Strontium Ranelate CAS 135459-87-9

The EMA concluded that the benefits of strontium ranelate outweighed the risks in patients with severe osteoporosis who were not contraindicated. Furthermore, contraindications to strontium ranelate are easily identified and monitored through routine medical practice, meaning they do not prevent proper patient management.

1. It is important to have a wide range of options for treating osteoporosis. In fact, many patients cannot take oral bisphosphonates because of contraindications or intolerable side effects. Although side effects are insignificant in most cases, they persist for 1 year in about 45% and are often the reason for discontinuation of treatment. The side effects of intravenous injection are similar to flu-like symptoms, and patients with renal impairment need to be treated with caution. At the same time, side effects of long-term use of bone resorption inhibitors have been reported rarely, but serious once they occur, such as atypical fractures or osteonecrosis of the jaw. Therefore, alternative therapy is warranted in patients with severe osteoporosis who cannot tolerate other drugs or who have been taking bone resorption inhibitors for many years.
2. The compliance with strontium ranelate is very good, which is suitable for patients who cannot tolerate other drugs. An informal survey in Southampton, UK showed that 30% of osteoporotic patients discontinued or could not tolerate bisphosphonates, of whom 50% had no contraindications to strontium ranelate. This suggests that at least 15% of patients with typical postmenopausal osteoporosis could be treated with strontium ranelate. Furthermore, since good adherence is recognized as an important component of cost-effectiveness, this may further contribute to the cost-effectiveness of strontium ranelate.
3. It is important to compare the mechanism of action of strontium ranelate with other drugs. Osteoporosis is treated in a variety of ways, broadly divided into bone resorption inhibitors (bisphosphonates, selective estrogen modulators, and anti-RANKL drugs) and bone-forming agents (parathyroid hormone 1–34). Strontium ranelate promotes bone rebuilding unlike other medications. This unique mechanism attenuates the inhibition of bone turnover by bone resorption inhibitors, and the distinct mechanism of action prevents discontinuation of pharmacological therapy to maintain continued protection against long-term osteoporotic fractures.

Thus, strontium ranelate is an excellent option in the management of osteoporosis today, and it is also useful in patients on long-term use of bone turnover inhibitors, especially those who have suffered fractures.