Clinical Trial Results:
A Multicenter, International, Randomized, Double-blind, Alendronate-controlled Study to Determine the Efficacy and Safety of Romosozumab in the Treatment of Postmenopausal Women With Osteoporosis
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Summary
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EudraCT number |
2011-003142-41 |
Trial protocol |
IT LT FI PL BE CZ ES EE GR DE GB SE AT DK LV NO NL HU IE SK BG |
Global end of trial date |
29 Jun 2017
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Results information
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Results version number |
v1(current) |
This version publication date |
15 Jul 2018
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First version publication date |
15 Jul 2018
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Other versions |
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Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
20110142
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT01631214 | ||
WHO universal trial number (UTN) |
- | ||
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Sponsors
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Sponsor organisation name |
Amgen Inc.
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Sponsor organisation address |
One Amgen Center Drive, Thousand Oaks, CA, United States, 91320
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Public contact |
IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
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Scientific contact |
IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
29 Jun 2017
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
29 Jun 2017
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The primary objective was to assess the effect of romosozumab treatment for 12 months followed by alendronate treatment compared with alendronate treatment alone on the subject incidence of:
- clinical fracture (nonvertebral fracture and clinical vertebral fracture); and
- new vertebral fracture
in postmenopausal women with osteoporosis.
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Protection of trial subjects |
This study was conducted in accordance with International Council on Harmonisation (ICH) Good Clinical Practice (GCP) and applicable Food and Drug Administration (FDA) or local regulations/guidelines.
The study protocol, subject information, and informed consent form (ICF) were reviewed and approved by the independent ethics committee (IEC) or institutional review board (IRB) for each study center.
Before any study procedures were performed or any investigational products were administered, the investigator obtained written informed consent from each subject after adequate explanation of the aims, methods, anticipated benefits, and potential hazards of the study.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
04 May 2012
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Poland: 704
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Country: Number of subjects enrolled |
Czech Republic: 282
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Country: Number of subjects enrolled |
Russian Federation: 157
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Country: Number of subjects enrolled |
Hungary: 142
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Country: Number of subjects enrolled |
Bulgaria: 112
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Country: Number of subjects enrolled |
Estonia: 51
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Country: Number of subjects enrolled |
Lithuania: 50
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Country: Number of subjects enrolled |
Latvia: 43
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Country: Number of subjects enrolled |
Austria: 37
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Country: Number of subjects enrolled |
Romania: 23
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Country: Number of subjects enrolled |
Slovakia: 16
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Country: Number of subjects enrolled |
Turkey: 9
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Country: Number of subjects enrolled |
Israel: 7
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Country: Number of subjects enrolled |
Colombia: 634
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Country: Number of subjects enrolled |
Brazil: 295
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Country: Number of subjects enrolled |
Peru: 119
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Country: Number of subjects enrolled |
Mexico: 117
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Country: Number of subjects enrolled |
Argentina: 108
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Country: Number of subjects enrolled |
Guatemala: 75
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Country: Number of subjects enrolled |
Dominican Republic: 29
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Country: Number of subjects enrolled |
Chile: 24
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Country: Number of subjects enrolled |
Italy: 76
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Country: Number of subjects enrolled |
United Kingdom: 76
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Country: Number of subjects enrolled |
Denmark: 73
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Country: Number of subjects enrolled |
France: 41
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Country: Number of subjects enrolled |
Germany: 38
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Country: Number of subjects enrolled |
Spain: 38
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Country: Number of subjects enrolled |
Norway: 35
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Country: Number of subjects enrolled |
Greece: 33
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Country: Number of subjects enrolled |
Belgium: 29
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Country: Number of subjects enrolled |
Sweden: 28
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Country: Number of subjects enrolled |
Netherlands: 25
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Country: Number of subjects enrolled |
Australia: 19
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Country: Number of subjects enrolled |
Finland: 13
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Country: Number of subjects enrolled |
New Zealand: 9
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Country: Number of subjects enrolled |
Hong Kong: 249
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Country: Number of subjects enrolled |
South Africa: 154
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Country: Number of subjects enrolled |
Korea, Republic of: 20
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Country: Number of subjects enrolled |
Taiwan: 6
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Country: Number of subjects enrolled |
United States: 57
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Country: Number of subjects enrolled |
Canada: 40
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Worldwide total number of subjects |
4093
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EEA total number of subjects |
1965
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
479
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From 65 to 84 years |
3286
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85 years and over |
328
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Recruitment
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Recruitment details |
The study was conducted at 270 centers in 41 countries globally from 04 May 2012 to 29 June 2017. | ||||||||||||||||||||||||||||||||||||||||||||||||
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Pre-assignment
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Screening details |
Participants were randomized in a 1:1 ratio to receive romosozumab or alendronate for 12 months. Randomization was stratified by age (< 75 vs. ≥ 75 years). After completion of the double-blind trial period, all participants received open-label alendronate until the end of the trial, with blinding to the initial treatment assignment maintained. | ||||||||||||||||||||||||||||||||||||||||||||||||
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Period 1
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Period 1 title |
Overall Study (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||||||||||||||||||||||||||
Roles blinded |
Subject, Investigator, Assessor | ||||||||||||||||||||||||||||||||||||||||||||||||
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Alendronate/Alendronate | ||||||||||||||||||||||||||||||||||||||||||||||||
Arm description |
Participants received 70 mg alendronate once a week and placebo to romosozumab subcutaneously once a month for the first 12 months. After completion of the 12-month double-blind treatment period participants continued to receive 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||
Arm type |
Active comparator | ||||||||||||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Alendronate
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Investigational medicinal product code |
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Other name |
Fosamax®
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Alendronate 70-mg tablet taken once a week
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Investigational medicinal product name |
Placebo to Romosozumab
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for injection in pre-filled syringe
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Administered by subcutaneous injection once a month during the double-blind treatment phase.
