Stress Fracture Clinical Trial
Official title:
Fracture Recovery for Returning to Duty (Teriparatide STRONG)
FORTEO (teriparatide [rDNA origin]; Eli-Lilly, Indiana, USA) is an injectable synthetic recombinant human parathyroid hormone analog that is commonly used to treat people with osteoporosis. In the current investigation this drug will be tested to evaluate its efficacy to accelerate bone healing and decrease the convalescence time of US Army Basic Trainees who have sustained a diaphyseal tibial stress fracture (DTSF). Investigators from the University of South Carolina will collaborate with military personnel to perform a prospective, randomized, double-blind, placebo-controlled study at Fort Jackson, SC.
Status | Not yet recruiting |
Enrollment | 183 |
Est. completion date | September 25, 2024 |
Est. primary completion date | September 25, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 40 Years |
Eligibility |
Inclusion Criteria: - Soldiers actively enlisted in the US Army attached to basic training unit at Fort Jackson who are 18 years of age or older. - Soldiers diagnosed with a diaphyseal tibial stress fracture - Skeletally mature - Willing to self-administer study medication - Desire to continue their military commitment and are willing to participate for the length of the project for up to one year. Exclusion Criteria: - History of any form of cancer - Currently pregnant - Paget's disease of bone - Unexplained elevations of alkaline phosphatase (elevations in alkaline phosphatase may signal undiagnosed Paget's disease of bone) - Pediatric and young adult participants with open epiphyses - Prior external beam or implant radiation therapy involving the skeleton - Recent (within the last 6 months) urolithiasis (kidney stones) - Elevated serum calcium - Elevated uric acid - Orthostatic hypotension |
Country | Name | City | State |
---|---|---|---|
United States | Fort Jackson, SC | Columbia | South Carolina |
Lead Sponsor | Collaborator |
---|---|
University of South Carolina | Washington University School of Medicine |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Days from diagnosis to full return to duty | This will be a time-based measure describing the total number of days of reduced duty associated with the diagnosis of tibial diaphyseal stress fracture. Between-group differences in this measure will be of key importance to determine the functional impact of the study drug compared to placebo. | Spans from time of enrollment until return to full-duty. This could range from 12 weeks to 24 weeks | |
Secondary | Change from baseline in Tibial A-P and Lateral Radiographic Findings | Radiographs will be viewed by study physicians who will make a qualitative, visual estimate of the presence, or absence, of radiographic evidence of disruption of cortical bone in the tibial diaphysis. This judgement that will provide an estimate of clinical healing over time. |
Follow-up films will be obtained in post-enrollment weeks 4, 12, 16, and 48 | |
Secondary | Change in Non-Contrast Tibial Magnetic Resonance Imaging Findings | Study physicians will use the Fredericson Classification to grade the magnitude of cortical bone and bone marrow involvement in the affected tibial diaphysis. This classification ranges from 0=Normal to 4b= the highest level of stress fracture (linear intra-cortical signal abnormality). Classifications using this scale have been demonstrated to have evidence of reliability and validity. This measure will provide an estimate of clinical healing over time. |
Follow-up images will be obtained in weeks 4, 12, and 48 | |
Secondary | Changes in activity performance measured by the Daily Activity Log | This log will be completed daily by the participant to provide an estimate of the likely loading and metabolic expenditure associated with his or her physical activity. 6 items will be sampled and evaluated individually. Three items will include distance (miles) from none to greater than 10 miles for marching, marching with combat gear, and running on that given day. The responses from these will be transformed to metabolic equivalent units (METS). One item will be categorical listing of the most stressful event of the day. The last 2 items will sample pain during activity and pain specific to walking using an 11 item 0-10 numeric rating scale. This measure will be used to assess the change in the participant's self report of activity tolerance over time. |
This will be completed daily between post-enrollment weeks 4-17. It will be completed once in week 48 | |
Secondary | Change in the Lower Extremity Functional Scale | The Lower Extremity Functional Scale (LEFS) is a commonly used self-report measure that reflects an individual's ability to perform several specific tasks that may be impaired by lower extremity dysfunction. 20 items are rated using a 5-point numeric rating scale (0= unable to perform; 4= no difficulty). The highest (best) score = 80% and indicates that the participant reports no difficulty performing activities. Measures obtained with the LEFS have strong evidence of reliability and longitudinal construct validity. This measure will be used to assess the change in the participant's self report of activity tolerance over time. |
This will be completed weekly during post-enrollment weeks 4-17. It will be completed once in week 48 | |
Secondary | Change in DEXA scan scores | This measure will be used to generate a T-score that will provide a norm-referenced estimate of overall bone mass of the participant. A T-score of +1.0 to -1.0 would considered normal. -1.0 to - 2.5 would be considered as reduced and classified as osteopenia. A T-score < -2.5 would be considered severely reduced and classified as osteoporosis. This measure will used in secondary analysis to sub-classify individuals based upon bone mass at enrollment/inception and will be used to determine changes in overall bone mass upon completion of the study. |
Post-enrollment week 16. This will be compared to baseline (week 1) images |
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