VERtebral Fracture Treatment Comparisons in Osteoporotic Women (VERO)

Study Description

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Brief Summary:

The primary purpose of participation in this study is to answer whether teriparatide is superior to risedronate in reducing the occurrence of new vertebral fractures during 24 months of therapy.

Condition or disease	Intervention/treatment	Phase
Postmenopausal Osteoporosis	Drug: Teriparatide; Drug: Risedronate; Drug: Placebo; Drug: Calcium; Drug: Vitamin D	Phase 4

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	1366 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	Teriparatide and Risedronate in the Treatment of Patients With Severe Postmenopausal Osteoporosis: Comparative Effects on Vertebral Fractures
Study Start Date :	October 2012
Actual Primary Completion Date :	July 2016
Actual Study Completion Date :	July 2016

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Teriparatide; Teriparatide 20 microgram (µg) administered by subcutaneous (SC) injection once daily for 24 months. Placebo given orally once weekly for 24 months. Elemental Calcium 500 to 1000 milligram per day and Vitamin D 400 to 800 International Units per day, both administered orally once daily while receiving treatment.	Drug: Teriparatide; Administered SC; Other Names: LY333334; Forteo; Forsteo Drug: Placebo; Teriparatide arm placebo administered orally. Risedronate arm placebo administered SC. Drug: Calcium; Administered orally Drug: Vitamin D; Administered orally
Active Comparator: Risedronate; Risedronate 35 milligram (mg) administered orally once weekly for 24 months. Placebo given by SC injection once daily for 24 months. Elemental Calcium 500 to 1000 milligram per day and Vitamin D 400 to 800 International Units per day, both administered orally once daily while receiving treatment.	Drug: Risedronate; Administered orally Drug: Placebo; Teriparatide arm placebo administered orally. Risedronate arm placebo administered SC. Drug: Calcium; Administered orally Drug: Vitamin D; Administered orally

Outcome Measures

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Primary Outcome Measures :

1. Proportion of Participants With New Vertebral Fractures [ Time Frame: Baseline through 24 Months ]

   The incidence of new vertebral fractures was assessed by quantitative vertebral morphometry measurements (QM) with qualitative visual semiquantitative grading (SQ) confirmation.

   A new vertebral fracture was diagnosed in a vertebra that was non-fractured at the baseline radiological examination. It was defined as a loss of vertebral body height of at least 20% and 4 mm from the baseline radiograph by vertebral QM, based upon placement of six points by a trained, central reader. Any fractures identified by QM were confirmed using SQ: if the vertebral body also had an increase of one or more severity grade, it was considered an incident vertebral fracture.

Secondary Outcome Measures :

1. Proportion of Participants With Pooled New and Worsening Vertebral Fractures [ Time Frame: Baseline through 24 Months ]
   Worsening of a pre-existing fracture was considered if the decrease in vertebral height was at least one severity grade in the semi-quantitative assessment, confirmed by a trained central reader, where vertebrae were graded as normal (SQ0) or as with mild (SQ1), moderate (SQ2), or severe (SQ3) fractures, defined as ~20 to 25% (mild), ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 to L4).
2. Proportion of Participants With Pooled Clinical Vertebral and Non-Vertebral Fragility Fractures [ Time Frame: Baseline through 24 Months ]

   A clinical vertebral fracture was defined as a new or worsening vertebral fracture, confirmed by radiography, that was associated with signs and symptoms highly suggestive of a vertebral fracture.

   All non-vertebral fractures that occurred and were diagnosed between visits required the confirmation by the site investigators after evaluating the original x-ray film(s), the radiology or surgical report. For clinical vertebral fractures, the final confirmation of the diagnosis required the centralized evaluation by a trained, independent reader.