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Arm title
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Romosozumab/Alendronate | ||||||||||||||||||||||||||||||||||||||||||||||||
Arm description |
Participants received 210 romosozumab mg subcutaneously once a month and placebo to alendronate orally once a week for the first 12 months. After completion of the 12-month double-blind treatment period participants received 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Placebo to Alendronate
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Matching placebo tablet taken once a week during the double-blind treatment phase.
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Investigational medicinal product name |
Alendronate
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Investigational medicinal product code |
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Other name |
Fosamax®
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Alendronate 70 mg tablet taken once a week during the open-label treatment phase.
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Investigational medicinal product name |
Romosozumab
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Investigational medicinal product code |
AMG 785
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Other name |
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Pharmaceutical forms |
Solution for injection in pre-filled syringe
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Romosozumab 210 mg administered by subcutaneous injection once a month during the double-blind treatment phase.
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Baseline characteristics reporting groups
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Reporting group title |
Alendronate/Alendronate
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Reporting group description |
Participants received 70 mg alendronate once a week and placebo to romosozumab subcutaneously once a month for the first 12 months. After completion of the 12-month double-blind treatment period participants continued to receive 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Romosozumab/Alendronate
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Reporting group description |
Participants received 210 romosozumab mg subcutaneously once a month and placebo to alendronate orally once a week for the first 12 months. After completion of the 12-month double-blind treatment period participants received 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Alendronate/Alendronate
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Reporting group description |
Participants received 70 mg alendronate once a week and placebo to romosozumab subcutaneously once a month for the first 12 months. After completion of the 12-month double-blind treatment period participants continued to receive 70 mg alendronate once a week until the end of the study. | ||
Reporting group title |
Romosozumab/Alendronate
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Reporting group description |
Participants received 210 romosozumab mg subcutaneously once a month and placebo to alendronate orally once a week for the first 12 months. After completion of the 12-month double-blind treatment period participants received 70 mg alendronate once a week until the end of the study. | ||
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End point title |
Percentage of Participants with New Vertebral Fractures Through Month 24 | ||||||||||||
End point description |
New vertebral fractures occurred when there was ≥ 1 grade increase from the previous grade of 0 in any vertebra from T4 to L4 using the Genant semiquantitative scoring method based on assessment of x-rays according to the following scale:
• Grade 0 (Normal) = no fracture;
• Grade 1 (Mild) = mild fracture, 20 to 25% reduction in vertebral height (anterior, middle, or posterior);
• Grade 2 (Moderate) = moderate fracture, 25 to 40% reduction in anterior, middle, and/or posterior height;
• Grade 3 (Severe) = severe fracture, greater than 40% reduction in anterior, middle, and/or posterior height.
The analysis was conducted in randomized participants with a baseline and ≥ 1 post-baseline evaluation of vertebral fracture at or before 24 months and includes participants who had vertebrae with missing Genant semiquantitative scores at baseline and whose first post-baseline spinal radiograph showed no fracture on the same vertebrae. Last observation carried forward imputation was used.
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End point type |
Primary
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End point timeframe |
24 months
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Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
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Number of subjects included in analysis |
3659
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Analysis specification |
Pre-specified
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Analysis type |
superiority [1] | ||||||||||||
P-value |
< 0.001 [2] | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
0.48
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.36 | ||||||||||||
upper limit |
0.64 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.15
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| Notes [1] - The primary endpoints were tested at the 5% level (2-sided), accounting for multiplicity using the Hochberg procedure. If the larger of the 2 P-values was significant at the 0.05 level (2-sided), the statistical testing continued to the secondary endpoint in the testing sequence. [2] - Based on logistic regression model adjusted for age strata, baseline total hip BMD T-score and presence of severe vertebral fracture at baseline. The standard error (SE) represents the standard error of log(odds ratio). |
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Statistical analysis title |
Risk Ratio | ||||||||||||
Statistical analysis description |
The risk ratio (ratio of proportions, Romosozumab over Alendronate) was based on the Mantel Haenszel method, adjusted for age strata (<75 vs. ≥75 years), the presence or absence of severe vertebral fracture at baseline, and baseline bone mineral density T score at the total hip (≤ -2.5, > -2.5).
