title: Use of strontium ranelate and risk of acute coronary syndrome: cohort study.
abstract: BACKGROUND
  A recent pooled analysis of randomised trials found an increased risk of myocardial infarction with use of the antiosteoporotic drug strontium ranelate. We conducted a nationwide cohort study in Denmark, 2005-2011, to investigate the risk of acute coronary syndrome among postmenopausal women treated with strontium ranelate.
  
  
  METHODS
  The study involved two analytic setups. The first analysis included new users of either strontium ranelate (n=1798) or one of the two first-line bisphosphonates in Denmark (alendronate and risedronate; n=65 236). The second analysis included patients who had first been treated with a first-line bisphosphonate and subsequently switched to either strontium ranelate (n=1219) or ibandronate (n=2290). The primary outcome was acute coronary syndrome (unstable angina or myocardial infarction). The secondary outcome was any-cause mortality. Cox regression was used to estimate HRs, with adjustment using a disease risk score.
  
  
  RESULTS
  Compared with use of alendronate/risedronate, use of strontium was not associated with significantly increased risk of acute coronary syndrome (rate per 1000 person-years 5.7 for strontium vs 6.3 for alendronate/risedronate; adjusted HR 0.89, 95% CI 0.52 to 1.55) or any-cause mortality (adjusted HR 0.96, 95% CI 0.76 to 1.21). In the analysis of switchers, strontium was not associated with significantly increased risk of acute coronary syndrome (rate per 1000 person-years 9.9 for strontium vs 9.9 for ibandronate; adjusted HR 1.00, 95% CI 0.49 to 2.05) or of any-cause mortality (adjusted HR 1.45, 95% CI 0.95 to 2.21).
  
  
  CONCLUSIONS
  These real-world data of antiosteoporotic drug users do not support a significant association between use of strontium ranelate and acute coronary syndrome.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, , Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Svanström
authors.forename: Björn
authors.initials: B
authors.lastname: Pasternak
authors.forename: Anders
authors.initials: A
authors.lastname: Hviid
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D016016:Proportional Hazards Models; D000068296:Risedronic Acid; D013876:Thiophenes / Q000009:adverse effects*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D013876:Thiophenes; C081587:strontium ranelate; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate
keywords: Cardiovascular Disease; Epidemiology; Osteoporosis