Arzneimittelforschung 2010; 60(5): 267-272
DOI: 10.1055/s-0031-1296284
Anti-osteoporotic Drugs
Editio Cantor Verlag Aulendorf (Germany)

Efficacy of strontium ranelate on bone mineral density in men with osteoporosis

Ringe Johann D
1   West German Osteoporosis Center (WOC) and Medical Clinic 4, Klinikum Leverkusen, University of Cologne, Germany
Dorst Alfred
1   West German Osteoporosis Center (WOC) and Medical Clinic 4, Klinikum Leverkusen, University of Cologne, Germany
Farahmand Parvis
1   West German Osteoporosis Center (WOC) and Medical Clinic 4, Klinikum Leverkusen, University of Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
02 December 2011 (online)


In an open-label, prospective, controlled, 12-month study the effects of strontium ranelate (SR, CAS 135459-87-9) or alendronate (CAS 129318-43-0) on bone mineral density (BMD) were compared in 152 men with primary osteoporosis. Patients were randomized to SR 2 g/day (n = 76) or alendronate 70 mg/week (n = 76) supplemented daily with 1200 mg calcium and 800 IU vitamin D. The main outcome measure was percent change in lumbar spine and total hip BMD from baseline.

Mean BMD ( ± SD) increased by 5.8 ± 3.7% at the lumbar spine and 3.5 ± 2.8% at the total hip with SR compared to increases of 4.5 ± 3.4% and 2.7 ± 3.2%, respectively, with alendronate. Increases in BMD in the SR group are consistent with 1-year results from two pivotal fracture studies in postmenopausal women with osteoporosis. SR was associated with a 22% greater increase in BMD at the lumbar spine (p = 0.033) and 23% greater increase at the total hip (p = 0.002) than alendronate. New fractures were observed in 7 SR and 10 alendronate patients. Height loss (− 0.1 ± 0.7 cm) was less with SR compared with alendronate (− 0.5 ± 0.8 cm) (p = 0.026). SR was also associated with significantly greater reductions in back pain and analgesic use scores. Adverse events were experienced by 28 (37%) patients in the SR group and 38 (50%) patients in the alendronate group, none of which were serious.

In men with osteoporosis, SR produced significantly greater mean increases in BMD over 12 months compared with alendronate, an agent already approved for male osteoporosis. Mean increases in BMD with SR in men were similar to those previously documented for this agent in postmenopausal women, suggesting that similar benefits on anti-fracture efficacy may be expected.

  • References

  • 1 Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd MJones. Treatment of established osteoporosis: a systematic review and costutility analysis. Health Technol Assess. 2002; 6 No. 29
  • 2 Hosking D, Ringe J. editors. Treatment of metabolic bone disease. Management strategy and drug therapy. London: Martin Dunitz 2000
  • 3 Gennari L, Bilezikian JP. Osteoporosis in men. Endocrinol Metab Clin N Am. 2007; 36: 399-419
  • 4 National Osteoporosis Foundation (NOF). America’s bone health: The state of osteoporosis and low bone mass. Washington, DC: National Osteoporosis Foundation; 2002.
  • 5 EPOS Group. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2002; 17: 716-24
  • 6 Sambrook P, Cooper C. Osteoporosis. Lancet. 2006; 367: 2010-18
  • 7 Cummings SR, Cawthon PM, Ensrud KE, Cauley JA, Fink HA, Orwoll ES. Osteoporotic Fractures in Men (MrOS) Research Groups; Study of Osteoporotic Fractures Research Groups. BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res. 2006; 21: 1550-6
  • 8 Szulc P, Munoz F, Duboeuf F, Marchand F, Delmas PD. Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study. Osteoporos Int. 2005; 16: 1184-92
  • 9 Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005; 20: 1185-94
  • 10 Bonnelye E, Chabadel A, Saltel F, Jurdic P. Dual effect of strontium ranelate: stimulation of osteoblast differentiation and inhibition of osteoclast formation and resorption in vitro. Bone. 2008; 42: 129-38
  • 11 Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD et al The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004; 350: 459-68
  • 12 Reginster JY, Seeman E, De MCVernejoul, Adami S, Compston J, Phenekos C et al Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: TROPOS study. J Clin Endocrinol Metab. 2005; 90: 2816-22
  • 13 Seeman E, Vellas B, Benhamou C, Aquino JP, Semler J, Kaufman JM et al Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women aged eighty years and over. J Bone Miner Res. 2006; 21: 1113-20
  • 14 Reginster JY, Felsenberg D, Boonen S, Diez-Perez A, Rizzoli R, Brandi ML et al Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: results of a five-year, randomized, placebo-controlled trial. Arthritis Rheum. 2008; 58: 1687-95
  • 15 Roux C, Reginster JY, Fechtenbaum J, Kolta S, Sawicki A, Tulassay Z et al Vertebral fracture risk reduction with strontium ranelate in women with postmenopausal osteoporosis is independent of baseline risk factors. J Bone Miner Res. 2006; 21: 536-42
  • 16 Seeman E, Devogelaer JP, Lorenc R, Spector T, Brixen K, Balogh A et al Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. J Bone Miner Res. 2008; 23: 433-8
  • 17 Roux C, Fechtenbaum J, Kolta S, Isaia G, Andia JB, Devogelaer JP. Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis. 2008; 67: 1736-8
  • 18 Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J et al Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000; 343: 604-10
  • 19 Ringe JD, Faber H, Dorst A. Alendronate treatment of established primary osteoporosis in men: results of a 2-year prospective study. J Clin Endocrinol Metab. 2001; 86: 5252-5
  • 20 Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH et al Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 333: 1437-43
  • 21 Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA et al Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res. 2002; 17: 2222-30
  • 22 Bruyère O, Roux C, Detilleux J, Slosman DO, Spector TD, Fardellone P et al Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrin Metab. 2007; 92: 3076-81
  • 23 Bruyère O, Roux C, Badurski J, Isaia G, deVernejoul MC, Cannata J et al Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate. Curr Med Res Opin. 2007; 23: 3041-5
  • 24 Kanis J, Burlet N, Cooper C, Delmas PD, Reginster JY, Borg-strom F et al European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and treatment of osteoporosis in postmenopausal women. Osteoporos Int. 2008; 19: 399-428
  • 25 Marie PJ. Strontium ranelate: a dual mode of action rebalancing bone turnover in favour of bone formation. Curr Opin Rheumatol. 2006; 18 (01) Sll-5
  • 26 Arlot ME, Jiang Y, Genant HK, Zhao J, Burt-Pichat B, Roux JP et al Histomorphometric and microCT analysis of bone biopsies from postmenopausal osteoporotic women treated with strontium ranelate. J Bone Miner Res. 2008; 23: 215-22
  • 27 Marquis P, Roux C, Diaz-Curiel M. Long-term beneficial effects of strontium ranelate on the quality of life in patients with vertebral osteoporosis (SOTI study). Osteoporos Int. 2007; 18 (01) S123
  • 28 Nevitt MC, Thompson DE, Black DM, Rubin SR, Ensrud K, Yates AJ et al Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med. 2000; 160: 77-85
  • 29 Marquis P, Roux C, De la CLoge, Diaz-Curiel M, Cormier C, Isaia G et al Strontium ranelate prevents quality of life impairment in postmenopausal women with established vertebral osteoporosis. Osteoporos Int. 2008; 19: 503-10