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Trial · Interventional

TerminatedPhase 2Results postedRegistry data

A Phase II Study Evaluating SB-751689 in Post-Menopausal Women With Osteoporosis.

Overview

Status
Terminated
Phase
Phase 2
Enrollment
564 participants (actual)
Sponsor
GlaxoSmithKline · Industry
Design
Randomized · Triple masking
Countries
14 countries

United States, Argentina, Australia, Belgium, Denmark, Germany, Hong Kong, Mexico, Norway, Poland, Russia, South Africa, South Korea, Spain

Start
14 May 2007
Primary completion
26 Dec 2008
Completion
26 Dec 2008
First posted
9 May 2007 (estimated)
Last update posted
7 Nov 2017
Conditions
Osteoporosis

Timeline

1 trial · 1 stopped early · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
200720082009
  1. Ph 2

    A Phase II Study Evaluating SB-751689 in Post-Menopausal Women With Osteoporosis.

    NCT00471237

    14 May 2007 to 26 Dec 2008

    Terminated

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This is a 12 month study designed to evaluate the safety and effectiveness of SB-751689 in the treatment of osteoporosis in post-menopausal women, in comparison with 2 active comparators and placebo.

Interventions

  • RonacaleretDrug
  • TeriparatideDrug
  • AlendronateDrug

Arms4

  • No intervention

    Placebo

    All subjects will take calcium (500-660mg elemental daily) and vitamin D (at least 400IU daily) supplements once daily in the evening throughout the study

  • Active comparator

    Alendronate

    All subjects will take calcium (500-660mg elemental daily) and vitamin D (at least 400IU daily) supplements once daily in the evening throughout the study

  • Active comparator

    Teriparatide

    Open-label arm. All subjects will take calcium (500-660mg elemental daily) and vitamin D (at least 400IU daily) supplements once daily in the evening throughout the study

  • Experimental

    Ronacaleret

    4 arms, 100mg, 200mg, 300mg, 400mg. All subjects will take calcium (500-660mg elemental daily) and vitamin D (at least 400IU daily) supplements once daily in the evening throughout the study.

Primary outcomes8

Outcomes the sponsor listed as primary.

  1. Percent Change From Baseline in Bone Marrow Density (BMD) at Month 12 Measured by Dual-Energy X-Ray Absorptiometry (DXA) Scans of the Lumbar Spine (L1-L4)

    Time frame · Baseline (Day 0) and 12 Months

    Registry description

    DXA scanners from Hologic and GE Lunar was used to measure BMD by a DXA scan. At least two vertebrae (L1-L4) that were suitable for measurement of BMD were evaluated. The same scanner was used throughout the study for all measurements for a given participant. DXA scans were sent to a central reading facility for quality control and central analysis. Assessments performed on Day 0 were considered as Baseline. Percent change from Baseline was computed as (change from baseline / baseline value) \* 100%. Percent change from Baseline in areal bone mineral density (aBMD) was reported.

  2. Number of Participants With Hypercalcemia

    Time frame · Up to Month 12

    Registry description

    Participants with albumin-adjusted serum calcium pre-dose values of \>11.0 mg/ deciliter (dL) or post-dose values of \>12.0 mg/dL were recorded as participants with hypercalcemia. Number of participant with hypercalcemia were reported.

  3. Number of Participants Withdrew Due to Hypercalcemia

    Time frame · Up to Month 12

    Registry description

    A confirmed albumin-adjusted serum calcium pre-dose value of \>11.0 mg/dL or post-dose value of \>12.0 mg/dL was set as a withdrawal criteria for the study. Number of participants who met this pre-defined stopping criteria were reported.

  4. Number of Participant With Laboratory Abnormalities of Potential Clinical Concern at Any Post-baseline Visit

    Time frame · Up to Month 12

    Registry description

    The hematology parameters analyzed were white blood cells (WBC) count with differential WBC count, red blood cells, haemoglobin, haematocrit, mean corpuscular volume and platelet count. The clinical chemistry parameters analyzed were sodium, potassium, calcium, calcium (albumin adjusted), phosphate, bicarbonate, creatinine, bilirubin (total), alanine amino transferase, aspartate amino transferase, glucose, albumin, alkaline phosphatase, creatine phosphokinase, urea, uric acid, total protein, 25-OH vitamin D, 1,25-2(OH) vitamin D, whole parathyroid hormone (PTH 1-84)) and intact PTH (1-84 and 7-84). Only those parameters for which at least one value of potential clinical importance was reported are summarized. The number of participants with potential clinical important laboratory findings at any visit were reported.

