Stem Cell Recruitment in Osteoporosis Therapy

Low Bone Density Clinical Trial

Official title:

Stem Cell Recruitment in Osteoporosis Therapy

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT01656629
• Other study ID #: NA_00050448
• Status: Terminated
• Phase: N/A
• Start date: August 2012
• Est. completion date: August 7, 2020

Study information

• Verified date: August 2020
• Source: Johns Hopkins University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Osteoporosis is an important health problem in the rapidly-aging demographic. Fragility fractures are devastating consequences of osteoporosis. The most common treatment approach in osteoporosis is inhibition of bone resorption with drugs like alendronate (ALN). Parathyroid hormone (PTH) stimulates bone formation and is the only anabolic drug available. Dual therapy with ALN and PTH is not as effective as single-drug therapy in preventing fracture. Bone progenitor cells (MSCs) are recruited to sites of bone remodeling when a growth factor called Transforming Growth Factor Beta (TGF-β1) is released from bone. Different osteoporosis medicines may have differing effects on this process. The effects of ALN versus PTH on bone progenitor recruitment in humans are unknown. This is a randomized, clinical trial of ALN, PTH, and calcium and vitamin D in post-menopausal women with low bone mass. Women will be treated for 3 months with ALN or PTH or calcium and vitamin D. Data collected will include bone biopsies for histomorphometry and micro computed tomography (µCT), bone marrow aspirates for molecular studies, peripheral blood to detect circulating bone progenitor cells and dual X-ray absorptiometry. The investigators hypothesize that in humans, PTH will 1) increase bone progenitor number, 2) enhance recruitment of bone progenitor cells to bone resorption sites, and 3) increase bone progenitor number in peripheral circulation. Furthermore, the investigators hypothesize that ALN treatment will have the opposite effect. Understanding the differences in bone progenitor cell activity and recruitment during osteoporosis therapy will provide a mechanistic rationale for effective use of PTH and anti-resorptive drugs in osteoporosis treatment.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 55
• Est. completion date: August 7, 2020
• Est. primary completion date: June 2014
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 50 Years to 80 Years

Eligibility

Inclusion Criteria:

• Post-menopausal women aged 50-80 years

• T score < -2.5 at lumbar spine, total hip or femoral neck on dual x-ray absorptiometry (DXA) OR T score < -1.5 with a personal or family history of fracture

Exclusion Criteria:

• Previous use of bisphosphonates or Teriparatide; current estrogen therapy; any other osteoporosis therapy in the past 6 months

• Metabolic bone disease other than osteoporosis

• Body mass index (BMI) < 18

• Weight > 325 lbs

• Current smoking or current alcohol use that exceeds 3 units of alcohol daily

• Use of medications known to affect bone metabolism

• Renal disease, history of kidney stones or hypercalciuria

• Hypo- or hyperparathyroidism; hypo- or hypercalcemia

• Serum vitamin D level < 20 ng/dL

• Refusal to adjust their dietary calcium to <750mg (i.e. two servings per day of calcium rich food)

• History of bone marrow or organ transplant

• History of malignancy or radiation to the bone

• History of esophageal stricture, dysmotility or severe reflux disease

• Gastrointestinal malabsorption

• Use of digoxin

• Need for chronic anticoagulation therapy such as Coumadin, heparin or low molecular weight heparin or inability to discontinue anti-platelet medication

• Bleeding diathesis; hemoglobin = 12.5 g/dL (American Red Cross cut-off to donate blood)

• International normalized ratio (INR) pro time > 1.1 or activated partial thromboplastin time (APT) T ratio > 1.2

• Platelets < 150K/cu mm

• Cellulitis at site of iliac crest

• History of allergy to medications used in bone biopsy (demeclocycline, lidocaine)

• Inability to understand and provide informed consent.

Related Conditions & MeSH terms

• Low Bone Density
• Osteoporosis

Intervention

Drug:
• Teriparatide
20 mcg subq daily for 3 months
• Alendronate
70 mg weekly for 3 months

Dietary Supplement:
• calcium and vitamin D

Locations

Country	Name	City	State
United States	Johns Hopkins Bayview Medical Center	Baltimore	Maryland

Sponsors (1)

Lead Sponsor	Collaborator
Johns Hopkins University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The Percent Change in Circulating Osteoprogenitor Cells as Assessed by Flow Cytometry in the Blood Before and After Treatment With Parathyroid Hormone (PTH) or Alendronate (ALN).		up to 3 months
Secondary	Difference in Bone Formation as Assessed by Bone Histomorphometry on Bone Biopsy Between Treatment Groups		3 months
Secondary	Difference in Osteogenic Potential of Bone Marrow as Measure by Colony Forming Unit Osteoblast (CFU-Ob) Assays Between Treatment Groups		3 months