Use of Strontium as a Treatment Method for Osteoporosis Authors
First Online: 01 December 2010 DOI:
Cite this article as: Cortet, B. Curr Osteoporos Rep (2011) 9: 25. doi:10.1007/s11914-010-0042-z Abstract
Given its increasing incidence and serious complications, osteoporosis requires safe and effective long-term treatment. Strontium ranelate (SR), a new anti-osteoporotic treatment with a unique mode of action, has been investigated in the SOTI (Spinal Osteoporosis Therapeutic Intervention) and the TROPOS (Treatment of Peripheral Osteoporosis) trials, two major 3-year multinational placebo-controlled phase 3 randomized clinical trials. Unlike antiresorptive agents, SR produced steady and significant bone mineral density increases that correlated directly with decreases in vertebral and hip fracture risk. The safety profile of SR was almost similar to placebo in both trials. A slight but significant increased risk of thromboembolism events was noted from the pooled phase 3 studies data. However, this increased was not found in a large retrospective observational study. Thus, SR demonstrates broad spectrum safety and efficacy in reducing the risks of both vertebral and nonvertebral (including hip) fractures in a wide variety of patients, and should be considered as a first-line option to treat women at risk of osteoporotic fractures, whatever their age, the severity of the disease, and their risk factors.
Keywords Osteoporosis Vertebral fracture Nonvertebral fracture Hip fracture Strontium ranelate Antifracture efficacy References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Reginster J-Y, Burlet N. Osteoporosis: a still increasing prevalence. Bone 2006;38 (Suppl. 1):S4-S9
Cooper C, Campion G, Melton LJ 3 rd. Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 1992;2:285-9
Burge R, Dawson-Hughes B, Solomon DH et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007;22:465-75
Gullberg B, Johnell O, Kanis JA. Worldwide projections for hip fracture. Osteoporos Int 1997;7:407-13
Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton L.J. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002;50:1644-50
Canalis E, Hott M, Deloffre P, Marie PJ. The divalent strontium S129 enhances bone cell replication and bone formation in vitro. Bone 1996;18:517-23
Atkins GJ, Weldon KJ, Halbout P, Findlay DM. Strontium ranelate treatment of primary osteoblasts promotes an osteocyte-like phenotype while eliciting and osteoprotegerin response. Osteoporos Int 2009;20:653-64
Amman P, Shen V, Robin B et al. Strontium ranelate improves bone resistance by increasing bone mass and improving architecture in intact female rats. J Bone Miner Res 2004; 19: 2012-2020.
Meunier PJ, Roux C, Seeman E et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004;350:459-68
Reginster JY, Seeman E, De Vernejoul MC et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 2005;90:2816-22
• Roux C, Fechtenbaum J, Kolta S et al. Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis 2008;67:1736-8.
In this study, the authors demonstrated that SR is efficacious in terms of fracture reduction whatever the level of risk factors for fracture at baseline.
• Meunier PJ, Roux C, Ortolani S et al. Effect of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis. Osteoporos Int 2009;20:1663-73.
In this study, the authors demonstrated that efficacy of SR for preventing vertebral facture is maintained for 4 years.
•• Reginster JY, Felsenberg D, Boonen S et al. Effects of long-term strontium ranelate treatment on the risk of non-vertebral and vertebral fractures in postmenopausal osteoporosis: results of a 5-year, randomized, placebo-controlled trial. Arthritis Rheum 2008;58:1687-95.
In this study, the authors demonstrated that SR is efficacious for preventing nonvertebral and vertebral fracture for 5 years.
• Seeman E, Boonen S, Borgstrom F et al. Five years treatment with strontium ranelate reduces vertebral and nonvertebral fractures and increases the number and quality of remaining life years in women over 80 years of age. Bone 2010;46:1038-42.
In this study, the authors demonstrated that SR is efficacious for preventing both vertebral and nonvertebral fractures for women over 80 years of age.
• Reginster JY, Bruyere O, Sawicki A et al. Long-term treatment of postmenopausal osteoporosis with strontium ranelate: results at 8 years. Bone 2009;45:1059-64.
In this study, the authors demonstrated that SR increase BMD both at the lumbar and the hip for a 8-year period with no plateau effect.
Roux C. Strontium ranelate: short- and long-term benefits for post-menopausal women with osteoporosis. Rheumatology 2008;47 Suppl4:iv20-22
Li Z, Chines AA, Meredith MP. Statistical validation of surrogate endpoints: is bone density a valid surrogate for fracture? J Musculoskelet Neuronal Interact 2004;4:64-74
Delmas PD, Li Z, Cooper C. Relationship between changes in bone mineral density and fracture risk reduction with antiresorptive drugs: some issues with meta-analyses. J Bone Miner Res 2004;19:330-7
Bruyere O, Roux C, Detilleux J et al. Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrinol Metab 2007;92:3076-81
Bruyere O, Roux C, Badurski J et al. Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate. Curr Med Res Opin 2007;12:3041-5
Delmas PD, Seeman E. Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with antiresorptive therapy. Bone 2004;34:599-604
Roux C, Reginster JY, Fechtenbaum J et al. Vertebral fracture risk reduction with strontium ranelate in women with postmenopausal osteoporosis is independent of baseline risk factors. J Bone Miner Res 2006;21:536-42
Siris ES, Chen YT, Abbott TA et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004;164:1108-12
Sanders KM, Nicholson GC, Watts JJ et al. Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost effective? Bone 2006;38:694-700
Kanis JA, Johnell O, Black DM et al. Effects of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the multiple outcomes of raloxifene evaluation trial. Bone 2008;33:293-300
Quandt SA, Thompson DE, Schneider DL, Nevitt MC, Black DM. Fracture intervention trial research group. Effect of alendronate on vertebral fracture risk in women with bone numeral density T scores of -1,6 to -2,5 at the femoral neck: the fracture intervention trial. Mayo Clin Proc 2005;80:343-9
Heaney RP, Zizic TM, Fogelman I. Risedronate reduces the risk of first vertebral fracture in osteoporotic women. Oseoporosis Int 2002;13:501-5
• Seeman E, Devogelaer JP, Lorenc R et al. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopaenia. J Bone Miner Res 2008;23:433-8.
In this study, the authors demonstrated that SR is efficacious for preventing vertebral fractures for women with osteopenia (and not osteoporosis) at baseline.
Cauley JA, Robbins J, Chen Z et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 2003;290:1729-38
Kanis JA, Barton IP, Johnell O. Risedronate decreases fracture risk in patients selected sofety on the basis of prior vertebral fracture. Osteoporos Int 2005;16:475-82
Newitt MC, Ettinger B, Black DM et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 1998;128:793-800
Boonen S. Addressing and meeting the needs of osteoporotic patients with strontium ranelate: a review. Curr Opin Rheumatol 2006;18 Suppl 1:S21-S27.
• Breart G, Cooper C, Meyer O et al. Osteoporosis and venous thromboembolism: a retrospective cohort study in the UK General Practice Research Database. Osteoporos Int 2009;20:1-7.
In this study, the authors demonstrated by using the UK General Practice Research Database that thromboembolism risk is not increased for patients treated by SR compared with patients treated by alendronate or osteoporotic patients not receiving treatment for osteoporosis.
• Kanis JA, Burlet N, Cooper C et al. European Society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int 2008;19:399-428.
On this position paper on behalf of the ESCEO, the authors indicate that SR is efficacious for preventing both vertebral and nonvertebral fractures for women with osteoporosis but also established osteoporosis.
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