  5. Number of Participant With Vital Signs of Potential Clinical Concern at Any Post-baseline Visit

    Time frame · Up to 12 Months

    Registry description

    The potential clinical importance ranges (low and high) of the vital sign parameters-systolic blood pressure (\> 30 millimeter of mercury \[mmHg\] decrease from Baseline, \> 30 mmHg increase from Baseline), diastolic blood pressure (\> 20 mmHg decrease from Baseline and \> 20 mmHg increase from Baseline) and heart rate (\<45 and \>120 beats per minute). Only those parameters for which at least one value of potential clinical importance was reported are summarized. The number of participants with potential clinical important vital parameter findings at any visit were reported.

  6. Number of Participant With Electrocardiogram (ECG) Findings Reported as Adverse Event

    Time frame · Up to 12 months

    Registry description

    Full 12-lead ECGs pre-dose at screening and visits 6, 8, 11, 12 and 14 were recorded. Participants rested supine or seated for at least 10 minutes before each reading. All ECGs were transmitted to a central reviewer for blinded assessment. The central reviewer measured the following parameters and provide a clinical interpretation: heart rate, RR interval, PR interval, QRS interval, QT (uncorrected) interval, QTcB (Bazett's correction) interval, QTcF (Fridericia's correction) interval. The central reviewer was provided the investigator or designated qualified site physician with a central ECG report or confirmatory report to assist them in identifying any clinically significant abnormalities that would preclude the participant from further participation in the study.

  7. Mean Change From Baseline in Height

    Time frame · Baseline (Day 0), Month 6, 12 and early withdrawal

    Registry description

    Assessments performed on Day 0 were considered as Baseline. Change from Baseline was computed as values at post baseline visit minus Baseline value. Mean change from baseline in height at Month 6 and 12 and early withdrawal were reported.

  8. Mean Change From Baseline in Weight

    Time frame · Baseline (Day 0), Month 6, 12 and early withdrawal

    Registry description

    Baseline values were assessed on Day 0. Change from Baseline was computed as values at post baseline visit minus Baseline value. Mean change from baseline in weight at Month 6, 12 and early withdrawal were reported.

Secondary outcomes(14)
  1. Percent Change From Baseline to Month 6 in BMD Measured by DXA Scans of the Lumbar Spine (L1-L4)

    Time frame · Baseline (Day 0) and Month 6

    Registry description

    DXA scanners from Hologic and GE Lunar was used to measure BMD by a DXA scan. At least two vertebrae (L1-L4) that were suitable for measurement of BMD were evaluated. The same scanner was used throughout the study for all measurements for a given participant. DXA scans were sent to a central reading facility for quality control and central analysis. Baseline values were assessed on Day 0. Percent Change from Baseline was computed as (change from baseline / baseline value) \* 100%. Percent change from baseline to month 6 in aBMD was reported.

  2. Percent Change From Baseline to Months 6 and 12 in BMD Measured by DXA Scans of the Hip (Total Hip, Femoral Neck and Trochanter).

    Time frame · Baseline (Day 0), Month 6 and Month 12

    Registry description

    DXA scanners from Hologic and GE Lunar was used to measure BMD by a DXA scan. At least two vertebrae (L1-L4) that were suitable for measurement of BMD were evaluated. The same scanner was used throughout the study for all measurements for a given participant. DXA scans were sent to a central reading facility for quality control and central analysis. Baseline values were assessed on Day 0. Percent Change from Baseline was computed as (change from baseline / baseline value) \* 100%. Percent change from baseline to month 6 and 12 in aBMD of hip (total hip, femoral neck and trochanter) were reported.