SE represents the standard error of log(risk ratio).
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Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
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Number of subjects included in analysis |
3659
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
Method |
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Parameter type |
Risk ratio (RR) | ||||||||||||
Point estimate |
0.5
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.38 | ||||||||||||
upper limit |
0.66 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.14
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Statistical analysis title |
Absolute Risk Reduction | ||||||||||||
Statistical analysis description |
The absolute risk reduction (difference in proportions, alendronate – romosozumab) based on the Mantel-Haenszel method adjusted for age strata, baseline total hip BMD T-score (≤ -2.5, > -2.5), and presence of severe vertebral fracture at baseline.
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Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
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Number of subjects included in analysis |
3659
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
Method |
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Parameter type |
Absolute risk reduction | ||||||||||||
Point estimate |
4.03
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
2.5 | ||||||||||||
upper limit |
5.57 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.78
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End point title |
Percentage of Participants with a Clinical Fracture at the Primary Analysis | ||||||||||||
End point description |
Clinical fractures included clinical vertebral and nonvertebral fractures (excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges) that were associated with signs and/or symptoms indicative of a fracture. Clinical vertebral fractures were included regardless of trauma severity or pathologic fractures; nonvertebral fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants. Missing values for clinical vertebral fractures were imputed using last observation carried forward.
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End point type |
Primary
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End point timeframe |
The primary analysis was performed when clinical fracture events had been confirmed in at least 330 patients and all participants had completed the month 24 visit. The median follow-up was 2.7 years (interquartile range, 2.2 to 3.3).
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Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
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Number of subjects included in analysis |
4093
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Analysis specification |
Pre-specified
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Analysis type |
superiority [3] | ||||||||||||
P-value |
< 0.001 [4] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.73
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.61 | ||||||||||||
upper limit |
0.88 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.09
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| Notes [3] - The primary endpoints were tested at the 5% level (2-sided), accounting for multiplicity using the Hochberg procedure. If the larger of the 2 P-values was significant at the 0.05 level (2-sided), the statistical testing continued to the secondary endpoint in the testing sequence. [4] - Based on a Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
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End point title |
Percentage of Participants with a Nonvertebral Fracture at the Primary Analysis | ||||||||||||
End point description |
A nonvertebral fracture was defined as a fracture present on a copy of radiographs or other diagnostic images such as computerized tomography (CT) or magnetic resonance imaging confirming the fracture within 14 days of reported fracture image date recorded by the study site, and/or documented in a copy of the radiology report, surgical report, or discharge summary, excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges. In addition, fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants.
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End point type |
Secondary
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End point timeframe |
The primary analysis was performed when clinical fracture events had been confirmed in at least 330 patients and all participants had completed the month 24 visit. The median follow-up was 2.7 years (interquartile range, 2.2 to 3.3).
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Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
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Number of subjects included in analysis |
4093
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Analysis specification |
Pre-specified
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Analysis type |
superiority [5] | ||||||||||||
P-value |
= 0.04 [6] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.81
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.66 | ||||||||||||
upper limit |
0.99 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.1
|
||||||||||||
| Notes [5] - If the 2 primary endpoints and the specified BMD secondary endpoints were all significant, the nonvertebral fracture at the primary analysis was evaluated based on a 1-sided test (overall α=0.025) determined by the Lan-DeMets alpha spending function that approximates a Pocock boundary, 0.0233 (1-sided). The adjusted 2-sided p-value is reported. [6] - Based on a Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with any Fracture at the Primary Analysis | ||||||||||||
End point description |
All fractures include any osteoporotic nonvertebral fractures that are not associated with high trauma severity or pathologic fractures and new or worsening vertebral fractures regardless of trauma severity or pathologic fractures.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
The primary analysis was performed when clinical fracture events had been confirmed in at least 330 patients and all participants had completed the month 24 visit. The median follow-up was 2.7 years (interquartile range, 2.2 to 3.3).
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [7] | ||||||||||||
P-value |
< 0.001 [8] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.65
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.56 | ||||||||||||
upper limit |
0.76 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.08
|
||||||||||||
| Notes [7] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [8] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a New or Worsening Vertebral Fracture Through Month 24 | ||||||||||||
End point description |
A new or worsening vertebral fracture was identified when there was a ≥ 1 grade increase from the previous grade in any vertebra from T4 to L4.
