Clinical trial NCT02527668: To Test the Effect of Calcifediol Hy.D Supplementation on Muscle Function and Bone Quality in Younger Postmenopausal Women With Osteopenia
Official title: To Test the Effect of Calcifediol Hy.D Supplementation on Muscle Function and Bone Quality in Younger Postmenopausal Women With Osteopenia: a Double-blind Randomized Placebo-controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Osteopenia/Osteoporosis
Lead sponsor: DSM Nutritional Products, Inc.
Sponsor class: INDUSTRY
Collaborators: name: University of Zurich
name: Tufts University
First posted: 2015-08-19
Enrollment: 150
Sex: FEMALE
Minimum age (years): 50
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Young postmenopausal women with osteopenia / or women with osteoporosis and a FRAX score below pharmacologic treatment indication have limited treatment options in the prevention of osteoporosis/treatment of osteopenia. Further, there is a concern about long-term side effects of bisphosphonate treatment among young postmenopausal women, and hormone replacement therapy has been controversial. In a pilot study 20 microgram Calcifediol Hy.D improved several muscle related function in this target population within 4 months of treatment, which can help to prevent falls and associated bone fractures. Thus the main aim of this study is to test whether Calcifediol Hy.D at a daily dose of 20 μg / day improves muscle function (lower extremity test battery) compared with (1) placebo and compared with (2) 3200 Vitamin D3 IU per day, at 3 and 6 month follow-up. As a secondary and exploratory objective of this study, the investigators will compare the beforementioned doses on muscle strength and the quality of the bones, beside muscle mass, body composition and systolic and diastolic blood pressure measurements.


Eligibility criteria: Inclusion Criteria:

* Women age 50 to 70
* Post-menopausal (defined as: at least 1 year after the last menstrual period)
* community-dwelling and ambulatory without help
* with documented osteopenia (BMD by DEXA t-score: \< -1.0 and \> -2.5 at the spine or hip) in the 6 months prior to enrolment or with documented osteoporosis (BMD by DEXA t-score: ≤ -2.5 at the spine or hip) and a FRAX score (online calculation tool of absolute 10 year fracture risk) below the Swiss age-dependent indication threshold for pharmacologic treatment for the 10-year risk of major osteoporotic fractures - at the screening visit and including DEXA (in the 6 months prior to enrolment) as part of the calculation
* body mass index \> 18.5 and \< 30 kg/m2
* 25(OH)D level \< 24 µg/l (\< 60 nmol/l)
* understands German in reading and writing plus able to read, understand, and complete questionnaires and tests
* willingness to limit additional vitamin D3 intake to 800 IU per day
* willingness to limit calcium supplement intake to 500 mg/day
* willingness to stop active vitamin D metabolites
* participant understands the study procedures, alternative treatments available and risks involved with the study and voluntarily agrees to participate by giving a written informed consent
* participant meets the routine clinical laboratory safety screening tests performed at screening visit
* participant is able and willing to perform all study tests, attend all required office visits, and provide blood and urine samples
* participant is able to swallow the study medication

Exclusion Criteria:

* Consumption of more than 1'000 IU vitamin D on any day in the 4 weeks prior to enrollment.
* Elevated serum calcium \> 2.60 mmol/l adjusted for albumin if albumin ≤ 35 or ≥ 45g/l
* estimated creatinine clearance \< 30 ml/min (Cockcroft and Gault = 140 - age(yr)\*weight(kg)/ serum Cr(mmol/l))×(1.04 for women)
* severe visual or hearing impairment
* malabsorption syndrome (celiac diseases, inflammatory bowel disease).
* Pathologic fracture (excl. fractures due to osteoporosis) in the last year
* Fracture due to osteoporosis in the last 10 years
* Chemo therapy / Radiation due to cancer in the last year
* Treatment which has an effect on calcium metabolism (e.g. PTH, calcitonin, chronic cortisone intake \> 5mg/day for more than 4 weeks in the last 12 months (except for inhalation and sporadic infiltration))
* Current treatment with a bisphosphonate
* For participants of the ancillary study "Muscle Biopsy" only: Treatment which has an effect on blood coagulation (e.g. factor X inhibitor, thrombin inhibitor, NSAR, low-molecular heparin, inhibitor for platelet aggregation, vitamin K antagonist) and/or abnormal blood coagulation status .
* Unwilling or unable to take study medication
* Diseases with a risk of recurrent falling (e.g. Parkinson's disease/syndrome, Hemiplegia after stroke, symptomatic stenosis of the spinal canal, polyneuropathy, epilepsy, recurring vertigo, recurring syncope)
* History of or current diseases that may enhance serum calcium: sarcoidosis, lymphoma, primary hyperparathyroidism
* Individual that heavily consumes alcohol containing products defined as greater than (\>) 3 drinks (beer, wine, or distilled spirits) of alcoholic beverages per day.
* Individual is unlikely to adhere to the study procedures, to keep appointments, or is planning to relocate during the study.
* Individuals who are planning a stay in a "sunny" location (e.g. winter sun resort) for more than one month during the course of the study
* Medication which has an effect on 25-hydroxyvitamin D level (e.g. certain anticonvulsants (e.g. Phenobarbital, Carbamazepin, Phenytoin))
* M. Paget (Ostitis deformans)
* Inflammatory arthritis (e.g. rheumatoid arthritis, Reiter syndrome, psoriasis arthritis)
* Participation in a study in the last 6 months, except for studies without drug-application, or any influence of the study-medication can be excluded