  3. Number of Participants Who Remained the Same or Had Any Improvement in DXA BMD (> Baseline)

    Time frame · Baseline (Day 0), Month 5, 6 and 12

    Registry description

    Responder rate of participants who remained the same or had any improvement as compared to baseline in DXA BMD of vertebra, femur and vertebra plus femur were reported. Baseline values were assessed on Day 0. Percent change (improvement) from Baseline was computed as (change from baseline / baseline value) \* 100%.

  4. Percent Change From Baseline to Month 12 in the Volumetric Integral, Cortical, and Trabecular Density (BMD) at the Hip and Lumbar Spine as Measured by Quantitative Computer Tomography (QCT) Scans

    Time frame · Baseline (Day 0) and Month 12

    Registry description

    QCT is a three-dimensional non-projectional technique to quantify BMD with a number of advantages to other densitometric techniques. Cortical and trabecular bone can be separated, trabecular volume of interest (VOI) are largely independent of degenerative changes in the spine and 3 dimensional geometric parameters can be determined. BMD as measured by QCT is a true density measured in g/cm\^3 in contrast to DXA Which determines an areal density measured in g/cm\^2. Baseline values were assessed on Day 0. Percent change from Baseline was computed as (change from baseline / baseline value) \* 100%. Percent change from Baseline to month 12 in the volumetric integral, cortical, and trabecular density (BMD) at the hip and lumbar spine measured by QCT were reported.

  5. Percent Change From Baseline to Month 12 in the Total Vertebra Integral VOI at the Lumbar Spine as Measured by QCT Scans

    Time frame · Baseline (Day 0) and Month 12

    Registry description

    QCT is a three-dimensional non-projectional technique to quantify BMD with a number of advantages to other densitometric techniques. Cortical and trabecular bone can be separated, trabecular VOI are largely independent of degenerative changes in the spine and 3 dimensional geometric parameters can be determined. BMD as measured by QCT is a true density measured in g/cm\^3 in contrast to DXA Which determines an areal density measured in g/cm\^2. Baseline values were assessed on Day 0. Percent change from Baseline was computed as (change from baseline / baseline value) \* 100%.

  6. Percent Change From Baseline to Month 12 in the Volumetric Integral, Cortical, and Trabecular Density (BMD) at the Hip as Measured by QCT Scans

    Time frame · Baseline (Day 0) and Month 12

    Registry description

    QCT is a three-dimensional non-projectional technique to quantify BMD with a number of advantages to other densitometric techniques. Cortical and trabecular bone can be separated, trabecular VOI are largely independent of degenerative changes in the spine and 3 dimensional geometric parameters can be determined. BMD as measured by QCT is a true density measured in mg/cm\^3 in contrast to DXA Which determines an areal density measured in g/cm\^2. Baseline values were assessed on Day 0. Percent change from Baseline was computed as (change from baseline / baseline value) \* 100%.

  7. Percent Change From Baseline to Month 12 in Cortical Thickness at the Hip as Measured by QCT Scans

    Time frame · Baseline (Day 0) and Month 12

    Registry description

    Percent change in thickness of femur neck cortical VOI thickness and trochanter cortical VOI thickness were at Month 12 measured by QCT were reported. Assessments performed on Day 0 were considered as Baseline. Percent change from Baseline was computed as (change from baseline / baseline value) \* 100%.

  8. Biochemical Markers of Bone Turnover: Levels of C-terminal Telopeptide α1 Chain of Type 1 Collagen (CTX1)

    Time frame · Baseline (Day 0), Week 4, Month 3, 6, and 12

    Registry description

    Blood samples were collected at Baseline (Day 0), Week 4, Month 3, 6, and 12 for measurement of CTX1.

  9. Biochemical Markers of Bone Turnover: Procollagen Type 1 N-terminal Propeptide (P1NP)

    Time frame · Baseline (Day 0), Week 4, Month 3, 6, and 12

    Registry description

    Blood samples were collected at Baseline (Day 0), Week 4, Month 3, 6, and 12 for measurement of P1NP.

  10. Biochemical Markers of Bone Turnover: Bone Specific Alkaline Phosphatase (BALP)

    Time frame · Baseline (Day 0), Week 4, Month 3, 6, and 12

    Registry description

    Blood samples were collected at Baseline (Day 0), Week 4, Month 3, 6, and 12 for measurement of BALP.

