Abaloparatide Before Total Knee Arthroplasty

Osteoporosis Clinical Trial

Official title:

An Open-Label Phase 2 Study of Abaloparatide to Mitigate Distal Femoral Bone Loss Following Total Knee Arthroplasty

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04167163
• Other study ID #: 2019-0685
• Secondary ID: A534255SMPH/MEDI
• Status: Active, not recruiting
• Phase: Phase 4
• Start date: January 10, 2020
• Est. completion date: March 2025

Study information

• Verified date: June 2024
• Source: University of Wisconsin, Madison
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The investigator hypothesizes that treating osteoporotic patients with abaloparatide prior to and after total knee arthroplasty will significantly reduce the amount of bone loss.

Description:

In primary unilateral total knee arthroplasty patients, The investigator will examine the effect of daily abaloparatide therapy in clinical osteoporotic patients beginning 3 months pre-op and continued for a total of 15 months. This will be compared to osteopenic patients receiving no therapy as well as previously published values in untreated osteoporotic patients 12 months following Total Knee Arthroplasty (TKA).

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 58
• Est. completion date: March 2025
• Est. primary completion date: March 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 55 Years and older

Eligibility

Inclusion Criteria

1. Post-menopausal women and men age ge = 55 years and scheduled to undergo primary TKA at the University of Wisconsin Total Joint Program.

2. Osteoporosis, i.e., BMD T-score (using female reference data) = -2.5 at the lumbar spine, femoral neck OR total hip or = -1.1 with Vertebral Fracture Assessment confirmed vertebral fracture or history of low-trauma nonvertebral fracture in the past 5 years OR osteopenia, BMD T-score (using female reference data) -1.1 to -2.4 at the lumbar spine, femoral neck or total hip and no prior low-trauma fracture.

3. Serum calcium (albumin-corrected), serum creatinine and Parathyroid(PTH) values all within the normal range and 25(OH)D > 10 ng/mL.

4. Willing to supplement with daily calcium and/or vitamin D3 at protocol specified doses.

5. Able to provide written informed consent.

Exclusion Criteria

1. Unevaluable distal femur BMD due to hardware or other artifacts.

2. History of bone disorders (e.g., Paget's disease) other than osteoporosis.

3. History of prior external beam or implant radiation therapy involving the skeleton other than radioiodine.

4. History of chronic or recurrent renal, hepatic, pulmonary, allergic, cardiovascular, gastrointestinal, endocrine, central nervous system, hematologic or metabolic diseases, or immunologic, emotional and/or psychiatric disturbances that, in opinion of the principal investigator, would compromise study data validity.

5. History of Cushing's disease, growth hormone deficiency or excess, hyperthyroidism, hypo- or hyperparathyroidism or malabsorptive syndromes within the past year.

6. History of significantly impaired renal function (serum creatinine >2.0 mg/dL. If the serum creatinine is > 1.5 and = 2.0 mg/dL, the calculated creatinine clearance (Cockcroft-Gault) must be = 37 mL/min.

7. History of nephrolithiasis or urolithiasis within the past five years.

8. History of cancer in prior 5 years (basal cell or squamous skin cancer is permissible).

9. History of osteosarcoma at any time.

10. Patients known to be positive for Hepatitis B, Hepatitis C, HIV-1 or HIV-2.

11. Known hypersensitivity to any of the test materials or related compounds.

12. Prior treatment with PTH- or PTHrP-derived drugs, (ABL, teriparatide or PTH (1-84)).

13. Prior treatment with intravenous bisphosphonates at any time or oral bisphosphonates within the past three years. Patients who had received a short course of oral bisphosphonate therapy (3 months or less) may be enrolled as long as the treatment occurred 6 or more months prior to enrollment.

14. Treatment with fluoride or strontium in the past five years or prior treatment with bone-acting investigational agents at any time.

15. Treatment with calcitonin the past 6 months or denosumab in the past 18 months.

16. Treatment with anticonvulsants affecting vitamin D metabolism (phenobarbital, phenytoin, carbamazepine or primidone) or chronic heparin within the prior 6 months.

