No difference between strontium ranelate (SR) and calcium/vitamin D on bone turnover markers in women with established osteoporosis previously treated with teriparatide: a randomized controlled trial

Summary Objective   To evaluate the effect of strontium ranelate (SR) on bone turnover markers in women with established osteoporosis previously treated with teriparatide (TPTD – recombinant human PTH 1–34). Design   patients: Twenty‐two postmenopausal Caucasian women (aged 65·7 ± 1·7 years) with established osteoporosis previously treated with TPTD 20 µg daily for 18 months were randomly assigned to receive either SR (SR group, n  = 11) or calcium and vitamin D (control group, n  = 11). Measurements   Blood samples for serum N‐terminal propeptide of type 1 collagen (P1NP), C‐terminal telopeptide of type 1 collagen (CTx) and total alkaline phosphatase (ALP) were obtained from all women before (pre‐TPTD) and after (post‐TPTD) TPTD administration, as well as 6 months after SR or calcium/vitamin D administration (post‐SR/Ca). Results   Serum P1NP, CTx and total ALP increased significantly after TPTD treatment and decreased at the end of the study in both SR and control groups, with no difference between them. Conclusions   SR following TPTD administration acts predominantly as an antiresorptive agent with no evidence of additional osteoanabolic action. In this setting, SR is not more effective than Ca/vitamin D as far as bone turnover markers are concerned.