  11. Blood Concentrations of Ronacaleret

    Time frame · Pre-dose (0.0 hour [h]) and 12 h post dose at Week 4, 20, 40 min, 1, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 1-4, 8-12, and 24 h at Month 3, 6 and 12

    Registry description

    Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive PK-PD subgroup of participants were analyzed by standard noncompartmental methods. Blood concentrations of ronacaleret were reported.

  12. Area Under the Concentration-time Curve Over the Dosing Interval (AUC 0-t) and Area Under the Concentration-time Curve Over the Dosing Interval (AUC 0-tau) of Ronacaleret

    Time frame · Pre-dose (0.0 h) and 12 h post dose at Week 4, 20, 40 min, 1, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 1-4, 8-12, and 24 h at Month 3, 6 and 12

    Registry description

    Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive pharmacokinetic and pharmacodynamics subgroup of participants were analyzed by standard noncompartmental methods. Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive PK-PD subgroup of participants were analyzed by standard noncompartmental methods. Following log transformation, AUC(0-t) and AUC(0-τ) of ronacaleret were separately analyzed by ANOVA using mixed effects model, fitting treatment and country/region as fixed effects.

  13. Maximum Blood Concentration (Cmax) of Ronacaleret

    Time frame · Pre-dose (0.0 h) and 12 h post dose at Week 4, 20, 40 min, 1, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 1-4, 8-12, and 24 h at Month 3, 6 and 12

    Registry description

    Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive pharmacokinetic and pharmacodynamics subgroup of participants were analyzed by standard noncompartmental methods. Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive PK-PD subgroup of participants were analyzed by standard noncompartmental methods. Following log transformation, Cmax of ronacaleret were separately analyzed by ANOVA using mixed effects model, fitting treatment and country/region as fixed effects.

  14. Time Required to Achieve Maximum Concentration of Ronacaleret in Blood (Tmax)

    Time frame · Pre-dose (0.0 h) and 12 h post dose at Week 4, 20, 40 min, 1, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 1-4, 8-12, and 24 h at Month 3, 6 and 12

    Registry description

    Blood samples were collected and analyzed for concentrations of ronacaleret. The individual blood concentration-time data from the intensive pharmacokinetic and pharmacodynamics subgroup of participants were analyzed by standard noncompartmental methods.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· Baseline (Day 0) and 12 Months

Percent Change From Baseline in Bone Marrow Density (BMD) at Month 12 Measured by Dual-Energy X-Ray Absorptiometry (DXA) Scans of the Lumbar Spine (L1-L4)

GroupValue (Percent change in BMD)Spread
Placebo0.030.38
Ronacaleret, 100 mg Tablet, OD0.320.40
Ronacaleret, 200 mg Tablet, OD1.390.40
Ronacaleret, 300 mg Tablet, OD1.610.39
Ronacaleret, 400 mg Tablet, OD1.620.40
Alendronate, 70 mg, Capsule, OW4.540.40
Primary outcomeCount of participants· Up to Month 12

Number of Participants With Hypercalcemia

GroupValue (Participants)
Placebo0
Ronacaleret, 100 mg Tablet, OD1
Ronacaleret, 200 mg Tablet, OD1
Ronacaleret, 300 mg Tablet, OD4
Ronacaleret, 400 mg Tablet, OD11
Alendronate, 70 mg, Capsule, OW0
Teriparatide, 20 mcg, SC Injection, OD1
Primary outcomeCount of participants· Up to Month 12

Number of Participants Withdrew Due to Hypercalcemia

GroupValue (Participants)
Placebo0
Ronacaleret, 100 mg Tablet, OD0
Ronacaleret, 200 mg Tablet, OD0
Ronacaleret, 300 mg Tablet, OD0
Ronacaleret, 400 mg Tablet, OD0
Alendronate, 70 mg, Capsule, OW0
Teriparatide, 20 mcg, SC Injection, OD0
Primary outcomeCount of participants· Up to Month 12

Number of Participant With Laboratory Abnormalities of Potential Clinical Concern at Any Post-baseline Visit