The analysis was conducted in randomized participants with a baseline and ≥ 1 post-baseline evaluation of vertebral fracture at or before 24 months and includes participants who had vertebrae with missing Genant semiquantitative scores at baseline and whose first post-baseline spinal radiograph showed no fracture on the same vertebrae. Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [9] | ||||||||||||
P-value |
< 0.001 [10] | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
0.49
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.37 | ||||||||||||
upper limit |
0.64 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.14
|
||||||||||||
| Notes [9] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [10] - Based on a logistic regression model adjusted for age strata, baseline total hip BMD T-score and presence of severe vertebral fracture at baseline; p-value based on score test. SE represents the standard error of log(odds ratio). |
|||||||||||||
Statistical analysis title |
Absolute Risk Reduction | ||||||||||||
Statistical analysis description |
The absolute risk reduction (difference in proportions, Alendronate – Romosozumab) based on the Mantel-Haenszel method adjusted for age strata, baseline total hip BMD T-score (≤ -2.5, > -2.5), and presence of severe vertebral fracture at baseline.
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Absolute Risk Reduction | ||||||||||||
Point estimate |
4.44
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
2.8 | ||||||||||||
upper limit |
6.08 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.84
|
||||||||||||
Statistical analysis title |
Risk Ratio | ||||||||||||
Statistical analysis description |
The risk ratio (ratio of proportions, Romosozumab over Alendronate) was based on the Mantel Haenszel method, adjusted for age strata (<75 vs. ≥75 years), the presence or absence of severe vertebral fracture at baseline, and baseline bone mineral density T score at the total hip (≤ -2.5, > -2.5).
SE represents the standard error of log(risk ratio).
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Risk ratio (RR) | ||||||||||||
Point estimate |
0.52
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.4 | ||||||||||||
upper limit |
0.66 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.13
|
||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Major Nonvertebral Fracture at the Primary Analysis | ||||||||||||
End point description |
A major nonvertebral fracture was a subset of nonvertebral fractures including pelvis, distal femur (ie, femur excluding hip), proximal tibia (ie, tibia excluding ankle), ribs, proximal humerus (ie, humerus excluding elbow), forearm, and hip.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
The primary analysis was performed when clinical fracture events had been confirmed in at least 330 patients and all participants had completed the month 24 visit. The median follow-up was 2.7 years (interquartile range, 2.2 to 3.3).
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [11] | ||||||||||||
P-value |
= 0.004 [12] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.73
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.59 | ||||||||||||
upper limit |
0.9 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.11
|
||||||||||||
| Notes [11] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [12] - Based on a Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Hip Fracture at the Primary Analysis | ||||||||||||
End point description |
Hip fractures were defined as a subset of nonvertebral fractures including fractures of the femur neck, femur intertrochanter, and femur subtrochanter.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
The primary analysis was performed when clinical fracture events had been confirmed in at least 330 patients and all participants had completed the month 24 visit. The median follow-up was 2.7 years (interquartile range, 2.2 to 3.3).
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [13] | ||||||||||||
P-value |
= 0.015 [14] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.62
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.42 | ||||||||||||
upper limit |
0.92 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [13] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [14] - Based on a Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with Multiple New or Worsening Vertebral Fractures Through Month 24 | ||||||||||||
End point description |
A new or worsening vertebral fracture was identified when there was a ≥ 1 grade increase from the previous grade in any vertebra from T4 to L4. A participant had multiple new or worsening vertebral fractures when there were ≥ 2 vertebrae from T4 to L4 with ≥ 1 grade increase from the previous grade. The multiple new or worsening vertebral fractures need not have occurred at the same visit.
The analysis was conducted in randomized participants with a baseline and ≥ 1 post-baseline evaluation of vertebral fracture at or before 24 months and includes participants who had vertebrae with missing Genant semiquantitative scores at baseline and whose first post-baseline spinal radiograph showed no fracture on the same vertebrae. Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [15] | ||||||||||||
P-value |
= 0.008 [16] | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
0.51
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.31 | ||||||||||||
upper limit |
0.85 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.25
|
||||||||||||
| Notes [15] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [16] - Based on logistic regression model adjusted for age strata, baseline total hip BMD T-score and presence of severe vertebral fracture at baseline. SE represents the standard error of log(odds ratio). |
|||||||||||||
Statistical analysis title |
Risk Ratio | ||||||||||||
Statistical analysis description |
The risk ratio (ratio of proportions, Romosozumab over Alendronate) was based on the Mantel Haenszel method, adjusted for age strata (<75 vs. ≥75 years), the presence or absence of severe vertebral fracture at baseline, and baseline bone mineral density T score at the total hip (≤ -2.5, > -2.5).
SE represents the standard error of log(risk ratio).
