Osteoporosis International

, Volume 20, Issue 7, pp 1101–1106

Monitoring strontium ranelate therapy in patients with osteoporosis

  • D. L. Kendler
  • J. D. Adachi
  • R. G. Josse
  • D. O. Slosman
Review

Abstract

Purpose

The purpose of this study was to review the monitoring of strontium ranelate osteoporosis therapy.

Methods

The method used in this study was comprehensive literature review with clinical perspectives.

Results

Changes in bone turnover markers (BTM) or bone mineral density (BMD) have been documented in osteoporosis clinical trials. However, neither BMD nor BTM changes fully explain the observed fracture risk reduction in treated patients. If changes in BMD or BTM on therapy would be easily discernable in individual patients, and were strongly associated with fracture risk reduction, monitoring individuals would be more useful. BMD changes in patients on strontium ranelate are of a greater magnitude and hence can be easily determined in an individual patient. In addition, there exists a better correlation between fracture risk reduction and increases in BMD.

Conclusions

The strong correlation between measured BMD increases and fracture risk reduction in patients on strontium ranelate therapy will be of clinical benefit to physicians wishing to evaluate both treatment persistence and fracture risk reduction.

Keyword

Bone mineral density Bone turnover markers Monitoring osteoporosis therapy Strontium ranelate 