GroupValue (Participants)
Placebo17
Ronacaleret, 100 mg Tablet, OD14
Ronacaleret, 200 mg Tablet, OD19
Ronacaleret, 300 mg Tablet, OD17
Ronacaleret, 400 mg Tablet, OD18
Alendronate, 70 mg, Capsule, OW28
Teriparatide, 20 mcg, SC Injection, OD6
Primary outcomeCount of participants· Up to 12 Months

Number of Participant With Vital Signs of Potential Clinical Concern at Any Post-baseline Visit

GroupValue (Participants)
Placebo5
Ronacaleret, 100 mg Tablet, OD10
Ronacaleret, 200 mg Tablet, OD8
Ronacaleret, 300 mg Tablet, OD9
Ronacaleret, 400 mg Tablet, OD11
Alendronate, 70 mg, Capsule, OW8
Teriparatide, 20 mcg, SC Injection, OD1
Primary outcomeCount of participants· Up to 12 months

Number of Participant With Electrocardiogram (ECG) Findings Reported as Adverse Event

GroupValue (Participants)
Placebo1
Ronacaleret, 100 mg Tablet, OD5
Ronacaleret, 200 mg Tablet, OD4
Ronacaleret, 300 mg Tablet, OD3
Ronacaleret, 400 mg Tablet, OD3
Alendronate, 70 mg, Capsule, OW5
Teriparatide, 20 mcg, SC Injection, OD0
Primary outcomeMean· Baseline (Day 0), Month 6, 12 and early withdrawal

Mean Change From Baseline in Height

GroupValue (Centimeter)Spread
Placebo-0.040.58
Ronacaleret, 100 mg Tablet, OD0.171.41
Ronacaleret, 200 mg Tablet, OD0.723.82
Ronacaleret, 300 mg Tablet, OD0.050.70
Ronacaleret, 400 mg Tablet, OD-0.040.82
Alendronate, 70 mg, Capsule, OW-0.071.13
Teriparatide, 20 mcg, SC Injection, OD0.110.65
Primary outcomeMean· Baseline (Day 0), Month 6, 12 and early withdrawal

Mean Change From Baseline in Weight

GroupValue (Kilogram)Spread
Placebo-0.022.12
Ronacaleret, 100 mg Tablet, OD0.273.27
Ronacaleret, 200 mg Tablet, OD0.452.98
Ronacaleret, 300 mg Tablet, OD-0.242.87
Ronacaleret, 400 mg Tablet, OD0.112.84
Alendronate, 70 mg, Capsule, OW0.291.89
Teriparatide, 20 mcg, SC Injection, OD0.511.84

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
PlaceboParticipants received matching placebo OD (matching to ronacaleret tablet) and matching placebo OW (matching to Alendronate capsule) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 900 / 9054 / 90
Ronacaleret, 100 mg Tablet, ODParticipants received ronacaleret, 100 mg tablet, OD and matching placebo, OW (matching to Alendronate capsule) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 872 / 8754 / 87
Ronacaleret, 200 mg Tablet, ODParticipants received ronacaleret, 200 mg tablet, OD and matching placebo, OW (matching to Alendronate capsule) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 825 / 8257 / 82
Ronacaleret, 300 mg Tablet, ODParticipants received ronacaleret, 300 mg tablet, OD and matching placebo, OW (matching to Alendronate capsule) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 887 / 8855 / 88
Ronacaleret, 400 mg Tablet, ODParticipants received Ronacaleret, 400 mg tablet, OD and matching placebo, OW (matching to Alendronate capsule) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 873 / 8761 / 87
Alendronate, 70 mg, Capsule, OWParticipants received Alendronate, 70 mg, capsule, OW and matching placebo OD (matching to ronacaleret tablet) for 12 months. Participants were supplied with elemental calcium 500-660 mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 896 / 8946 / 89
Teriparatide, 20 mcg, SC Injection, ODParticipants received Teriparatide, 20 mcg, SC injection, OD for 12 months. Participants were supplied with elemental calcium 500-660mg and vitamin D, at least 400 IU, OD in the evening as dietary supplements throughout the study.0 / 414 / 4130 / 41

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies0

Studies that cite this trial.

No study cites this trial.

Other registry references

References listed at the registry that are not in PepBank. They link to PubMed.

