Osteoporosis International

, Volume 26, Issue 6, pp 1667–1671 | Cite as

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

  • J.-Y. ReginsterEmail author
  • M.-L. Brandi
  • J. Cannata-Andía
  • C. Cooper
  • B. Cortet
  • J.-M. Feron
  • H. Genant
  • S. Palacios
  • J. D. Ringe
  • R. Rizzoli


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.


Efficacy Osteoporosis Safety Strontium ranelate Treatment 


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.


  1. 1.
    Kanis JA, Borgstrom F, Compston J et al (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8:144PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Hiligsmann M, Bruyere O, Reginster JY (2010) Cost-effectiveness of strontium ranelate versus risedronate in the treatment of postmenopausal osteoporotic women aged over 75 years. Bone 46:440–446Google Scholar
  3. 3.
    Hiligsmann M, Bruyere O, Reginster JY (2010) Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women. Osteoporos Int 21:157–165PubMedCrossRefGoogle Scholar
  4. 4.
    Hiligsmann M, Evers SM, Ben SW et al (2015) A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis. Pharmacoeconomics 33:205–224PubMedCrossRefGoogle Scholar
  5. 5.
    European Medicines Agency (2014) Strontium ranelate. Summary of product characteristics. Accessed 18 July 2014
  6. 6.
    Reginster JY (2014) Cardiac concerns associated with strontium ranelate. Expert Opin Drug Saf 13:1209–1213PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Compston J (2014) Strontium ranelate lives to fight another day. Maturitas 78:75–76PubMedCrossRefGoogle Scholar
  8. 8.
    European Medicines Agency (2013) Assessment report—periodic safety update report (EPAR - Protelos-H-C-560-PSU31). Accessed 3 Feb 2014
  9. 9.
    Audran M, Jakob FJ, Palacios S et al (2013) A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years. Rheumatol Int 33:2231–2239Google Scholar
  10. 10.
    Cooper C, Fox KM, Borer JS (2014) Ischaemic cardiac events and use of strontium ranelate in postmenopausal osteoporosis: a nested case–control study in the CPRD. Osteoporos Int 25:737–745PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Abrahamsen B, Grove EL, Vestergaard P (2014) Nationwide registry-based analysis of cardiovascular risk factors and adverse outcomes in patients treated with strontium ranelate. Osteoporos Int 25:757–762PubMedCrossRefGoogle Scholar
  12. 12.
    Svanström H, Pasternak B, Hviid A (2014) Use of strontium ranelate and risk of acute coronary syndrome: cohort study. Ann Rheum Dis 73:1037–1043Google Scholar
  13. 13.
    Meunier PJ, Roux C, Seeman E et al (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468PubMedCrossRefGoogle Scholar
  14. 14.
    Reginster JY, Seeman E, De Vernejoul MC et al (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822PubMedCrossRefGoogle Scholar
  15. 15.
    Kanis JA, Johansson H, Odén A et al. (2014) A meta-analysis of the effect of strontium ranelate on the risk of vertebral and non-vertebral fracture in postmenopausal osteoporosis: the impact of severe osteoporosis and contraindications. Abstract OC25. Presented at the World Congress on Osteoporosis and Osteoarthritis and Musculoskeletal Diseases. WCO-IOF-ESCEO, Seville, SpainGoogle Scholar
  16. 16.
    Falaschetti E, Mindell J, Knott C et al (2014) Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet 383:1912–1919PubMedCrossRefGoogle Scholar
  17. 17.
    Aspray TJ, Francis RM (2012) Treatment of osteoporosis in women intolerant of oral bisphosphonates. Maturitas 71:76–78PubMedCrossRefGoogle Scholar
  18. 18.
    Cramer JA, Silverman S (2006) Persistence with bisphosphonate treatment for osteoporosis: finding the root of the problem. Am J Med 119:S12–S17PubMedCrossRefGoogle Scholar
  19. 19.
    Rabenda V, Mertens R, Fabri V et al (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19:811–818PubMedCrossRefGoogle Scholar
  20. 20.
    Tadrous M, Wong L, Mamdani MM et al (2014) Comparative gastrointestinal safety of bisphosphonates in primary osteoporosis: a network meta-analysis. Osteoporos Int 25:1225–1235PubMedCrossRefGoogle Scholar
  21. 21.
    Kanis JA, Cooper C, Hiligsmann M et al (2011) Partial adherence: a new perspective on health economic assessment in osteoporosis. Osteoporos Int 22:2565–2573PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • J.-Y. Reginster
    • 1
    Email author
  • M.-L. Brandi
    • 2
  • J. Cannata-Andía
    • 3
  • C. Cooper
    • 4
  • B. Cortet
    • 5
  • J.-M. Feron
    • 6
  • H. Genant
    • 7
  • S. Palacios
    • 8
  • J. D. Ringe
    • 9
  • R. Rizzoli
    • 10
  1. 1.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
  2. 2.Metabolic Bone Unit, Department of Internal MedicineUniversity of FlorenceFlorenceItaly
  3. 3.Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de AsturiasUniversidad de OviedoOviedoSpain
  4. 4.MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research CentreUniversity of SouthamptonSouthamptonUK
  5. 5.Service de RhumatologieHôpital Roger SalengroLilleFrance
  6. 6.Service de Chirurgie Orthopédique et Traumatologique, Hôpital Saint AntoineUPMCParisFrance
  7. 7.Departments of Radiology, Medicine, Epidemiology and Orthopedic SurgeryUniversity of CaliforniaSan FranciscoUSA
  8. 8.Instituto PalaciosSalud y Medicina de la MujerMadridSpain
  9. 9.Med Klinik 4, Klinikum Leverkusen, Akadem, LehrkrankenhausUniversity of CologneCologneGermany
  10. 10.Division of Bone Diseases, Faculty of MedicineGeneva University HospitalGenevaSwitzerland

Personalised recommendations