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Effects of strontium ranelate on spinal osteoarthritis progression

O Bruyere¹, D Delferriere¹, C Roux², J D Wark³, T Spector⁴, J-P Devogelaer⁵, K Brixen⁶, S Adami⁷, J Fechtenbaum², S Kolta², J-Y Reginster¹

¹ Department of Epidemiology, Public Health and Health Economics, University of Liege, Liege, Belgium
² Department of Rheumatology, Cochin Hospital, Paris, France
³ Department of Medicine and Bone & Mineral Service, Royal Melbourne Hospital, Parkville, Australia
⁴ Department of Rheumatology, & Genetic Epidemiology, St Thomas Hospital, Kings Collegue, London, UK
⁵ St-Luc University Hostpital, Université Catholique de Louvain, Brussels, Belgium
⁶ Department of Endocrinology, Odense University Hospital, Odense, Denmark
⁷ Department of Rheumatology Unit, Valeggio, Italy

Prof Olivier BRUYERE, PhD, University of Liège, Department of Public Health, Epidemiology, and Health Economics, CHU Sart-Tilman, Bât B23, 4000 Liège, Belgium; olivier.bruyere{at}ulg.ac.be

Objective: The aim of this study was to determine whether a 3-year treatment with strontium ranelate could delay the progression of spinal osteoarthritis (OA).

Methods: This study was a post-hoc analysis of pooled data from the Spinal Osteoporosis Therapeutic Intervention (SOTI) and TReatment Of Peripheral OSteoporosis (TROPOS) trials performed on 1105 women with osteoporosis and concomitant radiological spinal OA at baseline, and for whom lumbar x-rays were available at baseline and over the 3-year treatment period. The presence and severity of osteophytes, disc space narrowing and sclerosis in the lumbar intervertebral spaces was graded according to a validated method, and an overall OA score was calculated for each intervertebral space. Back pain (measured on a five-point Likert scale only in SOTI) and health-related quality of life (SF-36 questionnaire) were assessed at baseline and after 3 years. Patients who suffered an incident or progressive vertebral fracture during the study were excluded from the analysis.

Results: The proportion of patients with worsening overall spinal OA score was reduced by 42% in the strontium ranelate group, compared with placebo (RR, 0.58; 95% CI, 0.42 to 0.79; p = 0.0005). Significantly more patients in the strontium ranelate group experienced an improvement in back pain after 3 years, compared with placebo (p = 0.03), while no significant difference was observed in terms of health-related quality of life between these patient groups.

Conclusions: The results of this post-hoc analysis suggest that strontium ranelate could reduce the progression of the radiographic features of spinal OA and back pain in women with osteoporosis and prevalent spinal OA.

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