17. Treatment with anabolic steroids or calcineurin inhibitors (cyclosporin, tacrolimus)

18. Daily treatment with oral, intranasal or inhaled glucocorticoids in the prior 12 months.

19. Exposure to any investigational drug within 12 months.

20. Consumption of > 2 alcoholic drinks per day or use of illegal drugs within 12 months of screening.

21. Not suitable for study participation due to other reasons at the investigators discretion.

Related Conditions & MeSH terms

• Arthroplasties, Knee Replacement
• Osteoporosis

Intervention

Drug:
• Abaloparatide
18 month ABL treatment

Locations

Country	Name	City	State
United States	University of Wisconsin	Madison	Wisconsin

Sponsors (2)

Lead Sponsor	Collaborator
University of Wisconsin, Madison	Radius Health, Inc.

Country where clinical trial is conducted

United States, 

References & Publications (43)

Au AG, James Raso V, Liggins AB, Amirfazli A. Contribution of loading conditions and material properties to stress shielding near the tibial component of total knee replacements. J Biomech. 2007;40(6):1410-6. doi: 10.1016/j.jbiomech.2006.05.020. Epub 2006 Jul 17. — View Citation

Bernatz JT, Brooks AE, Squire MW, Illgen RI 2nd, Binkley NC, Anderson PA. Osteoporosis Is Common and Undertreated Prior to Total Joint Arthroplasty. J Arthroplasty. 2019 Jul;34(7):1347-1353. doi: 10.1016/j.arth.2019.03.044. Epub 2019 Mar 28. — View Citation

Bernatz JT, Krueger DC, Squire MW, Illgen RL 2nd, Binkley NC, Anderson PA. Unrecognized Osteoporosis Is Common in Patients With a Well-Functioning Total Knee Arthroplasty. J Arthroplasty. 2019 Oct;34(10):2347-2350. doi: 10.1016/j.arth.2019.05.041. Epub 2019 May 30. — View Citation

Binkley N, Krueger D, Buehring B. What's in a name revisited: should osteoporosis and sarcopenia be considered components of "dysmobility syndrome?". Osteoporos Int. 2013 Dec;24(12):2955-9. doi: 10.1007/s00198-013-2427-1. Epub 2013 Aug 1. — View Citation

Blaty T, Krueger D, Illgen R, Squire M, Heiderscheit B, Binkley N, Anderson P. DXA evaluation of femoral bone mineral density and cortical width in patients with prior total knee arthroplasty. Osteoporos Int. 2019 Feb;30(2):383-390. doi: 10.1007/s00198-018-4682-7. Epub 2018 Aug 31. — View Citation

Buehring B, Hansen KE, Lewis BL, Cummings SR, Lane NE, Binkley N, Ensrud KE, Cawthon PM; Osteoporotic Fractures in Men (MrOS) Study Research Group. Dysmobility Syndrome Independently Increases Fracture Risk in the Osteoporotic Fractures in Men (MrOS) Prospective Cohort Study. J Bone Miner Res. 2018 Sep;33(9):1622-1629. doi: 10.1002/jbmr.3455. Epub 2018 Jun 21. — View Citation

Buehring B, Siglinsky E, Krueger D, Evans W, Hellerstein M, Yamada Y, Binkley N. Comparison of muscle/lean mass measurement methods: correlation with functional and biochemical testing. Osteoporos Int. 2018 Mar;29(3):675-683. doi: 10.1007/s00198-017-4315-6. Epub 2017 Dec 2. — View Citation

Chang CB, Kim TK, Kang YG, Seong SC, Kang SB. Prevalence of osteoporosis in female patients with advanced knee osteoarthritis undergoing total knee arthroplasty. J Korean Med Sci. 2014 Oct;29(10):1425-31. doi: 10.3346/jkms.2014.29.10.1425. Epub 2014 Oct 8. — View Citation

Della Rocca GJ, Leung KS, Pape HC. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma. 2011 Jun;25 Suppl 2:S66-70. doi: 10.1097/BOT.0b013e31821b8c28. — View Citation

