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DTB review Strontium

The Drugs and Therapeutics Bulletin has published a review of Strontium Ranelate (Protelos)® for osteoporosis.

NHS staff can access the iDTB via the National Electronic Library for Health.

The article discusses the trial data, which shows a statistically significant reduction in vertebral factures. A post-hoc analysis was also conducted that found a significant reduction in hip fracture. However, post-hoc analyses should be viewed with caution.

Adverse effects are also discussed, nausea and diarrhoea are common and although transient these effects account for most of the discontinuations of the treatment. Of greater concern is the statistically significant increase (42%) in venous thromboembolism. There have also been reports of disturbances of consciousness, memory loss and seizures.

The article concludes that Bisphosphonates (e.g. Alendronate) remain first line treatment for secondary prevention of fractures in osteoporosis. Strontium should be reserved for patients who cannot tolerate any bisphosphonate and all side effects should be reported via Yellow Cards.

Action: Clinicians should continue to use bisphosphonates as first line treatment, with calcium and vitamin D supplements, for prevention of fractures in patients with osteoporosis.