Abstract

Is there potential for strontium ranelate in the management of osteoarthritis?

Author(s): Jean-Yves Reginster*, Franz Pelousse and Olivier Bruy�?¨re

Although the exact process of osteoarthritis (OA) has yet to be elucidated, increasing evidence suggests that intensive biological and mechanical cross-talk between subchondral bone and cartilage becomes abnormal in OA. Compounds with a potential to influence the cartilage–subchondral bone unit, based on their mechanical or biologic properties might constitute a breakthrough in medical treatment of OA. Strontium ranelate (SR) is an antiosteoporotic drug that acts on bone remodeling, based on the concept of inducing opposite effects on bone resorption and formation. In postmenopausal osteoporosis, SR was shown to reduce vertebral, nonvertebral and hip fractures, in a wide range of patients (e.g., osteopenic subjects, patients between 50 and 65 years old, between 70 and 80 years old, over 80 years old, and patients without prevalent fracture, with one prevalent fracture or with multiple prevalent fractures). In cellular and molecular models of OA, SR prevents subchondral bone resorption and stimulates cartilage matrix synthesis. It also reduces the progression of in vivo experimental dog OA by inhibiting the expression of mediators of cartilage degradation and bone sclerosis. In women treated with SR for postmenopausal osteoporosis, biological markers of cartilage degradation are significantly reduced and radiological progression of spinal OA is decreased. SR is currently being tested in an extensive Phase III program for its ability to reduce progression of knee OA and to improve symptoms of the disease.