Osteoporosis International

, Volume 23, Issue 1, pp 305–315 | Cite as

Effects of strontium ranelate and alendronate on bone microstructure in women with osteoporosis

Results of a 2-year study
  • R. RizzoliEmail author
  • R. D. Chapurlat
  • J.-M. Laroche
  • M. A. Krieg
  • T. Thomas
  • I. Frieling
  • S. Boutroy
  • A. Laib
  • O. Bock
  • D. Felsenberg
Original Article



Strontium ranelate appears to influence more than alendronate distal tibia bone microstructure as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT), and biomechanically relevant parameters as assessed by micro-finite element analysis (μFEA), over 2 years, in postmenopausal osteoporotic women.


Bone microstructure changes are a target in osteoporosis treatment to increase bone strength and reduce fracture risk.


Using HR-pQCT, we investigated the effects on distal tibia and radius microstructure of strontium ranelate (SrRan; 2 g/day) or alendronate (70 mg/week) for 2 years in postmenopausal osteoporotic women. This exploratory randomized, double-blind trial evaluated HR-pQCT and FEA parameters, areal bone mineral density (BMD), and bone turnover markers.


In the intention-to-treat population (n = 83, age: 64 ± 8 years; lumbar T-score: −2.8 ± 0.8 [DXA]), distal tibia Cortical Thickness (CTh) and Density (DCort), and cancellous BV/TV increased by 6.3%, 1.4%, and 2.5%, respectively (all P < 0.005), with SrRan, but not with alendronate (0.9%, 0.4%, and 0.8%, NS) (P < 0.05 for all above between-group differences). Difference for CTh evaluated with a distance transformation method was close to significance (P = 0.06). The estimated failure load increased with SrRan (+2.1%, P < 0.005), not with alendronate (−0.6%, NS) (between-group difference, P < 0.01). Cortical stress was lower with SrRan (P < 0.05); both treatments decreased trabecular stress. At distal radius, there was no between-group difference other than DCort (P < 0.05). Bone turnover markers decreased with alendronate; bALP increased (+21%) and serum-CTX-I decreased (−1%) after 2 years of SrRan (between-group difference at each time point for both markers, P < 0.0001). Both treatments were well tolerated.


Within the constraints of HR-pQCT method, and while a possible artefactual contribution of strontium cannot be quantified, SrRan appeared to influence distal tibia bone microstructure and FEA-determined biomechanical parameters more than alendronate. However, the magnitude of the differences is unclear and requires confirmation with another method.


Alendronate Finite elements analysis HR-pQCT Microstructure Osteoporosis Strontium ranelate 



The study was sponsored by Servier.

Conflicts of interest

All authors are investigators in the study, except A. Laib, who was responsible for central reading of HR-pQCT parameters, and S. Boutroy, who was responsible for central reading of FEA parameters.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • R. Rizzoli
    • 1
    Email author
  • R. D. Chapurlat
    • 2
  • J.-M. Laroche
    • 3
  • M. A. Krieg
    • 4
  • T. Thomas
    • 5
  • I. Frieling
    • 6
  • S. Boutroy
    • 2
  • A. Laib
    • 7
  • O. Bock
    • 8
  • D. Felsenberg
    • 8
  1. 1.Division of Bone Diseases, Department of Medical SpecialtiesGeneva University Hospitals and Faculty of MedicineGeneva 14Switzerland
  2. 2.INSERM U831Université de Lyon, Edouard Herriot HospitalLyonFrance
  3. 3.Rangueil HospitalToulouseFrance
  4. 4.Department of Musculoskeletal MedicineCHUVLausanneSwitzerland
  5. 5.INSERM U890University HospitalSaint-EtienneFrance
  6. 6.OsteoporosezentrumHamburgGermany
  7. 7.SCANCO Medical AGBruettisellenSwitzerland
  8. 8.Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Centre of Muscle and Bone ResearchFree University and Humboldt UniversityBerlinGermany

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