Testosterone and Growth Hormone for Bone Loss in Men - Full Text View

Sponsored by:	National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information provided by:	National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
ClinicalTrials.gov Identifier:	NCT00080483

Purpose

Deficiency of testosterone, growth hormone, or both hormones can result in osteoporosis. If either hormone is replaced, the condition of the bones improves. The purpose of this study is to determine if dual hormone treatment for men deficient in testosterone and growth hormone improves bone structure more than testosterone treatment alone.

Condition	Intervention
Hypopituitarism Hypogonadism Growth Hormone Deficiency	Drug: Testosterone plus somatropin Drug: testosterone

Genetics Home Reference related topics: pseudoachondroplasia

Drug Information available for: Testosterone Methyltestosterone Oxymesterone Testosterone enanthate Testosterone Propionate Testosterone undecanoate Somatotropin Somatropin

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study
Official Title:	Will Testosterone and Growth Hormone Improve Bone Structure?

Further study details as provided by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

Primary Outcome Measures:

Increased bone volume fraction, as determined by magnetic resonance of the distal tibia [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Increased trabecular thickness, as determined by magnetic resonance of the distal tibia [ Time Frame: 2 years ] [ Designated as safety issue: No ]
improved architectural parameters of trabecular bone reflecting connectivity, as determined by magnetic resonance imaging [ Time Frame: 2 years ] [ Designated as safety issue: No ]
increased cortical thickness and cortical density, as determined by peripheral quantitative computed tomography of the tibial metaphysis [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Estimated Enrollment:	40
Study Start Date:	March 2004
Estimated Study Completion Date:	September 2010
Estimated Primary Completion Date:	September 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Testosterone transdermally 5 g a day and somatropin subcutaneously 2 µg/kg body weight a day	Drug: Testosterone plus somatropin AndoGel 5 grams transdermally a day for two years Somatropin 2 µg/kg body weight/day for two years
2: Active Comparator AndroGel transdermally 5 g a day for two years	Drug: testosterone AndroGel transdermally 5 g a day for two years

Detailed Description:

Replacement of testosterone or growth hormone in patients who are deficient improves osteoporosis associated with these deficiencies. In some tissues, such as muscle, the effects of testosterone and growth hormone are additive, but it is not known if the effects are additive in bone as well. This study will compare the effects of testosterone alone with testosterone plus growth hormone in improving bone structure in men with total pituitary hormone deficiency.

Participants in this study will be men who have pituitary or hypothalamic disease and have deficiencies of all pituitary hormones, but who have not been treated with either testosterone or growth hormone. The men will be randomly assigned to receive either testosterone alone or testosterone plus growth hormone for two years. Testosterone in a gel form will be applied daily to the skin. Growth hormone will be self-administered by daily subcutaneous injection. Blood concentrations of both hormones will be monitored with blood tests every 3 months during the 2-year study. Doses of the hormones will be adjusted to keep blood concentrations of the hormones within the normal range. Changes in bone structure will be assessed noninvasively before treatment and after one year and two years of treatment by magnetic resonance microimaging (µMRI) and dual energy X-ray absorptiometry (DEXA).

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Male
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Documented hypothalamic or pituitary hormone deficiency
Testosterone deficiency, defined as total serum testosterone less than 250 ng/dL at two 8 AM readings
Growth hormone deficiency, defined by either of the following:
For subjects who have thyroxine and cortisol deficiencies, either a subnormal age-specific IGF-1 or a peak GH response to arginine-GHRH of less than 4.1 ng/mL
For subjects who do not have thyroxine and cortisol deficiencies, either a subnormal age-specific IGF-1 or a peak GH response to arginine-GHRH of less than 4.1 ng/mL
Duration of testosterone and growth hormone deficiencies of two years or more
Replacement of cortisol and/or thyroxine deficiencies
Able to give informed consent

Exclusion Criteria:

Current testosterone treatment or treatment during the two years prior to study entry
Current growth hormone treatment or treatment during the three years prior to study entry
Use of other prescription or over-the-counter androgens (androstenedione, DHEA), estrogens, or antiandrogens (spironolactone, ketoconazole)
Diseases that could influence bone, such as hyperparathyroidism
Medications that could influence bone, such as anticonvulsants or glucocorticoids (prednisone greater than 20 mg/day for longer than 2 weeks/year). Calcium and over-the-counter vitamin D supplements are allowed.
Cancer that could limit life expectancy to fewer than 5 years
Neuromuscular disease or history of stroke with residual neurological defect
Severe or uncontrolled psychiatric illness or dementia
Noncancerous enlargement of the prostate gland (American Urological Association symptom score greater than 21)
Prostate cancer by history, prostate nodule on digital rectal exam (DRE), or prostate specific antigen (PSA) greater than 4
Current alcohol or drug dependence
Heart failure (New York class III or IV)
Unstable angina
Myocardial infarction within 3 months of study entry
Liver disease (ALT greater than 3 x normal)
Renal disease (serum creatinine greater than 2.5 mg/dl)
Diabetes mellitus (glycosolated hemoglobin greater than 8.0%)
Hypertension (systolic BP greater than 160 or diastolic BP greater than 100 mm Hg)
Hematocrit greater than 48%
Weight greater than 300 pounds
Poor quality scan at baseline even when repeated
Untreated, severe, obstructive sleep apnea (Epworth sleepiness score greater than 10)
Unable to undergo an MRI because of a cardiac pacemaker or ferrometallic objects in the body

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00080483

Locations

United States, Pennsylvania
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104

Sponsors and Collaborators

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Investigators

Principal Investigator:	Peter J. Snyder, MD	University of Pennsylvania
Principal Investigator:	Laurence Kennedy, MD	University of Pennsylvania

More Information

Responsible Party:	University of Pennsylvania ( Peter J. Snyder, MD Professor of Medicine )
Study ID Numbers:	NIAMS-118, RO1 AR050618-01
Study First Received:	April 5, 2004
Last Updated:	November 17, 2008
ClinicalTrials.gov Identifier:	NCT00080483
Health Authority:	United States: Federal Government

Study placed in the following topic categories:

Dwarfism
Bone Diseases, Endocrine
Hypopituitary dwarfism
Hypothalamic Diseases
Pituitary Diseases
Gonadal Disorders
Central Nervous System Diseases
Endocrine System Diseases
Methyltestosterone
Dwarfism, Pituitary

Brain Diseases
Bone Diseases
Growth hormone deficiency
Testosterone 17 beta-cypionate
Testosterone
Hypogonadism
Hypopituitarism
Musculoskeletal Diseases
Bone Diseases, Developmental
Endocrinopathy

Additional relevant MeSH terms:

Anabolic Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Therapeutic Uses
Physiological Effects of Drugs

Nervous System Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Hormones
Pharmacologic Actions
Androgens

ClinicalTrials.gov processed this record on January 16, 2009