Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate.
OBJECTIVE
Our objective was to analyze the relationship between bone mineral density (BMD) changes and fracture incidence during 3-yr treatment with strontium ranelate.


METHODS
Women from the strontium ranelate arm of the Spinal Osteoporosis Therapeutic Intervention study and the TReatment Of Peripheral OSteoporosis study were evaluated.


METHODS
The outcome measures included BMD at the lumbar spine, femoral neck, and total proximal femur assessed at baseline and after a follow-up of 1 and 3 yr; semiquantitative visual assessment of vertebral fractures; and nonvertebral fractures based on written documentation.


RESULTS
After 3 yr of strontium ranelate treatment, each percentage point increase in femoral neck and total proximal femur BMD was associated with a 3% (95% adjusted confidence interval, 1-5%) and 2% (1-4%) reduction in risk of a new vertebral fracture, respectively. The 3-yr changes in femoral neck and total proximal femur BMD explained 76% and 74%, respectively, of the reduction in vertebral fractures observed during the treatment. Three-year changes in spine BMD were not statistically associated with the incidence of new vertebral fracture (P = 0.10). No significant associations were found between 3-yr changes in BMD and incidence of new nonvertebral fractures, but a trend was found for femoral neck BMD (P = 0.09) and for total proximal femur BMD (P = 0.07). An increase in femoral neck BMD after 1 yr was significantly associated with the reduction in incidence of new vertebral fractures observed after 3 yr (P = 0.04).


CONCLUSIONS
During 3-yr strontium ranelate treatment, an increase in femoral neck BMD was associated with a proportional reduction in vertebral fracture incidence.
Bruyere
Olivier
O
World Health Organization Collaborating Center for Public Health Aspect of Osteoarticular Disorders, University of Liège, B-4000 Liège, Belgium. olivier.bruyere@ulg.ac.be
Roux
Christian
C
Detilleux
Johann
J
Slosman
Daniel O
DO
Spector
Tim D
TD
Fardellone
Patrice
P
Brixen
Kim
K
Devogelaer
Jean-Pierre
JP
Diaz-Curiel
Manuel
M
Albanese
Carlina
C
Kaufman
Jean-Marc
JM
Pors-Nielsen
Stig
S
Reginster
Jean-Yves
JY
D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005269:Femur / Q000187:drug effects; D005272:Femur Neck / Q000187:drug effects; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010024:Osteoporosis / Q000188:drug therapy; D040242:Risk Reduction Behavior; D016103:Spinal Fractures / Q000453:epidemiology; D013131:Spine / Q000187:drug effects; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
D009942:Organometallic Compounds; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D; D002118:Calcium