This article appears in the following Rheumatology issue: Improvement of bone microarchitecture: the foundation for a better protection against osteoporotic fractures [View the issue table of contents]
Reviews |
Osteoporosis: from early fracture prevention to better bone health with strontium ranelate
1University Department of Rheumatology, Lille Teaching Hospital, Lille, France
Correspondence to: Bernard Cortet, University Department of Rheumatology, Lille Teaching Hospital, Rue du Professeur Emile Laine, 59037 Lille cédex, France. E-mail: bcortet{at}chru-lille.fr
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Abstract |
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Given its increasing incidence and serious complications, osteoporosis requires safe and effective long-term treatment. Strontium ranelate (SR) is an osteoporosis treatment with a unique mode of action, which was launched in 2004. It has been investigated in the Spinal Osteoporosis Therapeutic Intervention (SOTI) and the TReatment Of Peripheral OSteoporosis (TROPOS) trials, two major 3-year multinational placebo-controlled Phase III randomized clinical trials. In SOTI, SR treatment reduced the risk of vertebral fracture by 41% (20.9 vs 32.8%; P < 0.001); in TROPOS, it reduced the risk of non-vertebral fracture by 16% (11.2 vs 12.9%; P = 0.04) and the risk of hip fracture in patients at high risk by 36% (4.3 vs 6.4%; P = 0.046). Unlike anti-resorptive agents, SR produced steady and significant BMD increases that correlated directly with decreases in vertebral and hip fracture risk. Preplanned analysis of the pooled dataset from SOTI and TROPOS showed that SR was effective whether or not patients had key risk factors for fractures at baseline. SR was also effective in patients with osteopenia and younger postmenopausal patients aged 50–65 years. Finally, SR significantly attenuated height loss and decreased back pain. The safety profile of SR was almost similar to placebo in both trials. Thus, SR demonstrates broad spectrum safety and efficacy in reducing the risks of both vertebral and non-vertebral (including hip) fractures in a wide variety of patients, and should be considered as a first-line option to treat women at risk of osteoporotic fractures, whatever their age, the severity of the disease and their risk factors.
KEY WORDS: Osteoporosis, Vertebral fracture, Non-vertebral fracture, Hip fracture, Strontium ranelate, Anti-fracture efficacy
Submitted 4 February 2009;
revised version accepted 31 July 2009.
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