CClinicalTrials.gg
CompletedNCT05346419Updated Apr 26, 2022

Antiresorptive Effect of Treatment With Risedronate and Vitamin D in Postmenopausal Patients

An interventional study of Risedronate and Vitamin D in Postmenopausal Osteoporosis, Hypovitaminosis D and Hyperparathyroidism, sponsored by Hospital Regional 1o de Octubre. Completed at 1 site in Mexico. Open to female participants aged 40 Years to 78 Years. Per ClinicalTrials.gov, last updated 2022-04-26.

Sponsored by Hospital Regional 1o de Octubre · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
33
Allocation
Not applicable
Ages
40 Years to 78 Years
Sex
Female
01

Study summary

Osteoporosis is defined as a systemic disease of bone mineralization, characterized by a decrease in bone mineral density that causes bone fragility and increases the risk of fractures during menopause. Recently, a high prevalence of hypovitaminosis D has been found worldwide, which could trigger a state of secondary hyperparathyroidism that can worsen the state of postmenopausal patients with osteoporosis. An open-label, clinical trial was conducted in Mexican women with postmenopausal osteopenia-osteoporosis to determine the efficacy of the combined treatment with risedronate and high-dose vitamin D in improving bone mineral density, hyperparathyroidism, and hypovitaminosis D.

Read the detailed description

Participants were selected from the climacteric clinic of the regional hospital "1ro de Octubre-Instituto de Seguridad y Servicios Sociales para Los Trabajadores del Estado (ISSSTE)", Mexico. All participants voluntarily accepted to be part of the study and provided written informed consent.This study was approved by the institutional ethical committee of the hospital with registration number COFEPRIS 17 CI 09005135 with the internal registration number 118.2021. Every participant was clinically examined. Their metabolic state was assessed by considering height, weight, body mass index (BMI) and the percentage of Hb1Ac.

33 patients were included among 40 to 78 years with the diagnosis of postmenopausal osteoporosis with associated hyperparathyroidism, hypovitaminosis D or both conditions. All the patients were treated for 6 months with 35 mg of risedronate and 2800 IU of vitamin D once a week, with additional daily supplementation of 4000 IU of vitamin D.

Statical analysis was performed using PAST 3.0 and GraphPad Prism 8.4.3. software. Some statical parameters, such as arithmetic median (µ), and standard deviation (S.D.) were calculated using Excel-Word. Graphics were constructed with GraphPad Prism 8.4.3 and tables were done in Excel-Word. The assigned α value for this study was \<0.05.

02

Conditions studied

  • Postmenopausal Osteoporosis
  • Hypovitaminosis D
  • Hyperparathyroidism

Keywords

  • Postmenopause
  • Postmenopausal Osteoporosis
  • Hypovitaminosis D
  • Hyperparathyroidism
  • Risedronate
  • Osteopenia
  • Bone Mineral Density
  • Bone resorption
03

Who can participate

Ages eligible
40 Years to 78 Years
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Participants with a diagnosis of postmenopausal osteoporosis or osteopenia.
  • Participants with a diagnosis of hyperparathyroidism or hypovitaminosis D.
  • Participants who accepted to participate and that provided informed consent.

Exclusion criteria

Exclusion Criteria:

  • Participants with oncological pathologies.
  • Participants with recent fractures.
  • Participants with gastric intolerance or hypersensitivity to the drugs.
  • Participants were under treatment with another antiresorptive or bone-forming drug, or if they were receiving treatment with thiazide diuretics, lithium, teriparatide or glucocorticoids.
  • Participants with Addison's disease, pheochromocytoma or depressive disorders.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
33 participants (actual)

Study arms

  • Experimental
    Postmenopausal Osteopenia-osteoporosis patients

    All participants were treated for 6 months with risedronate 35 mg and vitamin D 2800 IU once a week, with additional daily vitamin D supplementation of 4000 IU.

    Drug: Risedronate · Drug: Vitamin D

Interventions

  • DrugRisedronate

    Participants received risedronate 35 mg once a week for 6 months.

    Also known as: SERALIS®

  • DrugVitamin D

    Participants received 2,800 IU of vitamin D once a week, with additional daily supplementation of 4,000 IU of vitamin D

    Also known as: Generic

05

What researchers measure

Primary outcomes

  1. Remission of hyperparathyroidism

    Remission of hyperparathyroidism was considered when serum parathyroid hormone \[PTH\] values were below 45 pg/mL.

    Time frame: 6 months

  2. Remission of hypovitaminosis D

    Remission of hypovitaminosis D was considered when serum 25-hydroxy vitamin D \[25(OH)D\] was above 29 pg/ml.

