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The Benefits of Strontium in the treatment for Osteoporosis Questioned

Strontium ranelate for the treatment of osteoporosis is useful, but changes in bone// mineral density need careful interpretation. Nowadays the main treatment options are anti-resorptive agents that prevent bone breakdown.

For patients with previous fractures, treatment with an anabolic agent that enhances bone formation is preferable, and this is now possible since the introduction of recombinant parathyroid hormone (PTH). However, the use of PTH is limited by its high cost and the need for subcutaneous self-injection.

Recently strontium ranelate has been licensed in the United Kingdom for the treatment of osteoporosis. The mechanism of action of strontium ranelate is not yet fully understood, compared with other treatments, but it seems to have a unique effect in that it inhibits bone resorption as well as stimulating bone formation. Recent studies have shown its efficacy at preventing both vertebral and non-vertebral fractures, including hip fractures in older women. Strontium ranelate was well tolerated in these trials and the most common side effects reported were nausea and diarrhea.

Strontium ranelate is composed of two atoms of stable strontium combined with organic ranelic acid. The ranelic acid is a carrier that makes the treatment palatable, and the strontium is the active component with regard to the skeleton. As an alkaline earth element, strontium is similar to calcium in its absorption in the gut, incorporation in bone, and elimination from the body through the kidneys.

Strontium is naturally present in trace amounts with around 100 μg in every gram of bone, so treatment with strontium ranelate is simply making more strontium available for incorporation into bone. In the short term the strontium atoms are adsorbed on to the surface of hydroxyapatite crystals, and in the longer term some strontium will exchange with calcium in the bone mineral and may remain bound in the skeleton for years.

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