Strontium ranelate as a possible disease-modifying osteoarthritis drug: a systematic review

Abstract

Considering that osteoarthritis (OA) is the most prevalent joint disease worldwide, multiple pharmacological treatments have been proposed to alter the articular structure with potential benefit in the progression of the disease. The so-called disease-modifying OA drugs have been frequently investigated but conclusive findings are rare. Strontium ranelate (SrRan) is a drug usually prescribed to treat osteoporosis, with proven effects in decreasing the risk of fractures and possible effect in reducing the progression of OA. The objective of this review was to demonstrate the current panorama of knowledge on the use of SrRan in clinical and experimental models, clarifying its mechanisms of action and describing possible anti-nociceptive and anti-inflammatory effects. The systematic review was based on the PRISMA statement and included articles that are indexed in scientific databases. Fifteen studies were included: seven pre-clinical and eight clinical studies. Despite the limited number of studies, the results suggest a positive effect of SrRan in patients with OA, through changes in functional capacity and reduction of progression of morphological parameters and joint degradation, with moderate quality of evidence for those clinical outcomes. Novel studies are necessary to elucidate the molecular targets of SrRan, focusing on anti-inflammatory effects and histological changes promoted by SrRan, which seemed to reduce the progression of OA in the experimental and clinical studies.

Effect of vitamin K2 on bone mineral density and serum cathepsin K in female osteoporosis patients

“…It is used for treating osteoporosis and for reducing susceptibility to fractures, while simultaneously enhancing bone density and strength. It overcomes the drawbacks of one-way treatments with other drugs [16]. Many animal experiments have shown that strontium ranelate accelerates the formation of new bone while slowing down the resorption of old bone.…”

Medication taking in people with hip and knee osteoarthritis: An analysis of the English Longitudinal Study of Ageing

“…There was no relationship between taking medications for OA compared with anticoagulants or medicines for diabetes or hypertension. Given that taking medicines (such as strontium ranelate (Rodrigues et al, )) can slow OA disease progression and improve both pain and structural changes (Han et al, ; Wang et al, ), encouraging medicine taking for those at risk of not taking medicines, is clinically warranted. This is further encouraged by the present data, which indicated greater functional performance, as measured by timed chair raises, for individuals who took medications compared with those who did not.…”

“…Although these have demonstrated moderate to good effect sizes for those who follow this advice, patient experiences surrounding the effectiveness, particularly of paracetamol, have been shown to influence the extent to which pain relief is used (Lee, Cooke, Cooper, & Shield, ). Furthermore, Wang, Xu, Hunter, and Ding () highlighted the importance which some medications, such as strontium ranelate, may offer in respect to symptom improvement and joint structure changes, with a slowing of disease progression (Rodrigues, Freire, Bonfim, Cartágenes, & Garcia, ). Accordingly, encouraging the management of OA symptoms with medicines, particularly in the early stages of the disease, could have longer‐term beneficial consequences (Han, Fan, Bai, & Ding, ).…”

Advances in Osteoporotic Bone Tissue Engineering

“…The metabolic activity of osteoblasts is enhanced in the presence of strontium ions, while the activity of the osteoclasts is reduced depending on the concentration of strontium in the microenvironment [ 43 ]. Inhibited activity of osteoclast in the presence of Sr is due to reduced synthesis of matrix metalloproteinase coupled with control of osteoprotegerin-RANKL pathway [ 81 ].…”

“…In clinical usage it was also shown to decrease in patients with primary osteoporosis the risk of vertebral and non-vertebral fractures [ 68 ], femoral bone fractures also being positively impacted [ 63 ]. SrRan remains the main option for cases of severe osteoporosis [ 81 ].…”