Strontium ranelate: a new paradigm in the treatment of osteoporosis

Abstract

In vitro, strontium ranelate increases collagen and non-collagenic protein synthesis by mature osteoblast-enriched cells. The effects of strontium ranelate on bone formation were confirmed as the drug enhanced preosteoblastic cell replication. In the isolated osteoclast, a preincubation of bone slices with strontium ranelate induced a dose-dependent inhibition of the bone resorbing activity of treated rat osteoclast. Strontium ranelate dose-dependently inhibited preosteoclast differentiation. The drug was administered in 160 early postmenopausal women, in a 24-month, double-blind, placebo-controlled, prospective randomised study. At the conclusion of the study, the percentage variation of lumbar bone mineral density (BMD) from baseline was significantly different in the group receiving strontium ranelate 1000 mg/day as compared with placebo (+5.53 versus -0.75%, respectively). Increase in total hip and neck BMD averages were 3.2 and 2.5%, respectively. The effect of strontium ranelate in postmenopausal women with established osteoporosis was assessed during a multinational, prospective, double-blind, randomised, placebo-controlled trial. Strontium ranelate (500, 1000, 2000 mg/day) or placebo were given to 353 Caucasian women with prevalent vertebral osteoporosis. At the conclusion of this 2-year study, the annual increase in lumbar BMD of the group receiving strontium ranelate 2000 mg was 7.3% (p < 0.001). A significant increase in bone alkaline phophatase (p = 0.002) over a 6-month period and a significant decrease in N-telopeptide crosslinks (p = 0.004) throughout the 2-year period were seen in the group receiving 2000 mg of strontium ranelate. During the second year of treatment, the dose of 2000 mg was associated with a 44% reduction in the number of patients experiencing a new vertebral deformity. Bone histomorphometry showed no mineralisation defects. The primary analysis of the SOTI study, evaluating the effect of strontium ranelate 2000 mg on vertebral fracture rates, revealed a 41% reduction in the relative risk of patients experiencing a first new vertebral fracture with strontium ranelate throughout the 3-year study. The TROPOS study showed a significant reduction in the risk of experiencing a first non-vertebral fracture in the group treated with strontium ranelate throughout the 3-year study. A reduction in the risk of experiencing a hip fracture was also demonstrated in the patients treated for > or = 18 months.

Investigating the Effects of Systemically Administered Strontium Ranelate on Alveolar Bone Loss Histomorphometrically and Histopathologically on Experimental Periodontitis in Rats

“…Effect of SR on reducing risk of bone fractures and inducing bone formation and quality is explained by increased bone mineral density; 16 , 18 , 20 therefore, no significant difference was found in bone volume and number of megakaryocytes in a recent study performed by Rodriguez et al 14…”

Porous Allograft Bone Scaffolds: Doping with Strontium

“…For example, calcium (Ca) ions in bone can be exchanged with other divalent cations in serum, such as Sr. When strontium ranelate (SrR) was administrated to treat osteoporosis, Sr deposition was targeted in bone tissue and promoted bone formation while inhibiting local bone resorption [11,12]. Sr can promote bone formation even at low concentrations [7].…”

Strontium‐substituted apatite coating grown on Ti6Al4V substrate through biomimetic synthesis

“…In the recent years clinical trials have been conducted on humans using a specific molecule, Sr ranelate, composed of an organic moiety that binds two stable Sr atoms for increasing Sr bioavailability. Low doses of Sr ranelate, when orally supplemented, were reported to increase vertebral bone calcification in osteoporotic patients 12, 14–16. Important pharmacological and clinical data have clearly demonstrated that the presence of this Sr‐based drug reduces the risk of vertebral17, 18 and nonvertebral fractures19 in postmenopausal women with good tolerability in patients.…”