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Trial registered on ANZCTR
Registration number
ACTRN12620000321943
Ethics application status
Approved
Date submitted
7/02/2019
Date registered
9/03/2020
Date last updated
9/03/2020
Date data sharing statement initially provided
9/03/2020
Type of registration
Prospectively registered
Titles & IDs
Public title
Do bisphosphonate tablets improve bone health in patients on dialysis
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Scientific title
A double blind, randomised controlled pilot study of the effect of bisphosphonates versus placebo on parameters associated with fracture risk in patients on dialysis.
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Secondary ID [1]
297336
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None
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Universal Trial Number (UTN)
U1111-1228-1624
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Trial acronym
Study to Assess Bone after Risedronate in ESKD
SABRE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
End Stage Kidney Disease
311451
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fracture risk
315894
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Condition category
Condition code
Renal and Urogenital
291210
291210
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0
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Kidney disease
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Musculoskeletal
314166
314166
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0
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Osteoporosis
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The bisphosphonate risedronate 35 mg (Actonel EC) or identical placebo given orally once weekly after a haemodialysis session. The tablet will be given to the patient by a staff member within 1 hour of th3e completion of the dialysis session. The duration of treatment will be 12 months from commencement of the study.
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Intervention code [1]
288542
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Treatment: Drugs
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Comparator / control treatment
Matched microcellulose placebo capsule given once weekly after haemodialysis
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Control group
Placebo
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Outcomes
Primary outcome [1]
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change in Bone Mineral Density at the hip by DXA
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Assessment method [1]
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Timepoint [1]
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12 months
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Primary outcome [2]
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Change from baseline in the buckling ratio, which is an indicator of femoral neck instability and is calculated by the DXA software as the femoral neck radius divided by the femoral neck cortical thickness.
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Assessment method [2]
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Timepoint [2]
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12 months
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Secondary outcome [1]
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change in femoral neck cortical thickness assessed from hip DXA images using hip structural analysis
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Assessment method [1]
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Timepoint [1]
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12 months
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Secondary outcome [2]
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change in the trabecular bone score assessed from lumbar spine DXA images
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Assessment method [2]
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Timepoint [2]
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12 months
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Secondary outcome [3]
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change in cortical thickness at the calcar by hip structural analysis from DXA images
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Assessment method [3]
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Timepoint [3]
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12 months
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Secondary outcome [4]
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change in Bone Mineral Density at the lumbar spine assessed by DXA
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Assessment method [4]
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Timepoint [4]
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12 months
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Secondary outcome [5]
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change in 3D-Shaper hip cortical volume assessed from DXA images
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Assessment method [5]
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Timepoint [5]
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12 months
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Secondary outcome [6]
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change in the abdominal aortic calcification (AAC-24) score based on assessment of lateral abdominal X-rays that include the abdominal aorta.
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Assessment method [6]
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Timepoint [6]
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12 months
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Secondary outcome [7]
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incident non vertebral fracture.
For non vertebral fracture, patients are seen 3 times weekly by dialysis staff. Patients will be asked to report any incident fracture. Patients will be asked about fracture by a study coordinator, who will contact patients at 3 monthly intervals. Fractures will be confirmed from imaging studies.
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Assessment method [7]
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Timepoint [7]
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12 months
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Secondary outcome [8]
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change in Bone Mineral Density at the forearm using DXA
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Assessment method [8]
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Timepoint [8]
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12 months
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Secondary outcome [9]
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Change in cortical thickness at the femoral shaft using DXA images and hip structural analysis
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Assessment method [9]
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Timepoint [9]
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12 months
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Secondary outcome [10]
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Incident vertebral fracture
Vertebral fracture will be diagnosed using standard definitions of a reduction in vertebral height of 20% or more. An incident vertebral fracture will be diagnosed if a vertebral fracture is present on the 12 month lateral spine X-ray that was not present on the baseline lateral spine X-ray.
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Assessment method [10]
381008
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Timepoint [10]
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12 months
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Eligibility
Key inclusion criteria
age 50 and over
Satellite haemodialysis
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Minimum age
50
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Planned parathyroid surgery
Planned living related kidney transplant surgery within 12 months
Active non skin malignancy
Bilateral hip replacement making DXA hip bone mineral density impossible and hip structural analysis impossible
Gastro oesophageal reflux or gastritis or peptic ulcer disease symptoms that are not controlled with regular medications
A serum parathyroid hormone (PTH) level less than 2 times the upper normal range of the intact-PTH assay
A serum alkaline phosphatase (ALP) level below the normal lower range
Inability to provide informed consent
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
central randomisation by phone/fax/computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
computerised sequence generation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
stratified for age, sex and presence of diabetes.