3. Proportion of Participants With Non-Vertebral Fragility Fractures [ Time Frame: Baseline through 24 Months ]
   A non-vertebral fracture is a fracture at any of the following non-vertebral sites: clavicle, scapula, ribs, sternum, sacrum, coccyx, humerus, radius, ulna, carpus, pelvis, hip, femur, patella, tibia, fibula, ankle, calcaneus, tarsus, and metatarsal. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object were not considered fragility fractures but traumatic fractures.
4. Proportion of Participants With Major Non-Vertebral Fragility Fractures [ Time Frame: Baseline through 24 Months ]
   A major non-vertebral fracture is a fracture at any of the following non-vertebral sites hip, radius, humerus, ribs, pelvis, tibia and femur. Non-vertebral fractures were determined by direct questioning at each visit, and confirmed by the site investigators by x-ray, radiology or surgical report. Fractures resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving.
5. Proportion of Participants With New Moderate and/or Severe Vertebral Fractures [ Time Frame: Baseline through 24 Months ]
   Vertebrae were graded as moderate (SQ2), or severe (SQ3) fractures, based on ~25 to 40% (moderate) or ~40% or more (severe) decrease in anterior, central, or posterior vertebral height (T4 through L4).
6. Proportion of Participants With New Multiple (2 or More) Vertebral Fractures [ Time Frame: Baseline through 24 Months ]
7. Proportion of Participants With Pooled Fragility and Traumatic Non-Vertebral Fractures [ Time Frame: Baseline through 24 Months ]
   Traumatic fractures were considered if resulting from a severe trauma such as a traffic collision, a beating, or having been struck by a falling or moving object.
8. Change From Baseline to 24 Months Endpoint in Height [ Time Frame: Baseline, 24 Months ]
9. Change From Baseline to 24 Months Endpoint in Back Pain Using an 11-point Numerical Pain Rating Scale [ Time Frame: Baseline, 24 Months ]
   Participants rated the worst back pain during the 24 hours preceding the visit at baseline and each post-baseline visit. An 11-point numerical back pain rating scale (rated from 0 = no back pain to 10 = worst possible back pain) was used.
10. Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (UK) [ Time Frame: Baseline, 24 Months ]
    The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United Kingdom (UK) algorithm, with scores ranging from -0.59 to 1.0. A higher score indicates better health state.
11. Change From Baseline to 24 Months Endpoint in the European Quality of Life Questionnaire [EQ-5D-5L] (US) [ Time Frame: Baseline, 24 Months ]
    The EQ-5D-5L is a generic, multidimensional, health-related, quality-of-life instrument completed on five dimensions to measure health-related quality of life. The profile allowed participants to rate their health state in five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a five level scale (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems). The responses are used to derive the health state index scores using the United States (US) cross walk algorithm, with scores ranging from -0.11 to 1.0. A higher score indicates better health state.

Eligibility Criteria

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Ages Eligible for Study:	45 Years and older (Adult, Senior)
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Postmenopausal women with osteoporosis, as defined by low bone mineral density (BMD), i.e. anterior-posterior lumbar spine, total hip or femoral neck BMD ≥1.5 standard deviations below the average BMD for young, healthy, non-Hispanic, Caucasian women
• A minimum of 2 moderate or 1 severe vertebral fragility fractures (confirmed by central reader) were required

Exclusion Criteria:

• Increased risk of osteosarcoma
• History of unresolved skeletal diseases that affect bone metabolism
• History of atypical subtrochanteric or diaphyseal femoral fractures
• Abnormally high or low calcium levels
• Abnormally high parathyroid hormone (PTH) levels
• Severe vitamin D deficiency
• Abnormal thyroid function not corrected by therapy
• History of malignant neoplasms in the last 5 years
• Active liver disease, clinical jaundice
• Significant impairment of hepatic or renal function
• History of nephro- or urolithiasis
• Previous or planned kypho- or vertebroplasty
• Active or risk for osteonecrosis of the jaw
• Active or recent history of upper gastrointestinal disorders
• Unable to stand or sit in the upright position for at least 30 minutes

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

  Show 103 Study Locations

Sponsors and Collaborators

Eli Lilly and Company

Investigators

Study Director:	Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST)	Eli Lilly and Company

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2017 Nov 9. pii: S0140-6736(17)32137-2. doi: 10.1016/S0140-6736(17)32137-2. [Epub ahead of print] Erratum in: Lancet. 2017 Nov 30;:.

Responsible Party:	Eli Lilly and Company
ClinicalTrials.gov Identifier:	NCT01709110 History of Changes
Other Study ID Numbers:	14536; B3D-EW-GHDW ( Other Identifier: Eli Lilly and Company ); 2012-000123-41 ( EudraCT Number )
First Posted:	October 17, 2012
Results First Posted:	January 23, 2018
Last Update Posted:	January 23, 2018
Last Verified:	July 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Yes
Plan Description:	Lilly provides access to the individual patient data from studies on approved medicines and indications as defined by the sponsor specific information on ClinicalStudyDataRequest.com. This access is provided in a timely fashion after the primary publication is accepted. Researchers need to have an approved research proposal submitted through ClinicalStudyDataRequest.com. Access to the data will be provided in a secure data sharing environment after signing a data sharing agreement.

Keywords provided by Eli Lilly and Company:

Bone Loss; Vertebral fractures

Additional relevant MeSH terms:

Osteoporosis; Osteoporosis, Postmenopausal; Spinal Fractures; Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases; Spinal Injuries; Back Injuries; Wounds and Injuries; Fractures, Bone; Vitamins; Vitamin D	Ergocalciferols; Calcium, Dietary; Teriparatide; Risedronate Sodium; Etidronic Acid; Micronutrients; Growth Substances; Physiological Effects of Drugs; Bone Density Conservation Agents; Calcium Channel Blockers; Membrane Transport Modulators; Molecular Mechanisms of Pharmacological Action