Five years treatment with strontium ranelate reduces vertebral and nonvertebral fractures and increases the number and quality of remaining life-years in women over 80 years of age.
BACKGROUND
Longevity has resulted in a greater proportion of the population entering a time of life when increasing bone fragility and falls predispose to fractures, particularly nonvertebral fractures. Women over 80 years of age constitute 10% of the population but contribute 30% of all fractures and 60% of all nonvertebral fractures. Despite this, few studies have examined antifracture efficacy of treatments in this high-risk group and none has provided evidence for benefits beyond 3 years.


METHODS
To determine whether strontium ranelate reduces the risk of vertebral and nonvertebral fractures during 5 years, we analyzed a subgroup of 1489 female patients over 80 years of age (mean 83.5+/-3.0 years) with osteoporosis from the SOTI (spinal osteoporosis therapeutic intervention) and TROPOS (treatment of peripheral osteoporosis) studies randomized to strontium ranelate 2 g/d or placebo. All received a supplement of calcium plus vitamin D.


RESULTS
By intention to treat, vertebral fracture risk was reduced by 31% (relative risk, RR=0.69; 95% confidence interval, CI 0.52-0.92), nonvertebral fracture risk by 27% (RR=0.73; 95% CI 0.57-0.95), major nonvertebral fracture risk by 33% (RR=0.67; 95% CI 0.50-0.89) and hip fracture risk by 24% (RR=0.76; 95% CI 0.50-1.15, not significant). Treatment was cost-saving as it decreased cost and increased QALYs and life-years.


CONCLUSIONS
Strontium ranelate safely produced a significant reduction in vertebral and nonvertebral fracture risk during 5 years in postmenopausal women over 80 years of age and was cost saving.
Seeman
Ego
E
Austin Health, University of Melbourne, Melbourne, Australia. egos@unimelb.edu.au
Boonen
Steven
S
Borgström
Frederik
F
Vellas
Bruno
B
Aquino
Jean-Pierre
JP
Semler
Jutta
J
Benhamou
Claude-Laurent
CL
Kaufman
Jean-Marc
JM
Reginster
Jean-Yves
JY
D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001842:Bone and Bones / Q000187:drug effects*; D002136:Calcium, Dietary / Q000627:therapeutic use; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D057194:Intention to Treat Analysis; D009942:Organometallic Compounds / Q000627:therapeutic use*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D011788:Quality of Life; D016103:Spinal Fractures / Q000517:prevention & control*; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D009942:Organometallic Compounds; D013876:Thiophenes; C081587:strontium ranelate