  • DerivedFitzpatrick LA, Dabrowski CE, Cicconetti G, Gordon DN, Papapoulos S, Bone HG 3rd, Bilezikian JP. The effects of ronacaleret, a calcium-sensing receptor antagonist, on bone mineral density and biochemical markers of bone turnover in postmenopausal women with low bone mineral density. J Clin Endocrinol Metab. 2011 Aug;96(8):2441-9. doi: 10.1210/jc.2010-2855. Epub 2011 May 18. PMID 21593114

Eligibility

Who could join, as posted.

Sex
Female
Age
from 18 Years up to 79 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion: * Informed consent: Subject is willing and able to provide written informed consent. * Menopausal status: Ambulatory female aged \< 80 years at screening and \>5 years postmenopausal. * T-Score: A subject with either no or only one prevalent vertebral fracture is eligible for inclusion if she satisfies one of the following T-score requirements: If no prevalent vertebral fracture subject must have an absolute BMD value consistent with a T-score of less than or equal to -2.5 and greater than -4.0 at either the femoral neck, total hip, trochanter, or lumbar spine, or If one prevalent vertebral fracture subject must have an absolute BMD value consistent with a T-score of less than or equal to -2.0 and greater than -4.0 at either the femoral neck, total hip, trochanter, or lumbar spine. * Suitable vertebra: Two or more vertebra in the range of L1 to L4 that are suitable for BMD measurement by DXA. * Protocol compliance: Subject who, in the opinion of the investigator, is willing and able to comply with the requirements of the protocol. Exclusion: * T-Score: Has an absolute BMD value consistent with a T-score less than or equal to -4.0 at either the femoral neck, total hip, trochanter, or lumbar spine. * Vertebral fractures: Has \>1 prevalent vertebral fracture at the screening visit. * Non-vertebral fractures: Any previous non-vertebral osteoporosis related/fragility fracture after age 40. * Spine deformity: Significant spine deformity which would preclude DXA/QCT assessments. * BMI: BMI ≥33kg/m2. * Bone metabolic diseases: Other than osteoporosis, history or concurrent diseases affecting bone metabolism (e.g., osteomalacia, hyperparathyroidism, hyperthyroidism). * GI disease: History of major upper gastrointestinal disease * Malabsorption: Active or history of malabsorption (e.g., history of celiac disease, irritable bowel syndrome or inflammatory bowel disease). * Liver disease: Past or current history of liver disease or known hepatic or biliary abnormalities, (with the exception of previously documented diagnosis of Gilbert's syndrome). * Rheumatoid arthritis: Active disease or history of rheumatoid arthritis. * Nephrolithiasis: History of or active nephrolithiasis (kidney stones). * Osteosarcoma risk: Subjects at increased risk of osteosarcoma such as those with Paget's disease of bone or any prior external beam or implant radiation therapy involving the skeleton. * Malignancy: Malignant disease diagnosed within the previous 5 years (except resected basal cell cancer). * Biological abnormalities: Any clinically relevant biological abnormality found and/or volunteered at screening (other than those related to the disease under investigation) which, in the opinion of the investigator, is clinically significant and would preclude safe participation in this study. * Surgical and medical conditions: Presence of the following conditions within six months prior to screening: myocardial infarction, coronary bypass surgery, coronary artery angioplasty, unstable angina, cardiac arrhythmia, clinically evident congestive heart failure, or cerebrovascular accident. * Glomerular filtration rate: Glomerular filtration rate (GFR) \<35 mL/min as calculated by the Modification of Diet in Renal Disease (MDRD) equation as follows: GFR (mL/min/1.73 m2) = 186 x (Serum creatinine mg/dL)-1.154 x (Age)-0.203 x (0.742 if female) x (1.210 if African American) (conventional units). * QT/QTc prolongation: A marked baseline prolongation of QT/QTc interval (e.g., QTc interval ≥450 msec on the Screening ECG). * Torsades de Pointes: A history of risk factors for Torsades de Pointes (e.g., heart failure, hypokalemia, family history of Long QT Syndrome). * Liver chemistries: Liver chemistries \[aspartate aminotransferase (AST), alanine aminotransferase (ALT) or total bilirubin\] exceeding 2-fold the upper limit of the laboratory-specified reference