Ankle Fractures Treated With Teriparatide

Study Overview
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Brief Summary
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This is a single site feasibility trial to test whether daily administration of Teriparatide, in participants with Weber type B ankle fractures that are being conservatively managed, is superior to the standard care treatment with regard to the rate of healing.

Detailed Description
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Ankle fractures are common in older people, they are very disabling and require either a cast or a boot for treatment and the patients need to use crutches for balance. These fractures can lead to complications including non union or delayed union in addition to risks of clotting of the leg vessels (deep vein thrombosis) where these clots can dislodge and migrate to the lungs (pulmonary embolus) resulting in breathing difficulties and/or death. Also these fractures commonly result in patients needing a temporary period of residential care. Therefore, if the healing time can be reduced, there is a potential for large benefits for the patient and reduced care costs for health and social care services. Teriparatide hormone is one of the new medications used for treating osteoporosis(weak bones), and studies in the USA have reported that Teriparatide hormone treatment can accelerate bone fracture healing time in pelvic fractures. Other reports also support faster healing time when Teriparatide hormone is used. The investigators are carrying out this feasibility study with 10 participants, in order to provide the information that will prepare us for carrying out a definitive study in the future.

Official Title
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A Feasibility Study to Explore the Difference in Healing Time Between Teriparatide Treatment and Standard Care on Weber B Ankle Fractures in Older People

Conditions
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Fracture, Ankle

Intervention / Treatment
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* Drug: Forsteo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant is willing and able to give informed consent for participation in the study. Male or Female (women of non-child bearing potential only*), aged 50 years or above Ankle fracture Weber type B suitable for conservative treatment in a synthetic cast The fracture should be less than 10 days old Blood test results within the normal range as defined by Nottingham University Hospitals NHS Trust (FBC, ESR, LFT, RFT, PTH, Bone profile (Calcium, albumin, total protein and alkaline phosphatase) and thyroid function) Able and willing to comply with all study requirements Exclusion Criteria: Current smokers (both tobacco and electronic cigarettes) Chronic renal disease Insulin dependent diabetes mellitus History of hypercalcemia End stage liver disease (liver cirrhosis) Patient with any current or past history of cancer Use of bisphosphonates, Zolendronic acid or fluorides within the last 6 months Any bone conditions other than osteoporosis Unable to get out of a chair or bed and walk without the help of another person pre ankle fracture (walking aids are acceptable) Contraindication to Teriparatide hormone: Hypersensitivity High risk of Osteosarcoma, (Paget's disease, chondromas, exposure to radiation, unexplained alkaline phosphatase, etc.) Female participants of child-bearing potential, who are pregnant, lactating or planning pregnancy during course of study Scheduled elective surgery or other procedures requiring general anaesthesia during the study Terminally ill Planned blood donor donation during the study Participated in another research study involving an investigational product in the past 12 weeks Prior external beam of radiation or implant of radiation therapy to the skeleton. Any blood diseases leading to a bleeding tendency On Heparin, Warfarin or any Anticoagulants

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Teriparatide Intervention<br>Will be asked to self-administer Teriparatide treatment (self-injection) once a day for 12 weeks | Drug: Forsteo<br>* 20 micrograms/80 microlitres solution for injection in pre-filled pen<br>* Other names: Teriparatide hormone;|
| No Intervention: Usual care<br>No intervention, patients will be treated as per local practice but will be followed up identically to the intervention group. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of healing parameters of the fracture | Assessment of healing parameters of the fracture as identified on the CT scan at Trial Visits | Week 1 - Week 13 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identify the participant's pain during the treatment period | Pain scores on weight bearing, as assessed by 10-point visual analogue pain score scale | Week 1 - Week 13 | 
| Functional assessment of the ankle using Olerud and Molander questionnaire | measure ankle function at the end of brace/cast treatment | Week 7 - Week 13 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Weber B