Primary outcomes:
measure: Overall assessment of the "lower extremity function" test battery (difference in proportion of those who improved or maintained function compared to those who declined in function by treatment group)
timeFrame: Baseline, 3 months, 6 months
Secondary outcomes:
measure: Gait speed measurement (8-meter walk)
timeFrame: Baseline, 3 months, 6 months
measure: Knee flexion and extension strength test
timeFrame: Baseline, 3 months, 6 months
measure: Repeated sit-to-stand test (reaction time)
timeFrame: Baseline, 3 months, 6 months
measure: Systolic and diastolic blood pressure
timeFrame: Baseline, 3 months, 6 months
measure: Timed up and go test (functional mobility)
timeFrame: Baseline, 3 months, 6 months
Other outcomes:
measure: Bone mineral density (DXA)
timeFrame: Baseline and 6 months
measure: Muscle mass (DXA)
timeFrame: Baseline and 6 months
measure: Bone quality (Xtreme CT):
timeFrame: Baseline and 6 months
measure: Cognition (MoCa test score)
timeFrame: Baseline and 6 months
measure: Quality of life questionnaire
timeFrame: Baseline, 3 months, 6 months
measure: Upper extremity test (grip strength)
timeFrame: Baseline, 3 months, 6 months
measure: Cardiovascular fitness (6-minute walking test)
timeFrame: Baseline, 3 months, 6 months
measure: Cardio vascular risk marker (NT-BNP)
timeFrame: Baseline, 3 months, 6 months
measure: Bone marker: P1NP
timeFrame: Baseline, 3 months, 6 months
measure: Bone marker: Osteocalcin
timeFrame: Baseline, 3 months, 6 months
measure: Bone marker: Sclerostin
timeFrame: Baseline, 3 months, 6 months
measure: Muscle marker: myostatin
timeFrame: Baseline, 3 months, 6 months
measure: Safety: Serum calcium adjusted for albumin
timeFrame: Screening, 3 months, 6 months
measure: Safety: Serum creatinine
timeFrame: Screening, 3 months, 6 months
measure: Safety: Urinary calcium/creatinine Ratio
timeFrame: Screening, 3 months, 6 months
measure: Safety: Blood pressure
timeFrame: Screening, 3 months, 6 months
measure: Safety: Pulse rate
timeFrame: Screening, 3 months, 6 months
measure: Ancillary studies: Analysis of expression of the vitamin D receptor (VDR) in skeletal muscle
timeFrame: Baseline, 6 months
measure: Ancillary studies: Analysis of total cross-sectional area (CSA) of muscle fibers
timeFrame: Baseline, 6 months
measure: Ancillary studies: Dried blood spot
timeFrame: Baseline, 3 months
Locations:
city: Zurich
country: Switzerland
facility: Center on Aging and Mobility, Klinik für Geriatrie, UniversitätsSpital Zürich
Study officials:
affiliation: Center on Aging and Mobility, Klinik für Geriatrie, UniversitätsSpital Zürich
name: Heike Bischoff-Ferrari, Prof, Dr.PH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ceglia L, Rivas DA, Schlogl M, Fielding GB, Egli A, Bischoff-Ferrari HA, Dawson-Hughes B. Effect of vitamin D3 vs. calcifediol on VDR concentration and fiber size in skeletal muscle. J Bone Miner Metab. 2023 Jan;41(1):41-51. doi: 10.1007/s00774-022-01374-y. Epub 2022 Nov 16.