recombinant human parathyroid hormone for treatment of adynamic bone disorder in patients with chronic kidney disease. Read more about this study

Who is it for?
Ages 18 to 120 years
What is being tested?
Teriparatide, DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT and Bone biopsy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
4 sitesDenmark
Study dates
15 Dec 2021to 1 Sep 2027
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 120 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years
  • CKD stage 4-5D (eGFR ≤29 ml/min) according to Kidney Disease Improving Global Outcomes(KDIGO) definition
  • DXA scan with a T-score at the total hip, femoral neck or lumbar spine (L1-4) ≤-2 (or Z-score ≤-2) in a minimum of 2 vertebraes (for patients with active oral prednisolone treatment ≥ 5 mg/day for minimum 3 months the T-score or Z-score limit i < -1) and/or former fragility fracture (vertebral, hip, for- or upper arm, ankle) assessed with VFA or x-ray of the columna
  • Patients with expected adynamic bone disorder, based on BSAP≤21 µg/l or biopsy-verified low bone turnover

Who cannot join

  • Hypercalcemia defined as sustained ionized calcium >1.35 mmol/l
  • Previous fracture withon the last 6 months *Patients may be rescreened after the 6 months
  • Previous calciphylaxis
  • Thyroid disturbances not adequately treated based on the opinion by the clinician *Patients may be rescreened after treatment optimization
  • Treatment with digoxin
  • Paget's disease or other metabolic bone disorders
Show all 21Show fewer
  • Antiresorptive or bone anabolic medication during the last 24 months (for bisphosphonates it is only during the last 12 months)
  • Former or present malignant disease (except skin basal or planocellular carcinoma)
  • Previous external beam or implant radiation therapy to the skeleton
  • Patients who have undergone a kidney transplantation within the last 12 months
  • 25 hydroxyvitamin D2 and D3 <50 nmol/l *Patients may be rescreened after correction
  • Inability to administer teriparatide
  • Reduced liver function *Alanine Aminotransferase (ALAT) >3x upper limit of normal or bilirubin > 2x upper limit of normal
  • Pregnancy, lactation or fertile women (post-menopausal females are not considered fertile) not using safe anticonception (the following contraceptive methods are considered appropriate: Intrauterine device (IUD) or hormonal anticontraceptive (oral contraceptives, implant, transdermal patches, vaginal ring or depot injection)).
  • Hypersensitivity to the active substance in teriparatide or to any of the excipients or content
  • Inability to provide informed consent
  • Medical conditions or treatments that may interfere with assessments of the outcomes of the trial
  • Drug or alcohol abuse
  • Unable to participate in a clinical study based on the judgement by the local investigator
  • For those participating in the bone biopsy procedure: 1) Hypersensitivity to any of the tetracyclines or to any of the excipients or content, 2) Treatment with anticoagulants (vitamin K antagonists, Non-vitamin K Antagonist Oral Anticoagulants (NOAC), unfractionated or low-molecular heparin or antiplatelet agents that, due to clinical indication can't be paused, 3) Disturbances in thrombosis and/or haemostasis
  • For those participating in pulse wave measurements: 1) Atrial fibrillation, 2) Aorta stenosis

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Ditte Hansen, MD, PhD contact

+4538682056

ditte.hansen.04@regionh.dk

Denmark4 sites, 4 recruiting
  • Aalborg University Hospital

    Aalborg, 9000

    Charlotte Strandhave, MD, PhD, +4597665500, charlotte.strandhave@rn.dk

    My HS Svensson, MD, PhD, +4597665500, my.svensson@rn.dk

    Not yet recruiting
  • Steno Diabetes Center Copenhagen

    Gentofte Municipality, 2820

    Frederik Persson, MD, DMSc, +4539680800, frederik.persson@regionh.dk

    Frederik Persson, MD, DMSc.