    Time frame: 6 months

  3. Remission of osteopenia

    Osteopenia remission was considered when densitometry T-score values were below -1.

    Time frame: 6 months

  4. Remission of Osteoporosis

    Osteoporosis remission was considered when densitometry T-score values were below -2.4.

    Time frame: 6 months

Secondary outcomes

  1. Change from baseline serum calcium at 6 months

    Calcium was evaluated as a bone mineralization marker.

    Time frame: 6 months

  2. Change from baseline serum phosphorus at 6 months

    Phosphorus was evaluated as a bone mineralization marker.

    Time frame: 6 months

  3. Change from baseline urinary calcium at 6 months

    Urinary calcium was evaluated as an indirect marker of bone demineralization.

    Time frame: 6 months

  4. Change from bone resorption biomarker at 6 months

    Alkaline Phosphatase was evaluated as a bone resorption biomarker.

    Time frame: 6 months

  5. Fracture Risk Assessment Tool (FRAX®) for hip fracture

    Fracture Risk Assessment Tool (FRAX®) for hip fracture was used to determine the 10-year probability of hip fracture. When the predicted risk was greater than 3% was considered a high risk for hip fracture, and when it was lower than 3%, it was considered a low risk for hip fracture.

    Time frame: 6 months

  6. Fracture Risk Assessment Tool for major osteoporotic fracture (FRAX® Mo)

    Fracture Risk Assessment Tool for major osteoporotic fracture (FRAX® Mo) was used to determine the 10-year probability of major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). When the predicted risk was greater than 20% was considered a high risk for major osteoporotic fracture, and when it was lower than 20%, it was considered a low risk of major osteoporotic fracture.

    Time frame: 6 months

06

Study locations

1 site
  • Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE
    Mexico City, 07300, Mexico
07