Frenzel S, Vecsei V, Negrin L. Periprosthetic femoral fractures--incidence, classification problems and the proposal of a modified classification scheme. Int Orthop. 2015 Oct;39(10):1909-20. doi: 10.1007/s00264-015-2967-4. Epub 2015 Sep 2. — View Citation

Gazdzik TS, Gajda T, Kaleta M. Bone mineral density changes after total knee arthroplasty: one-year follow-up. J Clin Densitom. 2008 Jul-Sep;11(3):345-50. doi: 10.1016/j.jocd.2008.04.007. Epub 2008 Jul 10. — View Citation

Head J 2017 Periprosthetic distal femur fractures: Review of current treatment options. Reconstructive Review 7:NO4

Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury. 2012 Jul;43(7):1084-9. doi: 10.1016/j.injury.2012.01.025. Epub 2012 Feb 18. — View Citation

Jaroma A, Soininvaara T, Kroger H. Periprosthetic tibial bone mineral density changes after total knee arthroplasty. Acta Orthop. 2016 Jun;87(3):268-73. doi: 10.3109/17453674.2016.1173982. Epub 2016 Apr 27. Erratum In: Acta Orthop. 2016 Aug;87(4):x. — View Citation

Jaroma AV, Soininvaara TA, Kroger H. Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty. A seven-year randomised controlled trial of 26 patients. Bone Joint J. 2015 Mar;97-B(3):337-45. doi: 10.1302/0301-620X.97B3.33643. — View Citation

Kaneko T, Otani T, Kono N, Mochizuki Y, Mori T, Nango N, Ikegami H, Musha Y. Weekly injection of teriparatide for bone ingrowth after cementless total knee arthroplasty. J Orthop Surg (Hong Kong). 2016 Apr;24(1):16-21. doi: 10.1177/230949901602400106. — View Citation

Kobayashi N, Inaba Y, Uchiyama M, Ike H, Kubota S, Saito T. Teriparatide Versus Alendronate for the Preservation of Bone Mineral Density After Total Hip Arthroplasty - A randomized Controlled Trial. J Arthroplasty. 2016 Jan;31(1):333-8. doi: 10.1016/j.arth.2015.07.017. Epub 2015 Jul 17. — View Citation

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5. doi: 10.2106/JBJS.F.00222. — View Citation

Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R, Birrell FN, McCaskie AW. The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint arthroplasty. Age Ageing. 2010 Mar;39(2):234-9. doi: 10.1093/ageing/afp222. Epub 2009 Dec 23. — View Citation

Liu Y, Levack AE, Marty E, Or O, Samuels BP, Redko M, Lane JM. Anabolic agents: what is beyond osteoporosis? Osteoporos Int. 2018 May;29(5):1009-1022. doi: 10.1007/s00198-018-4507-8. Epub 2018 Apr 7. — View Citation

Lizaur-Utrilla A, Miralles-Munoz FA, Sanz-Reig J. Functional outcome of total knee arthroplasty after periprosthetic distal femoral fracture. J Arthroplasty. 2013 Oct;28(9):1585-8. doi: 10.1016/j.arth.2013.03.007. Epub 2013 Apr 17. — View Citation

Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015 Sep 2;97(17):1386-97. doi: 10.2106/JBJS.N.01141. — View Citation

Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011 Jan;93(1):96-101. doi: 10.1302/0301-620X.93B1.25087. — View Citation

Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC. Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther. 2008 May;38(5):246-56. doi: 10.2519/jospt.2008.2715. Epub 2007 Dec 14. — View Citation

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. — View Citation

Minoda Y, Ikebuchi M, Kobayashi A, Iwaki H, Inori F, Nakamura H. A cemented mobile-bearing total knee replacement prevents periprosthetic loss of bone mineral density around the femoral component: a matched cohort study. J Bone Joint Surg Br. 2010 Jun;92(6):794-8. doi: 10.1302/0301-620X.92B6.23159. — View Citation

Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005 May;87(5):1047-53. doi: 10.2106/JBJS.D.01992. — View Citation

