Cardiac concerns associated with strontium ranelate

Area of Science:

• Osteoporosis treatment
• Cardiovascular safety of medications

Background:

• Strontium ranelate is effective in reducing vertebral and non-vertebral fractures in osteoporosis patients.
• Cardiac safety concerns have led to contraindications for strontium ranelate in patients with specific cardiovascular conditions.

Purpose of the Study:

• To evaluate the cardiac safety of strontium ranelate.
• To assess the risk of myocardial infarction (MI) associated with strontium ranelate treatment.

Main Methods:

• Literature search and data collection from the European Medicines Agency.
• Analysis of randomized controlled trial (RCT) data on MI incidence.
• Review of observational studies from real-life medical practice.

Main Results:

• RCTs showed a higher incidence of non-adjudicated MI with strontium ranelate versus placebo (1.7% vs 1.1%).
• No increase in cardiovascular mortality was observed.
• Excluding patients with cardiovascular contraindications mitigated the MI risk (OR: 0.99).
• Observational studies in real-life settings did not report a cardiac safety signal.

Conclusions:

• Increased cardiac event risk with strontium ranelate detected in RCTs, but not in real-world data.
• Excluding patients with cardiovascular contraindications effectively controls MI risk.
• Strontium ranelate remains a viable option for severe osteoporosis patients without cardiovascular contraindications who cannot tolerate other treatments.