title: 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.
authors: Department of Public Health, Epidemiology and Health Economics, University of Liège, 4020, Liège, Belgium. jyreginster@ulg.ac.be.
authors: J-Y
authors: JY
authors: Reginster
authors: Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy.
authors: M-L
authors: ML
authors: Brandi
authors: Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
authors: J
authors: J
authors: Cannata-Andía
authors: MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK.
authors: C
authors: C
authors: Cooper
authors: Service de Rhumatologie, Hôpital Roger Salengro, Lille, France.
authors: B
authors: B
authors: Cortet
authors: Service de Chirurgie Orthopédique et Traumatologique, Hôpital Saint Antoine, UPMC, Paris, France.
authors: J-M
authors: JM
authors: Feron
authors: Departments of Radiology, Medicine, Epidemiology and Orthopedic Surgery, University of California, San Francisco, CA, USA.
authors: H
authors: H
authors: Genant
authors: Instituto Palacios, Salud y Medicina de la Mujer, Madrid, Spain.
authors: S
authors: S
authors: Palacios
authors: Med Klinik 4, Klinikum Leverkusen, Akadem, Lehrkrankenhaus, University of Cologne, Cologne, Germany.
authors: J D
authors: JD
authors: Ringe
authors: Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland.
authors: R
authors: R
authors: Rizzoli
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017277:Drug Approval; D011307:Drug Prescriptions / Q000592:standards; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D018570:Risk Assessment; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D013876:Thiophenes; C081587:strontium ranelate
keywords: Efficacy; Osteoporosis; Safety; Strontium ranelate; Treatment