Moon YW, Kim HJ, Ahn HS, Lee DH. Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis. PLoS One. 2016 Feb 5;11(2):e0148193. doi: 10.1371/journal.pone.0148193. eCollection 2016. — View Citation

Prince JM, Bernatz JT, Binkley N, Abdel MP, Anderson PA. Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis. Arch Osteoporos. 2019 Feb 23;14(1):23. doi: 10.1007/s11657-019-0572-7. — View Citation

Reeves RA, Schairer WW, Jevsevar DS. Costs and Risk Factors for Hospital Readmission After Periprosthetic Knee Fractures in the United States. J Arthroplasty. 2018 Feb;33(2):324-330.e1. doi: 10.1016/j.arth.2017.09.024. Epub 2017 Sep 23. — View Citation

Ruder JA, Hart GP, Kneisl JS, Springer BD, Karunakar MA. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures. J Arthroplasty. 2017 May;32(5):1571-1575. doi: 10.1016/j.arth.2016.12.013. Epub 2016 Dec 23. — View Citation

Sarmah SS, Patel S, Reading G, El-Husseiny M, Douglas S, Haddad FS. Periprosthetic fractures around total knee arthroplasty. Ann R Coll Surg Engl. 2012 Jul;94(5):302-7. doi: 10.1308/003588412X13171221592537. — View Citation

Smee DJ, Anson JM, Waddington GS, Berry HL. Association between Physical Functionality and Falls Risk in Community-Living Older Adults. Curr Gerontol Geriatr Res. 2012;2012:864516. doi: 10.1155/2012/864516. Epub 2012 Dec 4. — View Citation

Soininvaara T, Kroger H, Jurvelin JS, Miettinen H, Suomalainen O, Alhava E. Measurement of bone density around total knee arthroplasty using fan-beam dual energy X-ray absorptiometry. Calcif Tissue Int. 2000 Sep;67(3):267-72. doi: 10.1007/s002230001111. — View Citation

Soininvaara TA, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM, Kroger HP. Periprosthetic femoral bone loss after total knee arthroplasty: 1-year follow-up study of 69 patients. Knee. 2004 Aug;11(4):297-302. doi: 10.1016/j.knee.2003.09.006. — View Citation

Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res. 2003 Sep;21(5):775-9. doi: 10.1016/S0736-0266(03)00052-4. — View Citation

Suzuki T, Sukezaki F, Shibuki T, Toyoshima Y, Nagai T, Inagaki K. Teriparatide Administration Increases Periprosthetic Bone Mineral Density After Total Knee Arthroplasty: A Prospective Study. J Arthroplasty. 2018 Jan;33(1):79-85. doi: 10.1016/j.arth.2017.07.026. Epub 2017 Jul 25. — View Citation

Teng S, Yi C, Krettek C, Jagodzinski M. Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies. PLoS One. 2015 Oct 7;10(10):e0139927. doi: 10.1371/journal.pone.0139927. eCollection 2015. — View Citation

Thomas B, Binkley N, Anderson PA, Krueger D. DXA Measured Distal Femur Bone Mineral Density in Patients After Total Knee Arthroplasty: Method Development and Reproducibility. J Clin Densitom. 2019 Jan-Mar;22(1):67-73. doi: 10.1016/j.jocd.2018.08.003. Epub 2018 Aug 13. — View Citation

Valtonen A, Poyhonen T, Heinonen A, Sipila S. Muscle deficits persist after unilateral knee replacement and have implications for rehabilitation. Phys Ther. 2009 Oct;89(10):1072-9. doi: 10.2522/ptj.20070295. Epub 2009 Aug 27. — View Citation

Windisch C, Windisch B, Kolb W, Kolb K, Grutzner P, Roth A. Osteodensitometry measurements of periprosthetic bone using dual energy X-ray absorptiometry following total knee arthroplasty. Arch Orthop Trauma Surg. 2012 Nov;132(11):1595-601. doi: 10.1007/s00402-012-1601-9. Epub 2012 Aug 12. — View Citation

