TOP: Recombinant Human Parathyroid Hormone (ALX1-11) on Fracture Incidence in Women With Postmenopausal Osteoporosis

A. Vertebral Deformity:

Patient has 5 or more vertebral (thoracic and lumbar) deformities

Patient has 2 or more lumbar vertebral deformities (L1 to L4)

Severe lumbar scoliosis (\>15 degrees) which precludes a reliable evaluation of the dual x-ray absorptiometry (DXA)

B. DXA Imaging:

Inability to have a DXA scan performed.

C. History or Concurrent Illness:

Disorders of immunity

Endocrine system

Gastrointestinal system

Kidney and collecting system

Liver, biliary tract and pancreatic systems

Musculoskeletal system

Neoplasia

Nervous system

Vascular, respiratory and cardiac system

Significant diseases or disorders are determined by history, physical exam or laboratory screens and judged by the Principal Investigator to be significant.

D. Concurrent Medication:

Any patient who does not require medication washout (discontinuation) as specified below may start study drug dosing after 2 weeks of stabilization treatment with calcium and vitamin D3 supplements. All exceptions will be documented in the case report form (CRF).

Patients cannot be enrolled into this clinical trial if they have received any of the following therapies at any time:

* Any PTH or PTH analogs \[e.g., rhPTH(1-84), PTH(1-34), PTHrP and analogs\]

* Fluoride

* Strontium

Patients must have been off the following agents for the specified times before entering the screening phase of this clinical trial:

* Any investigational drug (30 days)

* Anabolic steroids or androgens (6 consecutive months)

* Active vitamin D3 metabolites and analogs(90 days)

* Systemic corticosteroids, more than 5 mg/day prednisone or a systemic corticosteroid formulation equivalent to 5 mg/day prednisone (12 consecutive months).

* A patient who has been enrolled in the study and needs to receive an acute bolus of steroids (oral or injectable) for a self-limited illness may continue treatment in the study if the following requirements are met:

1. Exposure to steroids is limited to no more than 30 consecutive days

2. The maximal dose of steroid (prednisone equivalent) is limited to no more than 225 mg (7.5 mg each day for 30 days)

3. The illness is acute in nature and is not expected to recur during the remaining treatment period of the study

* Daily inhaled corticosteroids unless dose is below 1200 mg/day of beclomethasone.

* Bisphosphonates, including investigational bisphosphonates.

* Intravenous (IV) pamidronate. Patient must be receiving pamidronate specifically to treat osteoporosis. Patient can have received only ONE IV dose of pamidronate in the 12 months immediately preceding the screening visit.

* Cyclical etidronate. Exposure to cyclical etidronate must be less than or equal to 6 months on a standard dose (e.g. 400 mg/day). Patient should not have exposure to cyclical etidronate for 9 months prior to the screening visit.

* Phenytoin for seizure control. If the patient has received phenytoin within five years of the screening visit, the patient is excluded from this study. The patient may continue in the screening process if 15 years have passed since the last dose of phenytoin at the time of the screening visit. If the phenytoin use was between 5-15 years before the screening visit and the patient received phenytoin for less than 2 months.

Patients may be enrolled if they have been stabilized on the following therapy for the specified amount of time:

\* Thyroid hormone (\<0.1 mg/day thyroxine) therapy for at least 6 months. \* Stable dosage of thiazide for at least 3 consecutive months.

All patients must stop the following therapies at least 4 weeks prior to the screening visit and remain off these therapies for the remainder of the clinical trial. Screening laboratories must be performed after the washout is complete. However, imaging studies (BMD, X-rays) may be performed prior to starting the calcitonin, estrogen, and selective estrogen receptor modulation (SERM) washout.

* Calcitonin

* Estrogen replacement therapy by oral, transdermal or intramuscular administration

* SERM drugs, e.g., tamoxifen, raloxifene, Evista

* Vaginal application of estrogen-containing creams unless the dose is conjugated estrogen or estradiol\* Cytostatics, e.g., azathioprine, recombinant human tumor necrosis fusion (Fc) protein, monoclonal antibody against tumor necrosis factor (e.g., remicade \[infliximab\])

* The drug class tetracyclines

* Medication known to affect the metabolism of bone (the Principal Investigator should discuss this with the Project Medical Officer before the patient is excluded from enrollment)

E. Miscellaneous Concurrent Medications:

Methotrexate

Intra-articular injections - Patients with chronic, active joint disease should be excluded from this Phase III study. Patients may receive a maximum of one intra-articular injection (ONE JOINT ONLY) every 6 months while participating in this Phase III study. The dose of corticosteroid injected should not exceed the anti-inflammatory equivalent dose of prednisone 40 mg suspension. The dose and volume should be adjusted downward as appropriate to the size of the joint.

Provera is an acceptable concomitant medication when used according to the label instructions.

F. Laboratory Values and Physical Examination Findings:

Serum calcium greater than 10.7 mg/dL (2.66 mmol/L). At screening, if the serum calcium is abnormal, the patient may have the additional evaluation described below ONCE:

1. Discontinue all oral calcium and vitamin D3 supplements.

2. Repeat a fasting serum calcium level two weeks later.

3. If the fasting serum calcium level is still abnormal, the patient is discontinued from the study.

4. If the repeat fasting serum calcium is normal, the patient should have supplemental calcium and vitamin D3 restarted at the time of study drug dosing, without going through a two-week stabilization period.

Serum creatinine \> 1.5 mg/dL (132.6 mmol/L)

Urinary calcium to creatinine ratio is greater than or equal to 1. At screening, if a patient's urinary calcium to creatinine ratio is abnormal, the patient may have the additional evaluation described below ONCE:

1. Discontinue all oral calcium and vitamin D3 supplements.

2. Repeat a fasting urine calcium to creatinine ratio two weeks later.

3. If the fasting urinary calcium to creatinine ratio is still abnormal, the patient is discontinued from the study.

4. If the repeat fasting urinary calcium to creatinine ratio is normal, the patient should have supplemental calcium and vitamin D3 restarted at the time of study drug dosing, without going through a two-week stabilization period.

Total serum alkaline phosphatase \>130 U/L except as noted - Argentina (311 U/L); Brazil (278 U/L); Mexico (159 U/L).

Any other clinically significant abnormal value as judged by the investigator

Body weight below 40 kg

G. Substance Abuse:

Alcohol and/or drug abuse

H. Psychiatric Disease:

Current or history of psychiatric disease that would interfere with the ability to comply with the clinical trial protocol

I. Compliance:

Suspected or confirmed poor compliance in completing clinical trial evaluations and/or clinical trial required questionnaires

What this study is about