Effects of strontium ranelate on bone mass and bone turnover in women with thalassemia major-related osteoporosis.

Abstract

Subjects affected by thalassemia major (TM) often have reduced bone mass and increased fracture risk. Strontium ranelate (SrR) is an effective treatment for postmenopausal and male osteoporosis. To date, no data exist on the use of SrR in the treatment of TM-related osteoporosis. Our aim was to evaluate the effects of SrR on bone mineral density (BMD), bone turnover markers and inhibitors of Wnt signaling (sclerostin and DKK-1). Twenty-four TM osteoporotic women were randomized to receive daily SrR 2g or placebo in addition to calcium carbonate (1,000mg) and vitamin D (800IU). BMD at the lumbar spine and femoral neck, bone turnover markers (C-terminal telopeptide of procollagen type I [CTX], bone-specific alkaline phosphatase [BSAP]) and insulin-like growth factor-1 (IGF-1), sclerostin and DKK-1 were assessed at baseline and after 24months. Back pain was measured by visual analog scale (VAS) every 6 months. After 24months, TM women treated with SrR had increased their spine BMD values in comparison to baseline (p<0.05). Moreover, they also exhibited a reduction of CTX and sclerostin levels (but not DKK-1) and exhibited an increase of BSAP and IGF-1 (p<0.05); however, no significant changes were observed in the placebo group. In the SrR group, a reduction of back pain was observed after 18months in comparison to baseline (p<0.05) and after 24months in comparison to placebo (p<0.05). Our study reports for the first time the effects of SrR in the treatment of TM-related osteoporosis. SrR treatment improved BMD and normalized bone turnover markers, as well as lowering sclerostin serum levels.