Osteoporosis strontium ranelate

Strontium stimulates bone formation and decreases bone resorption. In a preliminary study of postmenopausal women with severe osteoporosis, strontium ranelate 1 g twice daily or 2 g once daily reduced new vertebral fractures by 41%, and increased lumbar spine BMD by 14% and femoral neck BMD by 8% compared with placebo. Nonvertebral fracture rates were similar. Diarrhea was more common in the strontium group. Small decreases in serum calcium and PTH, small increases in serum phosphate, and transient increases in creatine kinase were measured. 

Strontium Ranelate Granules For post-menopausal women with osteoporosis... 

Strontium ranelate has not been approved in the United States for the treatment of osteoporosis but is being used in Europe, generally at a dose of 2 g/d. Denosumab, an antibody to RANKL that suppresses bone resorption by interfering with RANKL/RANK induction of osteoclast differentiation and function, has shown good efficacy in phase 3 trials and may be approved for clinical use in the near future. 

Meunier PJ et al The effects of strontium ranelate on the risk of vertebral fractures in women with postmenopausal osteoporosis. N Engl J Med 2004 350 459. [PMID 14749454]... 

NICE (National Institute for Health and Clinical Excellence) (2008). Osteoporosis -Secondary prevention including strontium ranelate. Available at http //www.nice. org.uk/guidance/TA161/guidance/pdf/English/ [Accessed 4 July 2008],... 

Options for treatment include hormone replacement therapy (HRT), bisphosphonates, calcitriol, calcitonin, raloxifene, strontium ranelate, and teriparatide. Hormone replacement therapy is generally indicated for women who are under 50 years and are experiencing a premature menopause. Symptomatic menopausal women may opt to use HRT also, as the benefits outweigh the risks for up to 5 years treatment. They may choose an alternative treatment for osteoporosis if preferred. Hormone replacement therapy is not recommended for first line treatment for long-term prevention of osteoporosis in women over 50 years of age. 

Raloxifene is recommended in patients (NICE, 2008) in whom bisphosphonates are contraindicated, those who cannot comply with the requirements needed to take bisphosphonates, or who have had an unsatisfactory response or are intolerant of bisphosphonates. Strontium ranelate is a suitable alternative if a bisphosphonate cannot be taken. However, NICE guidelines on secondary prevention of osteoporosis does not currently recommend the use of strontium ranelate. 

Olanzapine, already mentioned in CHEC-II(1996), has become one of the most commonly used atypical anti-psychotics. Strontium ranelate <2005MI728> has emerged as a novel medication in the treatment of osteoporosis. It increases the synthesis of collagen and noncollagenic proteins in vivo. 

Drugs currently used to treat osteoporosis are classified into those that inhibit osteoclastic bone resorption (including bisphos-phonates, denosumab, and selective estrogen receptor modulators) and those that stimulate bone formation by osteoblasts (parathyroid hormone and derivatives, such as teriparatide). Strontium ranelate may have a dual effect. Other drugs being tested in clinical trials include inhibitors of cathepsin K (an osteoclastic enzyme critical for bone resorption) and of sclerostin (a negative modulator of the Wnt pathway) [21],... 

Reginster J-Y, Leoart M-P, Deroisy R, et al. Strontium ranelate—a new paradigm in the treatment of osteoporosis. Expert Opin Investig Drugs 2004 13 857-864. 

Marie PJ. Strontium ranelate a novel mode of action optimizing bone formation and resorption. Osteoporosis Int 2005 16(Suppl 1) S7-S10. 

Skin Toxic epidermal necrolysis has been attributed to strontium ranelate 2 g/day in a 72-year-old Chinese woman with postmenopausal osteoporosis. The lesions resolved after treatment with intravenous immunoglobulin 1 g/kg/day for 3 days [53 ]. 

Lee HY, Lie D, Lim KS, Thirumoorthy T, Pang SM. Strontium ranelate-induced toxic epidermal necrolysis in a patient with post-menopausal osteoporosis. Osteoporos Int 2009 20(1) 161-2. 

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