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Risk ratio (RR) | ||||||||||||
Point estimate |
0.52
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.32 | ||||||||||||
upper limit |
0.85 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.25
|
||||||||||||
Statistical analysis title |
Absolute Risk Reduction | ||||||||||||
Statistical analysis description |
The absolute risk reduction (difference in proportions, alendronate – romosozumab) based on the Mantel-Haenszel method adjusted for age strata, baseline total hip BMD T-score (≤ -2.5, > -2.5), and presence of severe vertebral fracture at baseline.
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3659
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Absolute risk reduction | ||||||||||||
Point estimate |
1.21
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.33 | ||||||||||||
upper limit |
2.1 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.45
|
||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Clinical Fracture Through Month 24 | ||||||||||||
End point description |
Clinical fractures included clinical vertebral and nonvertebral fractures (excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges) that were associated with signs and/or symptoms indicative of a fracture. Clinical vertebral fractures were included regardless of trauma severity or pathologic fractures; nonvertebral fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants. Missing values for clinical vertebral fractures were imputed using last observation carried forward.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [17] | ||||||||||||
P-value |
= 0.005 [18] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.74
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.59 | ||||||||||||
upper limit |
0.91 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.11
|
||||||||||||
| Notes [17] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [18] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Nonvertebral Fracture Through Month 24 | ||||||||||||
End point description |
A nonvertebral fracture was defined as a fracture present on a copy of radiographs or other diagnostic images such as computerized tomography (CT) or magnetic resonance imaging confirming the fracture within 14 days of reported fracture image date recorded by the study site, and/or documented in a copy of the radiology report, surgical report, or discharge summary, excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges. In addition, fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [19] | ||||||||||||
P-value |
= 0.074 [20] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.81
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.64 | ||||||||||||
upper limit |
1.02 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.12
|
||||||||||||
| Notes [19] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [20] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Hip Fracture Through Month 24 | ||||||||||||
End point description |
Hip fractures were defined as a subset of nonvertebral fractures including fractures of the femur neck, femur intertrochanter, and femur subtrochanter.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [21] | ||||||||||||
P-value |
= 0.17 [22] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.72
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.46 | ||||||||||||
upper limit |
1.15 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.24
|
||||||||||||
| Notes [21] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [22] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Clinical Vertebral Fracture Through Month 24 | ||||||||||||
End point description |
A clinical vertebral fracture is a new or worsening vertebral fracture assessed at either a scheduled or unscheduled visit and associated with any signs and/or symptoms of back pain indicative of a fracture, regardless of trauma severity or whether it is pathologic.
The analysis was conducted in all randomized participants. Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
24 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [23] | ||||||||||||
P-value |
< 0.001 [24] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.41
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.24 | ||||||||||||
upper limit |
0.71 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.28
|
||||||||||||
| Notes [23] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [24] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log(hazards ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Clinical Fracture Through Month 12 | ||||||||||||
End point description |
Clinical fractures included clinical vertebral and nonvertebral fractures (excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges) that were associated with signs and/or symptoms indicative of a fracture. Clinical vertebral fractures were included regardless of trauma severity or pathologic fractures; nonvertebral fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants. Missing values for clinical vertebral fractures were imputed using last observation carried forward.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [25] | ||||||||||||
P-value |
= 0.027 [26] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.72
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.54 | ||||||||||||
upper limit |
0.96 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.15
|
||||||||||||
| Notes [25] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [26] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with New Vertebral Fractures Through Month 12 | ||||||||||||
End point description |
New vertebral fractures occurred when there was ≥ 1 grade increase from the previous grade of 0 in any vertebra from T4 to L4 using the Genant semiquantitative scoring method based on assessment of x-rays according to the following scale:
• Grade 0 (Normal) = no fracture;
• Grade 1 (Mild) = mild fracture, 20 to 25% reduction in vertebral height (anterior, middle, or posterior);
• Grade 2 (Moderate) = moderate fracture, 25 to 40% reduction in anterior, middle, and/or posterior height;
• Grade 3 (Severe) = severe fracture, greater than 40% reduction in anterior, middle, and/or posterior height.
The analysis was conducted in randomized participants with a baseline and ≥ 1 post-baseline evaluation of vertebral fracture at or before 12 months and includes participants who had vertebrae with missing Genant semiquantitative scores at baseline and whose first post-baseline spinal radiograph showed no fracture on the same vertebrae. Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3399
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [27] | ||||||||||||
P-value |
= 0.008 [28] | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
0.63
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.44 | ||||||||||||
upper limit |
0.89 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.18
|
||||||||||||
| Notes [27] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [28] - Based on logistic regression model adjusted for age strata, baseline total hip BMD T-score and presence of severe vertebral fracture at baseline. SE represents the standard error of log (odds ratio). |
|||||||||||||
Statistical analysis title |
Risk Ratio | ||||||||||||
Statistical analysis description |
The risk ratio (ratio of proportions, Romosozumab over Alendronate) was based on the Mantel Haenszel method, adjusted for age strata (<75 vs. ≥75 years), the presence or absence of severe vertebral fracture at baseline, and baseline bone mineral density T score at the total hip (≤ -2.5, > -2.5).