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Phase
Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The primary analysis will be on intention to treat basis but a per protocol analysis will also be conducted. All adverse events will be collected and analysed. Prespecified subgroup analyses will be by age 50-59, 60-69 and equal to or greater than 70 years of age, by number of comorbid conditions based on the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA): 0, 1-2 and equal to or greater than 3 and on diabetes present / presumed or absent, also recorded from ANZDATA.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/04/2020
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Actual
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Date of last participant enrolment
Anticipated
1/04/2021
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Actual
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Date of last data collection
Anticipated
1/04/2022
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Actual
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Sample size
Target
114
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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Auburn Hospital & Community Health Services - Auburn
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Recruitment hospital [2]
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Blacktown Hospital - Blacktown
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Recruitment hospital [3]
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Westmead Hospital - Westmead
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Recruitment postcode(s) [1]
25573
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2144 - Auburn
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Recruitment postcode(s) [2]
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2148 - Blacktown
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Recruitment postcode(s) [3]
25575
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2145 - Westmead
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Western Sydney Local Health District Research and Education Network
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Address [1]
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Westmead Hospital
Hawkesbury Rd
Westmead
NSW 2145
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Country [1]
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Australia
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Funding source category [2]
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Commercial sector/Industry
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Name [2]
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Theramex Australia Pty Ltd.,
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Address [2]
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Theramex Australia Pty Ltd.,
Nous House Level 34,
60 Margaret St.,
Sydney 2000
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Country [2]
304720
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Australia
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Primary sponsor type
Hospital
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Name
Westmead Hospital Research and Education Network
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Address
Westmead Hospital, Cnr Hawkesbury Rd, Westmead NSW 2145
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Country
Australia
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Secondary sponsor category [1]
301652
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None
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Name [1]
301652
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None
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Address [1]
301652
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Country [1]
301652
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
302589
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Western Sydney Local Health District HREC
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Ethics committee address [1]
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Westmead Hospital, Hawkesbury Rd. Westmead NSW 2145
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Ethics committee country [1]
302589
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Australia
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Date submitted for ethics approval [1]
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13/02/2019
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Approval date [1]
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07/06/2019
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Ethics approval number [1]
302589
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HREC Ref: 2 0 1 8 /ETH00734 Research Office File No: (5996)
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Summary
Brief summary
We hypothesise that in patients on dialysis, with normal or elevated bone turnover, the use of bisphosphonates will improve some or all of BMD, the trabecular bone score (indicating changes to bone microarchitectural parameters), cortical parameters and the buckling ratio assessed by hip structural analysis, and 3D-Shaper hip parameters that independently assess cancellous and cortical compartments from DXA images. If improvements in these parameters are seen with bisphosphonates, a larger study with fracture outcomes is proposed
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Trial website
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Trial related presentations / publications
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Public notes
1. Aleksova J, Milat F, Kotowicz M, Pasco J, Schultz C, Wong P, Ebeling, Elder GJ. Patients with End Stage Kidney Disease have Markedly Abnormal Cortical Hip Parameters by Dual-Energy X-ray Absorptiometry. Nephrology Dialysis Transplant 7 November 2019 gfz195, https://doi.org/10.1093/ndt/gfz195 2. Aleksova J, Kurniawan S, Elder GJ. The Trabecular Bone Score is Associated with Bone Mineral Density, Markers of Bone Turnover and Prevalent Fracture in Patients with End Stage Kidney Disease. Osteoporosis International 2018. 29(6), 1447-1455 3. Sharma AK, Toussaint ND, Masterton R, Holt SG, Rajapakse CS, Ebeling PR, Mohanty ST, Baldock P, Elder GJ. Deterioration of Cortical Bone Microarchitecture: Critical Component of Renal Osteodystrophy Evaluation. Am J Nephrol. 2018 May 23;47(6):376-384. 4. Aleksova J, Kurniawan S, Vucak-Dzumhur M, Kerr P, Ebeling PR, Milat F, Elder GJ. Aortic Vascular Calcification Is Inversely Associated With The Trabecular Bone Score In Patients Receiving Dialysis; Bone. 2018 Aug;113:118-123. 5. Lewis JR, Wong G, Taverniti A, Vucak-Dzumhur M, Elder GJ. Association between aortic calcification, cardiovascular events and mortality in kidney and pancreas-kidney transplant recipients. American Journal of Nephrology 2019 Aug 8:1-10. doi: 10.1159/000502328.
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Contacts
Principal investigator
Name
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Prof Grahame Elder
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Address
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Department of Renal Medicine, Westmead Hospital
Hawkesbury Rd.
Westmead
NSW 2145
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Country
45374
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Australia
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Phone
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+61 288906962
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Fax
45374
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+61 2 96339351
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Email
45374
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[email protected]
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Contact person for public queries
Name
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Grahame Elder
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Address
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Department of Renal Medicine, Westmead Hospital
Hawkesbury Rd.
Westmead
NSW 2145
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Country
45375
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Australia
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Phone
45375
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+61 288906962
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Fax
45375
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+61 2 96339351
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Email
45375
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[email protected]
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Contact person for scientific queries
Name
45376
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Grahame Elder
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Address
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Department of Renal Medicine, Westmead Hospital
Hawkesbury Rd.
Westmead
NSW 2145
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Country
45376
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Australia
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Phone
45376
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+61 288906962
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Fax
45376
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+61 2 96339351
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Baseline and 12 month DXA bone density data by site (hip, spine and forearm), advanced hip analysis data (buckling ratio and cortical thickness), trabecular bone score data and abdominal aortic calcification score data
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When will data be available (start and end dates)?
Start date: following submission of publication of the trial data. Completion of the trial is expected to be June 2022.
End date: not determined.
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Available to whom?
researchers on request or if required for publication purposes.
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Available for what types of analyses?
meta analysis and verification of results
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How or where can data be obtained?
request to Prof Grahame Elder
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
6461
Ethical approval
365579-(Uploaded-06-03-2020-18-01-29)-Study-related document.pdf
6863
Study protocol
[email protected]
6864
Informed consent form
[email protected]
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Statistical analysis plan
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF