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

Abstract

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.

Pharmacological treatment options for low Bone Mineral Density and secondary osteoporosis in Anorexia Nervosa: A systematic review of the literature

“…Strontium Ranelate is effective in increasing BMD in post-menopausal women [78], however restrictions have been placed by the European Medical Agency regarding administration to patients with existing heart disease [79]. Based on the association with AN and cardiac and nervous system disturbances [80], this review would not recommend Strontium Ranelate to increase BMD in adults or adolescents with AN.…”

On the Amazing Reactivity of the Ranelate Ion: New Applications of an Old Antiosporotic Drug

“…Despite its low toxicity, the drug was discontinued by the producer after the European Medicines Agency reported a slight increase (from 1.1 to 1.7% ) in cardiovascular events involving 7000 tested patients who used placebo or strontium ranelate, respectively. For this reason, it has been recommended as a therapeutic drug only for the treatment of severe cases of osteoporosis, for patients without cardiovascular contraindications.…”

Local delivery of strontium ranelate promotes regeneration of critical size bone defects filled with collagen sponge

“…Regarding the safety of SR, in vivo studies using rat models reported that the systemic use of SR (up to 625 g/kg daily) is well tolerated and safe, with no adverse effects . In a recent review of studies on the clinical use of SR for the management of osteoporosis (2 g/day), Reginster et al (2015) concluded that SR has an excellent benefit‐risk ratio, provided that its contraindications, including uncontrolled hypertension and a history of ischemic episodes, are respected.…”