Strontium ranelate 

Action and Spectrum

Actions and spectrum:  

Bone Formation Stimulation: Strontium ranelate had the ability to increase the formation of new bone tissue or Bone Formation Rate. It was believed to incite the formation of osteoblasts thus enhancing bone density.
Bone Resorption Inhibition: It prevented or slowed down the process of bone resorption, through which bone is dissolved releasing its minerals to the blood. Hence, it concentrated on inhibiting bone resorption to help prevent the continuous loss of bone density.
Calcium-Like Effects: Strontium ranelate is chemically like calcium. It used to believe that it gets deposited in the bone matrix in a manner like calcium, which helps in improving the bone mass. 

Drug Interaction

Adverse Reaction

Frequency not defined  

venous thromboembolism  

Hypercholesterolaemia  

Headache  

memory loss  

paraesthesia  

Dizziness  

Myocardial infarction  

Vertigo  

Nausea  

vomiting  

gastrointestinal pain  

dyspepsia  

Flatulence  

diarrhoea  

abdominal pain  

gastroesophageal reflux  

constipation  

Black Box Warning

Black Box Warning: 

The combination of strontium ranelate is categorized under black box warning due to high risk of Venous thromboembolism. 

Contraindication / Caution

Contraindication/Caution:  

Contraindication:  

Known Cardiovascular Disease 

Uncontrolled Hypertension 

Known Hypersensitivity or Allergy  

Caution:  

Cardiovascular Monitoring 

Pre-existing Cardiovascular Conditions 

Hypertension 

Discontinuation in Certain Populations  

Pregnancy / Lactation

Pregnancy/Lactation: 

Pregnancy consideration:  

Pregnancy category: Not assigned  

Lactation: Excreted into human milk is unknown  

Pregnancy category:  

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.  
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.  
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.  
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.  
• Category N: There is no data available for the drug under this category.  

Pharmacology

Pharmacology: 

It was believed that the drug has a direct positive impact on bone formation while at the same time, slowing down bone resorption.  

Pharmacodynamics:  

Bone Formation Stimulation: The osteoblasts, which are cells responsible for forming bones, were thought to be stimulated by strontium ranelate. This effect was designed to boost the level of bone density and thus have a positive impact on bone quality and could be useful in treating osteoporosis.
Inhibition of Bone Resorption: Besides the ability to stimulate bone formation as well as bone mineralization, it was believed that strontium ranelate also suppressed the functions of osteoclasts, cells involved in bone resorption. 

Pharmacokinetics:  

Absorption 

The drug is taken orally and absorbed from the GI tract. 

Distribution 

Strontium is found throughout the body, with a main concentration in bone tissue, where it is thought to influence bone metabolism through its pharmacological effects. 

Metabolism 

Strontium ranelate undergoes minimal metabolism in the body.  

Excretion and Elimination 

Renal excretion is the main route for strontium elimination. Most of the strontium component is eliminated through the urine. 

Adminstartion

Administration:  

Typically, strontium ranelate was taken orally with water, and it was suggested that it can be taken at night on an empty stomach. 

Patient Information Leaflet

Patient information leaflet  

Generic Name: strontium ranelate  

Pronounced: (Stron-tee-um ran-el-ate)  

Why do we use strontium ranelate? 
Strontium ranelate was approved to be used for the management of osteoporosis in postmenopausal females. The drug application was expected to reverse conditions such as osteoporosis and decrease incidences of fractures. Strontium ranelate has both a direct function, which is bone-forming activity and an indirect action, which is anti-resorptive activity.