Value of strontium in the prevention of bone fractures caused by falls in very old patients who suffer from primary osteoporosis: a systematic revision

MUSSO, CARLOS GUIDO; JAUREGUI, RICARDO; CIAPONNI, AGUSTÍN

Rev Electron Biomed

MJ Coma MD, PhD. Unidad de Investigación. Hospital General Yagüe

Año: 2011

Introduction: Since between 25-30% bone fractures, and 60% hip fractures in the general population are common in the subgroup which correspond to very old women. This happens due to the high predominance of primary osteoporosis and the incidence of falls which are characteristic of such group; thus, we have decided to investigate, through a systematic revision of the bibliography, the value of strontium in the prevention of bone fractures caused by falls in very old patients who suffer from primary osteoporosis.Material and Method: A systematic revision of the literature was carried out following the recommendations of the Cochrane methodology. Out of the 8 documents initially recovered, only two were included (2 independent reviewers selected, evaluated and extracted the data from the included tests) since such tests were the only ones which complied with the eligibility criteria tobe tests performed on a population of very old patients: older than 74 years old, thus reaching a total amount of 2616 patients who took part in this test.Results: Despite the abundance of information in favour of the treatment using strontium, there is a relative risk in the case of non-vertebral fractures one year after treatment which goes through unit: 0.58 [0.32, 1.06]. Regarding the risk of fracture at the hip level, there are certain differences when it is compared with the aforementioned data. On the one hand, the reduction of therisk of fractures (32%) after 3 years of treatment with strontium ranelate documented by the Seeman test 2006 did not reach statistical significance (p=0.112), and its relative risk goes through unit: 0.68 [0.45, 1.05]Nevertheless, the Reginster 2008 test showed that after 5 years of treatment with strontium ranelate there was a bigger reduction (43%) which was statistically significant (p=0.036) (Tables 1 and 4). Such data could mean that the hip bone may need a longer period of exposure to strontium to benefit from an effective reduction of its risk of fracture.Conclusions: The biggest reduction in the risk of fracture was evidenced in vertebral fractures compared with the non vertebral fractures, even when the IC 95% overlap significantly. Additionally, the biggest anti-fracture effect was documented one year after treatment using strontium ranelate in comparison with the 3 years of the same treatment, as well as a bigger reduction in the risk of fracture after 3 years compared with five years of it. We conclude that there are tests that support the use of strontium ranelate, in 2 grams doses administered daily for at least 3 years, to achieve a significant reduction of the incidence of vertebral as well as non vertebral fractures in very old women with primary osteoporosis.