SE represents the standard error of log (risk ratio).
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3399
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Risk ratio (RR) | ||||||||||||
Point estimate |
0.64
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.46 | ||||||||||||
upper limit |
0.89 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.17
|
||||||||||||
Statistical analysis title |
Absolute Risk Reduction | ||||||||||||
Statistical analysis description |
The absolute risk reduction (difference in proportions, alendronate – romosozumab) based on the Mantel-Haenszel method adjusted for age strata, baseline total hip BMD T-score (≤ -2.5, > -2.5), and presence of severe vertebral fracture at baseline.
|
||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3399
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
Method |
|||||||||||||
Parameter type |
Absolute risk reduction | ||||||||||||
Point estimate |
1.84
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.51 | ||||||||||||
upper limit |
3.17 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.68
|
||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with Any Fracture Through Month 12 | ||||||||||||
End point description |
All fractures include any osteoporotic nonvertebral fractures that are not associated with high trauma severity or pathologic fractures and new or worsening vertebral fractures regardless of trauma severity or pathologic fractures.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [29] | ||||||||||||
P-value |
= 0.002 [30] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.71
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.57 | ||||||||||||
upper limit |
0.88 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.11
|
||||||||||||
| Notes [29] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [30] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Nonvertebral Fracture Through Month 12 | ||||||||||||
End point description |
A nonvertebral fracture was defined as a fracture present on a copy of radiographs or other diagnostic images such as computerized tomography (CT) or magnetic resonance imaging confirming the fracture within 14 days of reported fracture image date recorded by the study site, and/or documented in a copy of the radiology report, surgical report, or discharge summary, excluding skull, facial, mandible, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, metacarpus, finger phalanges, and toe phalanges. In addition, fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [31] | ||||||||||||
P-value |
= 0.057 [32] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.74
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.54 | ||||||||||||
upper limit |
1.01 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.16
|
||||||||||||
| Notes [31] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [32] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Hip Fracture Through Month 12 | ||||||||||||
End point description |
Hip fractures were defined as a subset of nonvertebral fractures including fractures of the femur neck, femur intertrochanter, and femur subtrochanter.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [33] | ||||||||||||
P-value |
= 0.19 [34] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.64
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.33 | ||||||||||||
upper limit |
1.26 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.34
|
||||||||||||
| Notes [33] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [34] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Major Osteoporotic Fracture Through Month 12 | ||||||||||||
End point description |
Major osteoporotic fractures included clinical vertebral fractures and fractures of the hip, forearm and humerus. Fractures associated with high trauma severity or pathologic fractures were excluded.
The analysis was conducted in all randomized participants.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
[35] | ||||||||||||
P-value |
= 0.053 [36] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.72
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.52 | ||||||||||||
upper limit |
1.01 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.17
|
||||||||||||
| Notes [35] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [36] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percentage of Participants with a Clinical Vertebral Fracture Through Month 12 | ||||||||||||
End point description |
A clinical vertebral fracture is a new or worsening vertebral fracture assessed at either a scheduled or unscheduled visit and associated with any signs and/or symptoms of back pain indicative of a fracture, regardless of trauma severity or whether it is pathologic.
