Strontium ranelate for preventing and treating postmenopausal osteoporosis

O’Donnell, Siobhan; Cranney, Ann; Ga, Wells; Jd, Adachi; Reginster, JY

doi:10.1002/14651858.cd005326.pub2

Cited by 92 publications

(59 citation statements)

References 45 publications

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“…Any excess risk of fractures may be potentially serious due to the widespread use of bisphosphonates and the excess mortality linked to femoral fractures [10]. Other drugs effective against osteoporosis are raloxifene [11] and strontium ranelate [12]. It has not been studied if an excess risk of femoral shaft, diaphyseal, and subtrochanteric fractures is associated with these drugs.…”

Section: Introductionmentioning

confidence: 99%

Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

et al. 2010

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Section: Introductionmentioning

confidence: 99%

Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

et al. 2010

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“…Hormone therapy Reduces vertebral, nonvertebral, and hip fracture risk [37,38] Increased risk of coronary heart disease, thromboembolic events, and stroke [41,42] PO administration on a continuous daily or cyclical regimen, as appropriate SERMs (raloxifene) Reduces vertebral fracture risk [44] Increased frequency of hot flushes and venous thromboembolism [55] PO administration once daily Calcitonin Reduces vertebral fracture risk [65] Minor adverse events Intranasal and injectable formulations available Teriparatide Reduces vertebral and nonvertebral fracture risk [71] Osteosarcoma observed in rats [76] Daily subcutaneous injection Strontium ranelate Reduces vertebral and nonvertebral fracture risk [79][80][81] Increased incidence of nausea and diarrhea during first 3 months [79,81]; potential vascular and neurological adverse events [82] PO administration daily (granules dissolved in water to drink before bed)…”

Section: Safetymentioning

confidence: 99%

“…Other clinical investigations have suggested that strontium ranelate may be associated with a risk of blood clots, seizures, and loss of memory and consciousness, although the basis for these potential adverse events is not clear [82].…”

Section: Safetymentioning

confidence: 99%

Individualizing osteoporosis therapy

Silverman

Christiansen

2012

Osteoporos Int

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Guidelines for osteoporosis treatment are available; however, these guidelines suggest when to treat patients, without specific recommendations on what drugs to prescribe in various situations. Choice of osteoporosis therapy should be individualized based on consideration of the efficacy, safety, cost, convenience (i.e., dosing regimen and delivery), and other non-osteoporosis-related benefits associated with each agent. Bisphosphonates, administered orally or intravenously, should be considered first-line therapy, particularly in older patients, owing to their efficacy across multiple skeletal sites; however, there are potential short- and long-term safety concerns. Selective estrogen receptor modulators should be considered for younger postmenopausal women at greater risk for vertebral than hip fractures or as second-line therapy in women who cannot tolerate first-line therapies. Low-dose hormone therapy may be appropriate as prevention in women with menopausal symptoms at lower fracture risk. Calcitonin, with its relatively benign safety profile, may be appropriate for elderly women who may have difficulty following the complex dosing schedules of oral bisphosphonates. Anabolic therapies such as teriparatide should be considered for high-risk patients. Strontium ranelate (approved outside of North America), with both anabolic and antiresorptive properties, may be appropriate for women who cannot tolerate or are unable to take bisphosphonates. Denosumab is a monoclonal antibody appropriate for women at high fracture risk or who have failed other osteoporosis therapies, and may be considered in patients with renal insufficiency. It will be important to incorporate newer agents (e.g., bazedoxifene, tissue selective estrogen complex) into this individualized treatment paradigm to optimize clinical outcomes in patients with osteoporosis.

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“…When administered with adequate calcium and vitamin D replacement, they are effective in improving bone mineral density (BMD), reducing bone turnover and reducing risk of both vertebral and non-vertebral osteoporotic fractures when administered orally (daily, weekly, monthly or intermittently) or intravenously (3 month intermittently or annually) [5][6][7][8][9][10][11]. Daily raloxifene has been demonstrated to reduce vertebral fracture rates in postmenopausal osteoporotic patients [12], and strontium ranelate has been demonstrated to reduce both vertebral and non-vertebral fracture rates in postmenopausal women [13]. Newer novel therapies such as subcutaneous daily teriparatide (recombinant parathyroid hormone, rPTH) and twice yearly denosumab, a human monoclonal antibody inhibiting receptor activator of NF-kappaB ligand have given the clinician a wide number of options to tackle the treatment of osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, side effects and route of administration are more important than frequency of dosing of anti-osteoporosis treatments in determining patient adherence: a critical review of published articles from 1970 to 2009

2010

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The purposes of the study were to review available published literature on magnitude of non-adherence with osteoporosis regimens and to determine the association between frequency and modality of medication administration with patient preference and adherence. We searched peer-reviewed journal databases--MEDLINE, EMBASE, Biosis and Derwent Drug File for publications (January 1979 to January 2009) including MeSH terms--"patient preference", "adherence" and "compliance" based on "dosing frequency" and "modality". Since adherence was difficult to accurately quantify, preference, compliance and persistence were evaluated. Patients' preference and adherence at 12 months were higher with weekly over daily bisphosphonates (≥ 84% preference for weekly, medication possession ratios (MPR) 60-76% vs 46-64%; persistence 43.6-69.7% vs 31.7-55.7%). MPR reported for oral bisphosphonates were 68-71% at 12 months. At 2 years, only 43% of patients had MPR ≥ 80% for daily and weekly bisphosphonates. Observational studies (6-12 months) reported discontinuation rates of 18-22% for daily and 7% for weekly bisphosphonates. Data on monthly bisphosphonates are conflicting and confounded by cost differences, patient support programmes and definition of persistence. Studies suggest patient preference for annual zoledronic acid infusions over weekly bisphosphonates (66.4-78.8% vs 9.0-19.7%, respectively), but no data on compliance or persistence are available. Drug effectiveness, side effects and route of administration were more important than frequency. Although less frequent dosing is preferred, other factors such as perceived efficacy, side effects, medication cost, availability of patient support programmes and route of delivery are equally important. Adherence is complex and difficult to quantify and may not be exclusively influenced by frequency of medication administration.

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Strontium ranelate for preventing and treating postmenopausal osteoporosis

Cited by 92 publications

References 45 publications

Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

Individualizing osteoporosis therapy

Efficacy, side effects and route of administration are more important than frequency of dosing of anti-osteoporosis treatments in determining patient adherence: a critical review of published articles from 1970 to 2009

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