Yamada Y, Masuo Y, Yokoyama K, Hashii Y, Ando S, Okayama Y, Morimoto T, Kimura M, Oda S. Proximal electrode placement improves the estimation of body composition in obese and lean elderly during segmental bioelectrical impedance analysis. Eur J Appl Physiol. 2009 Sep;107(2):135-44. doi: 10.1007/s00421-009-1106-6. Epub 2009 Jun 17. — View Citation

Yamada Y, Schoeller DA, Nakamura E, Morimoto T, Kimura M, Oda S. Extracellular water may mask actual muscle atrophy during aging. J Gerontol A Biol Sci Med Sci. 2010 May;65(5):510-6. doi: 10.1093/gerona/glq001. Epub 2010 Feb 4. — View Citation

* Note: There are 43 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Distal femoral Bone mineral density (BMD) at the 25% regions of interest (ROIs)	Bone mineral density change at the 25% ROI of the surgical leg	Baseline and 18 months
Secondary	Change in Distal femoral BMD at the 15% and 60 %ROI	Bone mineral density change at the 15% and 60% ROI of the surgical leg	Baseline and 18 months
Secondary	Change in Femur cortical thickness at the 15%, 25% and 60% femur ROIs	Cortical thickness change at the 15% and 60% ROI of the surgical leg	Baseline and 18 months
Secondary	TBS assessment by TRIP at the 15%, 25% and 60% femur ROIs	Trabecular bone score (TBS) assessment by Texture Research Investigation (Platform (TRIP) software change at the 15%, 25% and 60% femur ROIs (TBS >1.350 is normal; TBS between 1.200 and 1.350 is indicative of partially degraded microarchitecture; and TBS<1.200 equals degraded microarchitecture)	18 months
Secondary	Knee injury & Osteoarthritis Outcome Score (KOOS) JR	Patient reported knee function score. The KOOS, JR was developed from the original long version of the Knee injury and Osteoarthritis Outcome Score (KOOS) survey using Rasch analysis. The KOOS, JR contains 7 items from the original KOOS survey. Items are coded from 0 to 4, none to extreme respectively. KOOS, JR is scored by summing the raw response (range 0-28) and then converting it to an interval score (0-100). The interval score ranges from 0 to 100 where 0 represents total knee disability and 100 represents perfect knee health.	18 months
Secondary	Change in Veterans RAND 12 (VR-12) Question Health Survey score	12 Item Health Survey using patient's self assessment of their perspective of their health and ability to do daily functions. Scores are derived using an algorithm that is referenced to a metric centered at 50.0 where a zero score indicates the lowest level of health and 100 indicates the highest level of health.	Baseline and 18 months
Secondary	Forgotten Joint Survey(FJS) score	FJS-12 consists of 12 questions and is scored using a 5-point response format with the raw scores transformed onto a 0- to 100-point scale.; High scores indicate good outcome, that is, a high degree of forgetting the joint in everyday life (forgotten joint phenomenon).	18 months
Secondary	Change in body composition using bioelectrical impedance analysis of lean mass	Change in body composition using bioelectrical impedance analysis of lean mass.	Baseline and 18 months
Secondary	Change in body composition using bioelectrical impedance analysis of skeletal mass.	Change in body composition using bioelectrical impedance analysis of skeletal mass.	Baseline and 18 months
Secondary	Change in body composition using bioelectrical impedance analysis of fat mass.	Change in body composition using bioelectrical impedance analysis of fat mass.	Baseline and 18 months
Secondary	TKA complications: Number of participants needed revision surgery	TKA complications: Number of participants needed revision surgery	18 months
Secondary	TKA complications: Number of participants had fracture	TKA complications: Number of participants had fracture	18 months
Secondary	Precision Error on Knee Bone Density Measurement	Precision assessment in the field of bone densitometry is the process whereby the ability of the instrument and the technologist to reproduce similar results, given no real biologic change, is tested. The mathematical result of precision assessment is called the precision error. To achieve statistical power, the investigators will take duplicate knee bone density measurements on 30 participants at either their 6 month or 15 month visit. The standard deviation for each participant is calculated, then the root mean square standard deviation for the group is calculated.	up to 15 months