The analysis was conducted in all randomized participants. Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
12 months
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
4093
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [37] | ||||||||||||
P-value |
= 0.14 [38] | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Hazard ratio (HR) | ||||||||||||
Point estimate |
0.56
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
0.26 | ||||||||||||
upper limit |
1.22 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.39
|
||||||||||||
| Notes [37] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [38] - Based on Cox proportional hazards model adjusting for age strata, baseline total hip BMD T-score, and presence of severe vertebral fracture at baseline. SE represents the standard error of log (hazard ratio). |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density at the Lumbar Spine at Month 24 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 24; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 24
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3148
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [39] | ||||||||||||
P-value |
< 0.001 [40] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
8.1
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
7.58 | ||||||||||||
upper limit |
8.57 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.3
|
||||||||||||
| Notes [39] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [40] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Total Hip at Month 24 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 24; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 24
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3249
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [41] | ||||||||||||
P-value |
< 0.001 [42] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.8
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
3.42 | ||||||||||||
upper limit |
4.1 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [41] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [42] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Femoral Neck at Month 24 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 24; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 24
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3249
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [43] | ||||||||||||
P-value |
< 0.001 [44] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.8
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
3.4 | ||||||||||||
upper limit |
4.14 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [43] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [44] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density at the Lumbar Spine at Month 12 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation at or before month 12; Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 12
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3440
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [45] | ||||||||||||
P-value |
< 0.001 [46] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
8.7
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
8.31 | ||||||||||||
upper limit |
9.09 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [45] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [46] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Total Hip at Month 12 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation at or before month 12; Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 12
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3562
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [47] | ||||||||||||
P-value |
< 0.001 [48] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.3
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
3.03 | ||||||||||||
upper limit |
3.6 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.1
|
||||||||||||
| Notes [47] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [48] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Femoral Neck at Month 12 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation at or before month 12; Last observation carried forward imputation was used.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 12
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3562
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [49] | ||||||||||||
P-value |
< 0.001 [50] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.2
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
2.9 | ||||||||||||
upper limit |
3.54 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [49] - If the differences in both primary end points were significant with the use of the Hochberg procedure, a fixed-sequence testing procedure was used for bone mineral density and the key secondary end point of nonvertebral fracture to adjust for multiple comparisons and to maintain an overall significance level of 0.05. [50] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density at the Lumbar Spine at Month 36 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 36; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 36
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3190
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [51] | ||||||||||||
P-value |
< 0.001 [52] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
7.4
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
6.84 | ||||||||||||
upper limit |
7.89 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.3
|
||||||||||||
| Notes [51] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [52] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Total Hip at Month 36 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 36; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 36
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3306
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [53] | ||||||||||||
P-value |
< 0.001 [54] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.7
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
3.29 | ||||||||||||
upper limit |
4.02 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [53] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [54] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction. |
|||||||||||||
|
|||||||||||||
End point title |
Percent Change from Baseline in Bone Mineral Density of the Femoral Neck at Month 36 | ||||||||||||
End point description |
Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). DXA scans were analyzed by a central imaging center.
The analysis was conducted in all randomized participants with a baseline and ≥ 1 post-baseline evaluation during the open-label period at or before month 36; Missing values were imputed by carrying forward the last non-missing post-baseline value in the open-label treatment period prior to the missing value.
|
||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
Baseline and month 36
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Primary Analysis | ||||||||||||
Comparison groups |
Alendronate/Alendronate v Romosozumab/Alendronate
|
||||||||||||
Number of subjects included in analysis |
3306
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority [55] | ||||||||||||
P-value |
< 0.001 [56] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
LS Mean Difference | ||||||||||||
Point estimate |
3.6
|
||||||||||||
Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
3.18 | ||||||||||||
upper limit |
3.97 | ||||||||||||
Variability estimate |
Standard error of the mean
|
||||||||||||
Dispersion value |
0.2
|
||||||||||||
| Notes [55] - This endpoint was not included in the sequential testing procedure and was analyzed without multiplicity adjustment at a significance level of 0.05 (two-sided). [56] - Based on ANCOVA model adjusting for treatment, age strata, presence of severe vertebral fracture at baseline, baseline BMD value, machine type, and baseline BMD value-by-machine type interaction |
|||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Adverse events information
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Timeframe for reporting adverse events |
The 12-month double-blind treatment phase and overall study period which includes AEs up to the end of study for subjects who received an open-label dose and up to 12 months for subjects who did not; overall median duration of follow-up was 36 months.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adverse event reporting additional description |
The safety analysis set included all randomized subjects who received ≥ 1 active dose of investigational product in the 12-month double-blind alendronate-controlled study period. Two participants randomized to alendronate received romosozumab in error and are counted in the romosozumab group for safety.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Dictionary used for adverse event reporting
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
20.0
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Reporting groups
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
12-Month Double-blind Period: Alendronate 70 mg QW
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group description |
Participants received 70 mg alendronate once a week (QW) and placebo to romosozumab subcutaneously once a month for 12 months during the double-blind treatment period. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Overall Study: Alendronate / Alendronate
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Reporting group description |
Participants received 70 mg alendronate once a week and placebo to romosozumab subcutaneously once a month for the first 12 months. After completion of the 12-month double-blind treatment period participants continued to receive 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Overall Study: Romosozumab / Alendronate
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Reporting group description |
Participants received 210 romosozumab mg subcutaneously once a month and placebo to alendronate orally once a week for the first 12 months. After completion of the 12-month double-blind treatment period participants received 70 mg alendronate once a week until the end of the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
12-Month Double-blind Period: Romosozumab 210 mg QM
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Reporting group description |
Participants received 210 mg romosozumab subcutaneously once a month (QM) and placebo to alendronate orally once a week for the first 12 months during the double-blind treatment period. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Frequency threshold for reporting non-serious adverse events: 0% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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| Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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27 Apr 2012 |
- Subjects with a reported history of hearing loss associated with cranial nerve VIII compression due to excessive bone growth were excluded from study participation.