range, at screening. * Abnormal serum calcium: Serum calcium (total or albumin-adjusted) outside the central laboratory reference range at the screening visit. * Abnormal PTH: PTH (intact or whole) outside the normal range. * Abnormal creatine phosphokinase: Creatine phosphokinase (CPK) outside the normal range. * Abnormal alkaline phosphatase: Alkaline phosphatase outside of the normal range. * Thyroid hormone replacement: Subjects receiving thyroid hormone replacement therapy must have a TSH level checked. Subjects will be excluded if TSH levels are \<0.1 or \>10.0mIU/L. However, subjects will not be excluded if TSH is in the range 0.1-4.5 mIU/L. If TSH is \>4.5 and ≤10.0mIU/mL, measure T4 and exclude the subject only if the T4 is outside the normal range. * Vitamin D deficiency: Vitamin D deficiency (serum 25-hydroxy vitamin D \< 20ng/mL, equivalent to 50nmol/L) at screening. Subjects can undergo vitamin D repletion as per local practice and be re-screened once only for vitamin D levels within the 6-week screening period. They will remain excluded if the re-screened value is \< 20ng/mL. * Previous strontium or IV bisphosphonate: Any previous treatment with strontium ranelate or intravenous bisphosphonate. * Oral bisphosphonates: Any previous treatment with an oral bisphosphonate as follows: any treatment within the last six months * one month cumulative treatment within the last 12 months * three months cumulative treatment within the past two years, or * two years cumulative treatment within the past five years. * Fluoride: Treatment with fluoride (dose greater than 10mg/day) within the previous 5 years for osteoporosis. * Digoxin: Current therapy with digoxin. * Bone metabolism drugs: Treatment with other drugs affecting bone metabolism within the last six months prior to screening: Chronic systemic corticosteroid \[e.g., glucocorticoid, mineralocorticoid\] treatment of no more than 2 intra-articular injections within the past year or use of oral, parenteral, or long-term, high-dose inhaled corticosteroids. Treatment with any topical corticosteroid will not exclude the subject from participating. Hormones \[e.g., estrogens/"natural estrogen preparations"(except for nonsystemic vaginal treatment), 19-norprogestins, SERMs such as raloxifene, anabolic steroids/androgens such as dehydroepiandrosterone (DHEA) or its sulfated form (DHEAS), nandrolone, tibolone, active vitamin D analogs/metabolites such as 1,25-dihydroxy vitamin D (calcitriol) or 1alpha-hydroxyvitamin D3 (1-alpha hydroxycholecalciferol), calcitonin\]. Calcineurin inhibitors \[e.g., cyclosporine, tacrolimus\] or methotrexate. * Previous anabolic agents: Treatment with PTH, PTH analogues or similar anabolic agent for osteoporosis within the last two years. * Contraindications: Contraindications to therapy with calcium or vitamin D. * Pregnancy: Women who are pregnant are not allowed in this study. * Interfering medications: Vitamin A in excess of 10,000 IU per day, heparin, or lithium, or anticonvulsant medications except benzodiazepines. * Investigational drug exposure: Administration of any investigational drug within 90 days preceding the first dose of the study drug. * Substance abuse: History or current evidence of drug or alcohol abuse within the previous 12 months. * Problems swallowing: Inability to swallow a tablet whole. The following exclusion criteria do not apply to subjects allocated to the open-label teriparatide group: * Calcium channel blockers: Current therapy with calcium channel blockers diltiazem and verapamil. * Oral Azole Antifungals: Current therapy with any oral azole antifungal. * Immunosuppressants: Current therapy with cyclosporine or oral tacrolimus. * Ritonavir: Current therapy with ritonavir. * Quinidine: Current therapy with quinidine. * Macrolide Antibiotics: Subjects anticipated to require chronic use of macrolide antibiotics. * Alendronate Contraindications: Contraindications to therapy with alendronate. Additional Exclusion Criteria for Subjects Recruited at QCT Sites * Hip surgery: History of hip surgery resulting in a metal implant on either the left or right side that would cause an artefact on a QCT scan. Additional Exclusion Criteria for Teriparatide Subjects * Teriparatide contraindications: Contraindications to therapy with teriparatide according to locally approved datasheet.

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