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The position of strontium ranelate in today’s management of osteoporosis

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Abstract

Osteoporosis accounts for about 3 % of total European health-care spending. The low proportion of costs for the pharmacological prevention of osteoporotic fracture means that it is highly cost saving, especially in patient with severe osteoporosis or patients who cannot take certain osteoporosis medications due to issues of contraindications or tolerability. Following recent regulatory changes, strontium ranelate is now indicated in patients with severe osteoporosis for whom treatment with other osteoporosis treatments is not possible, and without contraindications including uncontrolled hypertension, established, current or past history of ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease. We review here today’s evidence for the safety and efficacy of strontium ranelate. The efficacy of strontium ranelate in patients complying with the new prescribing information (i.e. severe osteoporosis without contraindications) has been explored in a multivariate analysis of clinical trial data, which concluded that the antifracture efficacy of strontium ranelate is maintained in patients with severe osteoporosis without contraindications and also demonstrated how the new target population mitigates risk. Strontium ranelate is therefore an important alternative in today’s management of osteoporosis, with a positive benefit-risk balance, provided that the revised indication and contraindications are followed and cardiovascular risk is monitored. The bone community should be reassured that there remain viable alternatives in patients in whom treatment with other agents is not possible and protection against the debilitating effects of fracture is still feasible in patients with severe osteoporosis.

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Conflict of interest

J.-Y. Reginster received consulting fees, paid advisory boards, lecture fees and/or grant support from Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB, Merck Sharp and Dohme, Rottapharm, IBSA, Genevrier, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Novo Nordisk and Bristol Myers Squibb. M.-L. Brandi received consulting fees, paid advisory boards, lecture fees and/or grant support from Amgen, Eli Lilly, Merck Sharp & Dohme, Novartis, Servier, Spa, Stroder and NPS. J. Cannata Andia is a member of international steering committees and scientific advisory boards of Amgen, Abbott, Shire, Roche and Servier. C. Cooper received consulting fees and paid advisory boards for Alliance for Better Bone Health, GlaxoSmithKline, Roche, Merck Sharp and Dohme, Lilly, Amgen, Wyeth, Novartis, Servier and Nycomed. B. Cortet received consultancy or speaker fees from Amgen, Ferring, Lilly, MSD, Medtronic, Novartis, Roche diagnostics, Rottapharm and Servier. J.-M. Feron received paid advisory board and consultant fees for Servier and Lilly. H. Genant is a consultant and/or advisory board for Servier, Amgen, Merck, Lilly, Pfizer, GSK, BMS, Novartis, Roche, Takeda, Janssen, ONO and Radius. S. Palacios is a symposium speaker or advisory board member for Servier, Pfizer, GSK, Abbott, Ferrer, Bioiberica, Shionogi, Amgen Inc. and Novo Nordisk and received research grants and/or consulting fees from Pfizer, Servier, Amgen Inc., MSD, Preglem, Leon Farma, Gynea, Sandoz and Bayer. J.D. Ringe received paid advisory board for Servier and advises to and lectures for various pharmaceutical companies in the field of osteoporosis. R. Rizzoli received paid advisory boards and lecture fees for Merck Sharp and Dohme, Amgen, Servier, Takeda and Danone.

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Authors and Affiliations

  1. Department of Public Health, Epidemiology and Health Economics, University of Liège, 4020, Liège, Belgium

    J.-Y. Reginster

  2. Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy

    M.-L. Brandi

  3. Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain

    J. Cannata-Andía

  4. MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK

    C. Cooper

  5. Service de Rhumatologie, Hôpital Roger Salengro, Lille, France

    B. Cortet

  6. Service de Chirurgie Orthopédique et Traumatologique, Hôpital Saint Antoine, UPMC, Paris, France

    J.-M. Feron

  7. Departments of Radiology, Medicine, Epidemiology and Orthopedic Surgery, University of California, San Francisco, CA, USA

    H. Genant

  8. Instituto Palacios, Salud y Medicina de la Mujer, Madrid, Spain

    S. Palacios

  9. Med Klinik 4, Klinikum Leverkusen, Akadem, Lehrkrankenhaus, University of Cologne, Cologne, Germany

    J. D. Ringe

  10. Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland

    R. Rizzoli

Authors
  1. J.-Y. Reginster
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  2. M.-L. Brandi
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  3. J. Cannata-Andía
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  4. C. Cooper
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  5. B. Cortet
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  6. J.-M. Feron
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  7. H. Genant
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  8. S. Palacios
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  9. J. D. Ringe
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  10. R. Rizzoli
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Corresponding author

Correspondence to J.-Y. Reginster.

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Reginster, JY., Brandi, ML., Cannata-Andía, J. et al. The position of strontium ranelate in today’s management of osteoporosis. Osteoporos Int 26, 1667–1671 (2015). https://doi.org/10.1007/s00198-015-3109-y

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  • DOI: https://doi.org/10.1007/s00198-015-3109-y

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