    Not yet recruiting
  • Herlev and Gentofte Hospital, Herlev Hospital

    Herlev, 2730

    Sabina C Hauge, MD, +4528965887, sabina.chaudhary.hauge@regionh.dk

    Ditte Hansen, MD, PhD, +4538682056, ditte.hansen.04@regionh.dk

    Recruiting
  • Odense University Hospital

    Odense, 5000

    Morten F Nielsen, MD, PhD, +4522877448, mmfnielsen@health.sdu.dk

    Subagini Nagarajah, MD, +4528598621, subagininagarajah3@rsyd.dk

    Not yet recruiting

Other trials in Denmark

About this study

Official title: Treatment of Adynamic Bone Disorder With Parathyroid Hormone in Patients With Chronic Kidney Disease

This study is a 1:1 randomized controlled trial with an intervention for 18 months and a follow up period of 12 months. The purpose of the study is to assess the safety and efficacy of recombinant human parathyroid hormone for treatment of adynamic bone disorder in patients with chronic kidney disease.

Read the detailed description

This study is a 1:1 randomized controlled trial with an intervention for 18 months and a follow up period of 12 months.

The study will explore if treatment with recombinant human parathyroid hormone (PTH) improves bone turnover and bone mineral density (BMD), and thereby prevents the high risk of fracture in patients with chronic kidney disease (CKD).

Disturbed bone metabolism is related to increased risk of cardiovascular disease in patients with CKD. This study also wishes to examine of treatment with recombinant PTH improves cardiovascular parameters.

Being tested
Teriparatide, DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT, Bone biopsy, Cardiac tests, Blood and urine samples and physical examination
Keywords
Fracture risk, Teriparatide
Medical subject headings
Renal Insufficiency, Chronic, Heart Diseases, Chronic Kidney Disease-Mineral and Bone Disorder

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TeriparatideDrug

    Also called Terrosa

    20 micrograms

  • DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CTDiagnostic test

    All participants undergo DXA and VFA or X-ray scans 3 times during the study. Some participants (those connected to Herlev) are offered 18F NAF PET/CT scans at baseline and after 12 months and some participants (those connected to Odense University Hospital and Aalborg University Hospital) are offered HR-pQCT scans at baseline and after 12 months. The 18F-NAF PET/CT and HR-pQCT are optional, so it is not a must to have these procedures done to participate in the study.

  • Bone biopsyProcedure or surgery

    All participants are invited to undergo a bone biopsy after 12 months, but it is not a must to have the procedure done to participate in the study.

  • Cardiac testsDiagnostic test

    All participants are invited to undergo 24-hour blood pressure measurements and pulse wave measurements at baseline and after 18 months, but it is not a must to have these procedures done to participate in the study.

  • Blood and urine samples and physical examinationOther

    All participants must undergo a physical examination and deliver blood and urine samples in order to participate in the study.

Study groups in NCT04522622
Study groupRoleWhat they receive
TeriparatideExperimentalPatients receive teriparatide 20 micrograms once daily for 18 months
Receives: Drug: Teriparatide; Diagnostic Test: DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT; Procedure: Bone biopsy; Diagnostic Test: Cardiac tests; Other: Blood and urine samples and physical examination
ControlsOtherControls receive no treatment with teriparatide
Receives: Diagnostic Test: DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT; Procedure: Bone biopsy; Diagnostic Test: Cardiac tests; Other: Blood and urine samples and physical examination

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in bone specific alkaline phosphatase (BSAP)

    The difference between treated and controls in changes from baseline to 18 months in bone specific alkaline phosphatase

    Measured: Baseline and 18 months

Secondary outcomes (27)
  1. Number of patients who no longer has adynamic bone disorder based on a BSAP >21 µg/l

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. It is also measured through study completion, an average of 30 months

  2. BMD at the lumbar spine, antebrachium, femoral neck and total hip

    Changes between baseline and 18 months as well as differences between treated and controls

    Measured: Baseline and 18 months. The scan is also performed at 30 months

  3. Incidence of fragility fractures and vertebral fractures assessed using x-ray of columna or vertebral fracture assessment (VFA)

    Changes between baseline and 18 months as well as differences between treated and controls

    Measured: Baseline and 18 months. The scan is also performed at 30 months

  4. Bone microarchitecture assessed using high-resolution peripheral quantitative computed tomography (HR-pQCT)

    Changes between baseline and 12 months as well as differences between treated and controls. The HR-pQCT scan is a voluntary procedure.

