Stem Cell Recruitment in Osteoporosis Therapy
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Osteoporosis |
| Therapuetic Areas: | Rheumatology |
| Healthy: | No |
| Age Range: | 50 - 80 |
| Updated: | 5/11/2018 |
| Start Date: | August 2012 |
| End Date: | August 2019 |
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.
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.
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.
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