- A physician was to be available during administration of investigational product, and all subjects were closely observed for approximately 30 minutes after dosing with IP.
- The investigator was to be alerted if a subject experienced a BMD loss from baseline of ≥ 7% at the total hip and/or at the lumbar spine at any time during the study, and was required to discuss implications for individual fracture risk, alternative treatment options, and options for continuing in the study with the subject. |
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14 Nov 2012 |
Following regulatory agency feedback, this amendment incorporated
changes to facilitate optimal evaluation of the risk/benefit profile of
romosozumab, to clarify statistical considerations, and to outline expectation
for reporting of serious adverse events. Study procedures were simplified
there was no impact on the evaluation of study objectives.
- Amended exclusion criteria to ensure that pre-existing disorders and/or the administration of medications did not confound the risk/benefit assessment for romosozumab.
- Amended proscribed treatments during the study to ensure those did not confound the risk/benefit assessment for romosozumab.
- Provided more detail on the adjudication of possible events of osteonecrosis of the jaw, atypical femoral fractures, and cardiovascular events.
Statistical considerations:
- Clarified that worsening vertebral fractures were considered for endpoints evaluating the incidence of all fractures.
- For endpoints evaluating the incidence of major osteoporotic fractures, corrected the definition to include forearm instead of wrist fractures.
- Baseline total hip BMD T-score was aligned with the Statistical Analysis Plan as an adjustment factor for the evaluation of new vertebral fracture incidence.
Serious adverse event reporting:
- Specified that serious adverse events must be reported within 24 hours after the investigator¡¦s knowledge of the event and clarified the point of reference for evaluation of expectedness of serious adverse events.
Changes to study procedures:
- Clarified the day 1 lumbar spine DXA scan may have been taken together with the screening proximal femur DXA scan for subject convenience.
- Replaced the month 21 clinic visit with a telephone call.
- For subjects participating in the Imaging and PK/BTM /Biomarker Substudy, the spine QCT assessments at month 36 and the end-of-study visits were eliminated. |
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21 Jun 2013 |
The eligibility criteria were modified to allow participation of a wider range of subjects. Criteria revisions included the following:
- Lowering the minimum age from 60 to 55 years and allowing 3 additional qualifying BMD and fracture history combinations.
- The protocol-mandated off-treatment times for exclusionary medications were revised.
- Rescreening was allowed for subjects who previously failed screening if in the opinion of the investigator the reason for the initial screen failure has resolved or was no longer applicable.
- Based on regulatory agency feedback, assessments for formation of antiromosozumab antibodies were added at the month 1 and month 3 study visits to allow a more comprehensive characterization of the antibody response.
- Retesting of serum calcium would be permitted within the screening window if the initial test indicated an elevated level of serum calcium within 1.1 x the upper limit of normal. |
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08 Jul 2015 |
The protocol was amended to include the addition of a Final Analysis. The study's previous primary analysis remained unchanged.
- Upon completion of the primary analysis period, subjects were followed for nonvertebral fractures. Subjects and site personnel remained blinded to initial treatment assignments and the study proceeded in an event-driven manner. The final analysis (end-of-study) occurred when nonvertebral fracture events were confirmed for at least 440 subjects, or earlier if the primary analysis demonstrated superiority of romosozumab treatment for nonvertebral fracture risk reduction. The duration of participation for subjects was changed from 25 to 59 months if study completion was achieved at primary analysis, or from 37 to 71 months if study completion was achieved when 440 subjects experienced a nonvertebral fracture.
- Approximately 200 subjects were planned to be enrolled in an Imaging and PK/BTM/Biomarker Substudy, with a subset of approximately 100 subjects participating in the imaging (DXA, QCT) portion of the substudy.
- The exclusion criteria for hyper-/hypothyroidism and hyper-/hypoparathyroidism were clarified.
- The month 15 study visit was eliminated for all but the substudy participants, and sampling for antibody testing was added to the month 18 visit. The end of primary analysis and end-of-study visits were replaced by telephone contact. |
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14 Sep 2016 |
- Moved the following month-12 exploratory endpoints to secondary endpoints: nonvertebral fracture, hip fracture, major osteoporotic fracture (hip, forearm, humerus, and clinical vertebral).
- Added clinical vertebral fracture as a new month-12 secondary endpoint.
- Added new endpoints to the overall study period and the month 12 to 24 open-label alendronate period.
- Added the following new secondary endpoints through month 24 during the primary analysis period: clinical fracture, nonvertebral fracture, hip fracture, and clinical vertebral fracture.
- Based on regulatory agency feedback, DXA BMD endpoints were added to the testing sequence for multiplicity adjustment. |
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Interruptions (globally) |
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| Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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| Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
| None reported | |||