Effect of Acetylcholinesterase Inhibitors on Bone Metabolism

• Status: Not yet recruiting
• Trial end date: 2025-06-01
• Target enrollment: 0
• Participant gender: All

Summary

People with Alzheimer's disease are at an increased risk of bone fracture. Some studies have shown that those taking donepezil have a lower rate of bone fractures, but the reasons for this are unknown. The purpose of this study is to measure the effect of donepezil treatment on bone metabolism factors including bone mineral density, bone turnover markers, and bone quality.

Participants in this study will have a bone density test and have blood samples collected at the baseline study visit. Participants will then be randomly assigned to donepezil or matching placebo to be taken daily by mouth for 12 months. Blood samples will be collected at 6 and 12 months. A repeat bone density test will be performed at 12 months. Participants will also complete questionnaires at each study visit.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Duke University
• Collaborator: National Institute on Aging (NIA)
• Treatments: Donepezil

Criteria

Inclusion Criteria:

1. Diagnosis of ADRD, including clinical assessment and either radiographic or laboratory biomarker assessment

2. Meets NIA-AA clinical dementia criteria

3. Willing to initiate treatment with AchEI for ADRD

4. MoCA score < 24

5. For females, either age > 55 years, or Age < 55 years and at least 12 months since last menstrual period

6. For males, age > 50 years

7. Geriatric Depression Scale score < 6

Exclusion Criteria:

1. Currently on acetylcholinesterase inhibitor

2. Currently on osteoporosis medication (e.g., bisphosphonate, SERM, denosumab, teripar-atide, abaloparatide, romozosumab)

3. Use of bisphosphonate within last 2 years

4. Use within last 6 months of estrogens or testosterone, androgen deprivation therapy or aromatase inhibitors, antiepileptic, heparin therapy, thiazolidinediones

5. History of disorders associated with osteoporosis: collagen vascular diseases, malab-sorption, inflammatory bowel disease, severe liver disease/cirrhosis, hyperthyroidism (endogenous or exogenous)

6. History of hip fracture, hip replacement, or non-ambulatory

7. Long-term use (>6 months) of corticosteroids

8. History of Parkinson's, HIV, Huntington's disease

9. History of solid organ transplantation

10. Severe kidney impairment (eGFR < 30 ml/sec),

11. Active malignancy, except non-melanomatous skin cancer

12. 1-year mortality > 25%, measured by ePrognosis calculator

13. Initiation of investigational or FDA-approved anti-amyloid drug