IBMS BoneKEy | Perspective

Bone quality and strontium ranelate

Georges Boivin



Given its increasing incidence and serious complications, osteoporosis requires safe and effective long-term treatment. Strontium ranelate is an osteoporosis treatment with a broad spectrum of safety and efficacy in reducing the risks of both vertebral and nonvertebral (including hip) fractures in a wide variety of patients. This treatment should be considered as a first-line option to treat women at risk of osteoporotic fractures, whatever their age, the severity of the disease and their risk factors. The analysis of transiliac bone biopsies has provided further evidence of the good bone tissue safety of strontium ranelate. Results are fully consistent with the mode of action of strontium ranelate involving dissociation between bone formation and bone resorption. Strontium ranelate treatment appears to stimulate both trabecular and cortical bone formation in 3D analyses, but without increasing cortical porosity. The change in 3D trabecular and cortical microarchitecture may improve bone biomechanical competence and explain the decreased fracture rate after treatment. We now have evidence that strontium (Sr) is heterogeneously distributed in bone tissue and is exclusively present in bone formed after the beginning of treatment. Sr is absent from old bone formed before treatment, but focal bone Sr content is constant during treatment. Whatever the duration of treatment and the content of Sr in bone, the variables reflecting secondary mineralization at the tissue level are maintained at normal levels. However, the influence of Sr on the quality of bone mineral and its mineralization remains to be clarified.

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