    Measured: Baseline and 12 months

  5. Volumetric BMD assessed using high-resolution peripheral quantitative computed tomography (HR-pQCT)

    Changes between baseline and 12 months as well as differences between treated and controls. The HR-pQCT scan is a voluntary procedure.

    Measured: Baseline and 12 months

  6. Bone geometry assessed using high-resolution peripheral quantitative computed tomography (HR-pQCT)

    Changes between baseline and 12 months as well as differences between treated and controls. The HR-pQCT scan is a voluntary procedure.

    Measured: Baseline and 12 months

  7. Bone strength assessed using high-resolution peripheral quantitative computed tomography (HR-pQCT)

    Changes between baseline and 12 months as well as differences between treated and controls. The HR-pQCT scan is a voluntary procedure.

    Measured: Baseline and 12 months

  8. Regional bone formation using 18F-Sodium Fluoride Positron Emission Tomography/Computed Tomography (18F-NAF PET/CT)

    Changes between baseline and 12 months as well as differences between treated and controls. The 18F-NAF PET/CT is a voluntary procedure.

    Measured: Baseline and 12 months

  9. Changes in p-PTH

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. Some of them are also measured during follow up.

  10. Changes in p-phosphate

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. Some of them are also measured during follow up.

  11. Changes in p-magnesium

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. Some of them are also measured during follow up.

  12. Changes in calcium

    P-ionised calcium. Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. Some of them are also measured during follow up.

  13. Bone histomorphometry

    Static and dynamic bone histomorphometry classified by the bone Turnover Mineralization Volume (TMV) classification assessed by bone biopsy. Performed after 12 months. This is a voluntary procedure.

    Measured: 12 months

  14. Changes in Intact Procollagen type 1 N-terminal Propeptide (P1NP)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  15. Changes in total P1NP

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  16. Changes in Tartrate-Resistant Acid Phosphatase 5b (TRAP5b)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  17. Changes in sclerostin

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  18. Changes in Receptor Activator of Nuclear factor Kappa-B Ligand (RANKL)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  19. Changes in Osteoprotegerin (OPG)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  20. Changes in Fibroblast Growth Factor 23 (FGF-23)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months. They are also measured during follow up

  21. 24-hour blood pressure

    Changes between baseline and 18 months as well as differences between treated and controls. These are voluntary procedures.

    Measured: Baseline and 18 months

  22. Pulse wave measurements including velocity

    Changes between baseline and 18 months as well as differences between treated and controls. These are voluntary procedures.

    Measured: Baseline and 18 months

  23. Changes in cardiovascular marker Calciprotein Particles (CPP)/T50

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months

  24. Changes in cardiovascular marker N-Terminal pro B-type Natriuretic Peptide (NT-proBNP)

    Changes between baseline and 18 months as well as differences between treated and controls.

    Measured: Baseline and 18 months

  25. Adverse reactions

    The incidence of adverse reactions in treated patients. This is examined during the entire study.

    Measured: From baseline to 18 months

  26. Bone microstructure

    Bone mictrostructure by micro-compyter tomography of the bone biopsy

    Measured: 12 months

  27. Bone histology

    Detailed histology of underlying cellular mechanisms using a combination of immunostainings and advanced in situ hybridizations on the bone biopsy

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Aug 2020
  2. Study start15 Dec 2021
  3. Primary completion1 Sep 2026 (estimated)
  4. Study completion1 Sep 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04522622
Sponsor's protocol ID
DANDYNAMIC BONE
Other IDs
2018-003888-56, 2018
Status last verified
Apr 2024
First submitted
13 Aug 2020
Last updated
23 Apr 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: As of now we have no plan to share Individual Participant Data (IPD) with other researchers

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Teriparatide, DXA,VFA, X-ray, HR-pQCT, 18-F NAF PET/CT and Bone biopsy in people with Adynamic Bone Disease and Chronic Kidney Diseases, run by Ditte Hansen at 4 sites in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 21 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 23 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Sabina C Hauge, MD (+4528965887, sabina.chaudhary.hauge@regionh.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in bone specific alkaline phosphatase (BSAP) (time frame: Baseline and 18 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Apr 2024.

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