Strontium Ranelate

How it works

It is thought to act on bone metabolism by both increasing bone formation and reducing bone resorption, improving bone mineral density.

Prescribing in practice

• Because of an increased risk of myocardial infarction and venous thromboembolism, it is restricted to severe osteoporosis where alternatives cannot be used and is contraindicated in ischaemic heart disease, peripheral arterial disease, cerebrovascular disease and uncontrolled hypertension.
• It has been associated with serious skin reactions including DRESS syndrome, and should be stopped immediately if a rash develops.
• Its absorption is reduced by food, milk and calcium-containing products, so dosing should be separated from these.

Monitoring

Assess cardiovascular risk before and periodically during treatment and review the continued need for therapy.

Counselling the patient

• Stop the medicine and seek medical advice immediately if you develop a skin rash.
• Take it separated from food, milk and calcium products, ideally at bedtime.
• Report any chest pain, leg swelling or breathlessness promptly.

Evidence & guidelines

European regulators restricted use following data showing an increased cardiovascular risk.