References and documents

Publications

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  • Wihlborg A, Bergstrom K, Gerdhem P, Bergstrom I. Parathyroid Hormone Disturbances in Postmenopausal Women with Distal Forearm Fracture. World J Surg. 2022 Jan;46(1):128-135. doi: 10.1007/s00268-021-06331-w. Epub 2021 Oct 13. PubMed 34647149 ↗
  • Yalla N, Bobba G, Guo G, Stankiewicz A, Ostlund R. Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status. J Endocrinol Invest. 2019 Nov;42(11):1353-1360. doi: 10.1007/s40618-019-01075-w. Epub 2019 Jul 4. PubMed 31273631 ↗
  • Clark P, Vivanco-Munoz N, Pina JT, Rivas-Ruiz R, Huitron G, Chico-Barba G, Reza-Albarran AA. High prevalence of hypovitaminosis D in Mexicans aged 14 years and older and its correlation with parathyroid hormone. Arch Osteoporos. 2015;10:225. doi: 10.1007/s11657-015-0225-4. Epub 2015 Jul 14. PubMed 26168767 ↗
  • Yuan F, Peng W, Yang C, Zheng J. Teriparatide versus bisphosphonates for treatment of postmenopausal osteoporosis: A meta-analysis. Int J Surg. 2019 Jun;66:1-11. doi: 10.1016/j.ijsu.2019.03.004. Epub 2019 Mar 16. PubMed 30890377 ↗
  • Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, Alexandersen P, Zerbini CA, Hu MY, Harris AG, Fitzpatrick LA, Cosman F, Christiansen C; ACTIVE Study Investigators. Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis: A Randomized Clinical Trial. JAMA. 2016 Aug 16;316(7):722-33. doi: 10.1001/jama.2016.11136. Erratum In: JAMA. 2017 Jan 24;317(4):442. doi: 10.1001/jama.2016.20139. PubMed 27533157 ↗
  • Soreskog E, Lindberg I, Kanis JA, Akesson KE, Willems D, Lorentzon M, Strom O, Berling P, Borgstrom F. Cost-effectiveness of romosozumab for the treatment of postmenopausal women with severe osteoporosis at high risk of fracture in Sweden. Osteoporos Int. 2021 Mar;32(3):585-594. doi: 10.1007/s00198-020-05780-8. Epub 2021 Jan 6. PubMed 33409591 ↗
  • Miyoshi A, Kameda H, Nagai S, Nakamura A, Miya A, Takase T, Atsumi T, Miyoshi H. Beneficial effects of switching to denosumab from bisphosphonates or selective estrogen receptor modulators in postmenopausal women with type 2 diabetes and osteopenia/osteoporosis. J Diabetes Investig. 2021 Jul;12(7):1293-1300. doi: 10.1111/jdi.13458. Epub 2020 Dec 13. PubMed 33141482 ↗
  • Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-1622. doi: 10.1210/jc.2019-00221. PubMed 30907953 ↗
  • Kobayakawa T, Miyazaki A, Saito M, Suzuki T, Takahashi J, Nakamura Y. Denosumab versus romosozumab for postmenopausal osteoporosis treatment. Sci Rep. 2021 Jun 3;11(1):11801. doi: 10.1038/s41598-021-91248-6. PubMed 34083636 ↗
  • Hiligsmann M, Reginster JY. Cost-effectiveness of gastro-resistant risedronate tablets for the treatment of postmenopausal women with osteoporosis in France. Osteoporos Int. 2019 Mar;30(3):649-658. doi: 10.1007/s00198-018-04821-7. Epub 2019 Jan 30. PubMed 30701342 ↗
  • McClung MR, Ebetino FH. History of risedronate. Bone. 2020 Aug;137:115407. doi: 10.1016/j.bone.2020.115407. Epub 2020 May 6. PubMed 32387834 ↗
  • American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc. 2014 Jan;62(1):147-52. doi: 10.1111/jgs.12631. Epub 2013 Dec 18. PubMed 24350602 ↗
  • Jilka RL, Weinstein RS, Bellido T, Roberson P, Parfitt AM, Manolagas SC. Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest. 1999 Aug;104(4):439-46. doi: 10.1172/JCI6610. PubMed 10449436 ↗
  • Balani DH, Ono N, Kronenberg HM. Parathyroid hormone regulates fates of murine osteoblast precursors in vivo. J Clin Invest. 2017 Sep 1;127(9):3327-3338. doi: 10.1172/JCI91699. Epub 2017 Jul 31. PubMed 28758904 ↗
  • Brent MB, Stoltenborg FE, Bruel A, Thomsen JS. Teriparatide and Abaloparatide Have a Similar Effect on Bone in Mice. Front Endocrinol (Lausanne). 2021 Apr 19;12:628994. doi: 10.3389/fendo.2021.628994. eCollection 2021. PubMed 33953694 ↗
  • McClung MR, Harvey NC, Fitzpatrick LA, Miller PD, Hattersley G, Wang Y, Cosman F. Effects of abaloparatide on bone mineral density and risk of fracture in postmenopausal women aged 80 years or older with osteoporosis. Menopause. 2018 Jul;25(7):767-771. doi: 10.1097/GME.0000000000001080. PubMed 29462094 ↗
  • Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001 May 10;344(19):1434-41. doi: 10.1056/NEJM200105103441904. PubMed 11346808 ↗
  • Haas AV, LeBoff MS. Osteoanabolic Agents for Osteoporosis. J Endocr Soc. 2018 Jul 9;2(8):922-932. doi: 10.1210/js.2018-00118. eCollection 2018 Aug 1. PubMed 30087947 ↗
  • Lindsay R, Nieves J, Formica C, Henneman E, Woelfert L, Shen V, Dempster D, Cosman F. Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet. 1997 Aug 23;350(9077):550-5. doi: 10.1016/S0140-6736(97)02342-8. PubMed 9284777 ↗
  • Choi H, Magyar CE, Nervina JM, Tetradis S. Different duration of parathyroid hormone exposure distinctively regulates primary response genes Nurr1 and RANKL in osteoblasts. PLoS One. 2018 Dec 21;13(12):e0208514. doi: 10.1371/journal.pone.0208514. eCollection 2018. PubMed 30576321 ↗
  • Choudhary S, Santone E, Yee SP, Lorenzo J, Adams DJ, Goetjen A, McCarthy MB, Mazzocca AD, Pilbeam C. Continuous PTH in Male Mice Causes Bone Loss Because It Induces Serum Amyloid A. Endocrinology. 2018 Jul 1;159(7):2759-2776. doi: 10.1210/en.2018-00265. PubMed 29757436 ↗
  • Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, Meisner PD, Grauer A. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-1427. doi: 10.1056/NEJMoa1708322. Epub 2017 Sep 11. PubMed 28892457 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT05346419
Lead sponsor
Hospital Regional 1o de Octubre
Collaborators
National Polytechnic Institute, Mexico, Universidad Nacional Autonoma de Mexico
Responsible party
Sponsor
First posted
Apr 26, 2022
Start date
Jul 1, 2021
Primary completion
Feb 3, 2022
Completion
Feb 26, 2022
Last update
Apr 26, 2022

Study contacts

Juan M Ocampo Godínez, M.D., Ph.D.
study director · Tissue Bioengineering Laboratory, National Autonomous University of Mexico [UNAM]
Patricia Loranca-Moreno, M.D., M.Sc.
study director · Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE.
Merle Y Hernández-Castañón, M.D.
principal investigator · Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
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