References

  1. 1.
    Rizzoli R, Greenspan SL, Bone G, Schnitzer TJ, Watts NB, Adami S, Foldes AJ, Roux C, Levine MA, Uebelhart B, Santora AC 2nd, Kaur A, Peverly CA, Orloff JJ (2002) Alendronate Once-Weekly Study Group. Two-year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal osteoporosis. J Bone Miner Res 17(11):1988–96PubMedCrossRefGoogle Scholar
  2. 2.
    Brown JP, Kendler DL, McClung MR, Emkey RD, Adachi JD, Bolognese MA, Li Z, Balske A, Lindsay R (2002) The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Calcif Tissue Int 71(2):103–11PubMedCrossRefGoogle Scholar
  3. 3.
    Miller PD, McClung MR, Macovei L, Stakkestad JA, Luckey M, Bonvoisin B, Reginster JY, Recker RR, Hughes C, Lewiecki EM, Felsenberg D, Delmas PD, Kendler DL, Bolognese MA, Mairon N, Cooper C (2005) Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1-year results from the MOBILE study. J Bone Miner Res. 20(8):1315–22PubMedCrossRefGoogle Scholar
  4. 4.
    Sarkar S, Mitlak BH, Wong M, Stock JL, Black DM, Harper KD (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res 17(1):1–10PubMedCrossRefGoogle Scholar
  5. 5.
    Cummings SR, Karpf DB, Harris F et al (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112(4):281–289PubMedCrossRefGoogle Scholar
  6. 6.
    Miller PD (2005) Bone density and markers of bone turnover in predicting fracture risk and how changes in these measures predict fracture risk reduction. Curr Osteoporos Rep 3:103–10PubMedCrossRefGoogle Scholar
  7. 7.
    Wasnich RD, Miller PD (2000) Anti-fracture efficacy of anti-resorptive agents are related to changes in bone density. J Clin Endoc Metab 85(1):231–236CrossRefGoogle Scholar
  8. 8.
    Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20(7):1185–94PubMedCrossRefGoogle Scholar
  9. 9.
    Kendler D (2006) Strontium ranelate—data on vertebral and non vertebral fracture efficacy and safety: mechanism of action. Current Osteoporosis Reports 4:34–39PubMedCrossRefGoogle Scholar
  10. 10.
    Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Diaz-Curiel M, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: TROPOS Study. JCEM 90(5):2816–2822PubMedGoogle Scholar
  11. 11.
    Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata J, Balogh A, Lemmel E-M, Pors-Nielsen S, Rizzoli R, Genant HK, Reginster J-Y (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
  12. 12.
    Blake GM, Lewiecki EM, Kendler DL, Fogelman I (2007) A review of strontium ranelate and its effect on DXA scans. J Clin Densitom 10(2):113–9PubMedCrossRefGoogle Scholar
  13. 13.
    Blake G, Fogelman I (2005) Bone densitometry: an update. editorial Lancet 366(9503):2068–2070Google Scholar
  14. 14.
    Blake GM, Fogelman I (2005) Long-term effect of strontium ranelate treatment on BMD. J Bone Miner Res 20(11):1901–4PubMedCrossRefGoogle Scholar
  15. 15.
    Boivin G, Khebbab MT, Jaurand X, Farlay D, Meunier PJ, Delmas PD (2007) Localization of strontium, by X-ray microanalysis cartography, in bone biopsies of postmenopausal osteoporotic women treated for 3 years with strontium ranelate. Calcif Tissue Int 80:S118Google Scholar
  16. 16.
    Meunier PJ, Slosman DO, Delmas PD (2002) Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis—a 2-year randomized placebo controlled trial. J Clin Endocrinol Metab 87:2060–2066PubMedCrossRefGoogle Scholar
  17. 17.
    Dahl SG, Allain P, Marie PJ (2001) Incorporation and distribution of strontium in bone. Bone 28:446–453PubMedCrossRefGoogle Scholar
  18. 18.
    Pors Nielsen S, Slosman D, Sorensen OH, Basse-Cathelinat B, De Casin P, Roux C, Meunier PJ (1999) Influence of strontium on bone mineral density and bone mineral content measurements by dual x-ray absorptiometry. J Clin Densitom 2:371–379CrossRefGoogle Scholar
  19. 19.
    Ammann P, Shen V, Robin B, Mauras Y, Bonjour JP, Rizzoli R (2004) Strontium ranelate improves bone resistance by increasing bone mass and improving architecture in intact female rats. J Bone Miner Res 19:2012–2020PubMedCrossRefGoogle Scholar
  20. 20.
    Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC et al (1999) Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis Fracture Intervention Trial Research Group. Arthritis Rheum 42:1246–54PubMedCrossRefGoogle Scholar
  21. 21.
    Delmas PD, Li Z, Cooper C (2004) Relationship between changes in bone mineral density and fracture risk reduction with antiresorptive drugs: some issues with metaanalyses. J Bone Miner Res 19:330–7PubMedCrossRefGoogle Scholar
  22. 22.
    Bruyere O, Roux C, Detilleux J, Slosman DO, Spector TD, Fardellone P, Brixen K, Devogelaer JP, Diaz-Curiel M, Albanese C, Kaufman JM, Pors-Nielsen S, Reginster JY (2007) Relation between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrinol Metab 92:3076–3081PubMedCrossRefGoogle Scholar
  23. 23.
    Bruyere O, Roux C, Badurski J, Isaia G, De Vernejoul MC, Cannata J, Ortolani S, Slosman D, Detilleux J, Reginster J-Y (2007) Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate. Curr Med Res Opin 23(12):3041–5PubMedCrossRefGoogle Scholar
  24. 24.
    Watts NB, Cooper C, Lindsay R, Eastell R, Manhart MD, Barton IP, van Staa TP, Adachi JD (2004) Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk. J Clin Densitom 7:255–61PubMedCrossRefGoogle Scholar
  25. 25.
    Chapurlat RD, Palermo L, Ramsay P, Cummings SR (2005) Risk of fracture among women who lose bone density during treatment with alendronate The Fracture Intervention Trial. Osteoporos Int 16:842–8PubMedCrossRefGoogle Scholar
  26. 26.
    Chen P, Miller PD, Delmas PD, Misurski DA, Krege JH (2006) Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated postmenopausal women with osteoporosis. J Bone Miner Res 21:1785–90PubMedCrossRefGoogle Scholar
  27. 27.
    Cramer JA, Amonkar MM, Hebborn A, Altman R (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21(9):1453–60PubMedCrossRefGoogle Scholar
  28. 28.
    Bouxsein ML, Delmas PD (2008) Considerations for development of surrogate endpoints for antifracture efficacy of new treatments in osteoporosis: a perspective. J Bone Miner Res 23(8):1155–67PubMedCrossRefGoogle Scholar
  29. 29.
    Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment—The fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 396:2927–2938CrossRefGoogle Scholar
  30. 30.
    Watts NB, Chines A, Olszynski WP, McKeever CD, McLung MR, Zhou X, Grauer A (2008) Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int 2007. Osteoporos Int 19(3):365–72PubMedCrossRefGoogle Scholar
  31. 31.
    Ortolani S, Diaz-Curiel M (2007) Strontium ranelate: changes in BMD one year after treatment discontinuation. Osteoporos Int 18:S25CrossRefGoogle Scholar
  32. 32.
    Farlay D, Boivin G, Panczer G, Lalande A, Meunier PJ (2005) Long-term strontium ranelate administration in monkeys preserves characteristics of bone mineral crystals and degree of mineralization of bone. J Bone Miner Res 20(9):1569–1578PubMedCrossRefGoogle Scholar
  33. 33.
    Pors Nielsen S, Barenholdt O, Barenholdt-Schioler C, Mauras Y, Allain P (2004) Noninvasive measurement of bone strontium. J Clinical Densitometry 7:262–268CrossRefGoogle Scholar
  34. 34.
    Reginster JY, Felsenberg D, Boonen S, Diez-Perez A, Rizzoli R, Brandi ML, Spector TD, Brixen K, Goemaere S, Cormier C, Balogh A, Delmas PD, Meunier PJ, Reginster JY, Brixen K, Cormier C, Cannata J (2008) Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: results of a five-year, randomized, placebo-controlled trial. Arthritis Rheum 58(6):1687–95PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • D. L. Kendler
    • 1
  • J. D. Adachi
    • 2
  • R. G. Josse
    • 3
  • D. O. Slosman
    • 4
  1. 1.University of British ColumbiaVancouverCanada
  2. 2.Department of Medicine, St. Joseph’s HealthcareMcMaster UniversityHamiltonCanada
  3. 3.Osteoporosis Centre, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  4. 4.Institut de Médecine Nucléaire, 20 Chemin BeausoleilClinique Générale BeaulieuGenevaSwitzerland

Personalised recommendations