The position of Strontium ranelate in today's management of osteoporosis

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 strontiumranelate 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.