Background Although glucocorticoids (GC) may effectively be used in the management of many inflammatory conditions, such as asthma, rheumatoid arthritis, inflammatory bowel disease and autoimmune diseases, their use is associated with significant morbidity and mortality. Osteoporosis, with resultant fractures, constitutes one of these morbid complications and is associated with significant pain and disability. According to ACR 2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis (GIOP) bisphosphonates should be used as a first-line treatment in these patients. Nevertheless, in some cases of chronic continuous use of GC bisphosphonates remain inefficacious, creating a major requisite for investigation of efficacy of other anti-osteoporotic medications in the treatment of GIOP
Objectives To evaluate the efficacy of strontium ranelate after 24 weeks of treatment of GIOP in postmenopausal women with inadequate response to bisphosphonates.
Methods 30 female postmenopausal patients (mean age (± SD) 51,87±4,9 years, mean daily dose of prednisone 8,16±2,7 mg, mean duration of GC therapy 12,5±9,07 months, 13 patients (43,3%) had prior history of fragility fractures) with rheumatoid arthritis and confirmed concomitant GIOP, having prior inadequate response to bisphosphonates, were treated with strontium ranelate (2 g/daily) for a follow-up period of 24 weeks. Calcium and vitamin D preparations in standard doses were included in the treatment regimen. Exclusion criteria included congenital bone defects, endocrine diseases, hematological diseases, renal diseases, cardiovascular diseases. Dual-energy x-ray absorptiometry (DXA), vertebral and hip imaging, as well as determination of serum concentration of β-CrossLaps (β-form of C-terminal telopeptide of type I collagen) were performed twice – at baseline and at the end of follow-up period. Routine investigation included accurate collection of disease history, objective examination with determining the disease activity (DAS) and functioning (HAQ-Di and global functional status), CBC, measurement of plasma creatinine level and lipid profile, ECG, echocardiography and other examinations.
Results DXA had shown the following results at baseline: mean spine T-score -3,16±0,48, mean hip T-score -3,18±0,52. Serum concentration of β-CrossLaps at baseline made 989,9±506,4 pg/mL. All enrolled patients completed 24 weeks of treatment. Strontium ranelate was well tolerated, no serious adverse events occurred. At the end of study period DXA mean T-scores both spine and hip had shown significantly higher results: -3,0±0,45 (p<0,01) and -3,01±0,53 (p<0,05) respectively. Mean serum concentration of β-CrossLaps after 24 weeks of strontium ranelate treatment was significantly lower than at baseline (874,4±505,6 pg/mL, p<0,05).
Conclusions Strontium ranelate may be used for the treatment of GIOP in patients with inadequate response to bisphosphonates. Taking into account the possible negative impact of strontium ranelate on cardiovascular system, serious measurement of cardiovascular risk should be done before the prescription of the drug.
S.S. Yeap, D.J. Hosking. Management of corticosteroid-induced osteoporosis. Rheumatology 2002;41:1088–1094.
National Osteoporosis Foundation. 2013 Clinician's Guide to Prevention and Treatment of Osteoporosis. http://nof.org/hcp/clinicians-guide.
Disclosure of Interest None declared