Division of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland.
Rheumatol Int. 2010 Aug;30(10):1341-8. doi: 10.1007/s00296-010-1542-y. Epub 2010 May 29.
The structural basis of the antifracture efficacy of strontium ranelate and alendronate is incompletely understood. We compared the effects of strontium ranelate and alendronate on distal tibia microstructure over 2 years using HR-pQCT. In this pre-planned, interim, intention-to-treat analysis at 12 months, 88 osteoporotic postmenopausal women (mean age 63.7 +/- 7.4) were randomized to strontium ranelate 2 g/day or alendronate 70 mg/week in a double-placebo design. Primary endpoints were changes in microstructure. Secondary endpoints included lumbar and hip areal bone mineral density (aBMD), and bone turnover markers. This trial is registered with http://www.controlled-trials.com, number ISRCTN82719233. Baseline characteristics of the two groups were similar. Treatment with strontium ranelate was associated with increases in mean cortical thickness (CTh, 5.3%), cortical area (4.9%) and trabecular density (2.1%) (all P < 0.001, except cortical area P = 0.013). No significant changes were observed with alendronate. Between-group differences in favor of strontium ranelate were observed for CTh, cortical area, BV/TV and trabecular density (P = 0.045, 0.041, 0.048 and 0.035, respectively). aBMD increased to a similar extent with strontium ranelate and alendronate at the spine (5.7% versus 5.1%, respectively) and total hip (3.3% versus 2.2%, respectively). No significant changes were observed in remodeling markers with strontium ranelate, while suppression was observed with alendronate. Within the methodological constraints of HR-pQCT through its possible sensitivity to X-ray attenuation of different minerals, strontium ranelate had greater effects than alendronate on distal tibia cortical thickness and trabecular volumetric density.
锶雷奈酸和阿仑膦酸钠抗骨折疗效的结构基础尚不完全清楚。我们使用高分辨率 pQCT 比较了雷奈酸锶和阿仑膦酸钠在 2 年内对远端胫骨微结构的影响。在这项预先计划的、中期、意向治疗分析中，12 个月时，88 名骨质疏松绝经后妇女（平均年龄 63.7±7.4 岁）按双安慰剂设计随机分为锶雷奈酸 2g/天或阿仑膦酸钠 70mg/周。主要终点是微结构的变化。次要终点包括腰椎和髋部面积骨密度（aBMD）和骨转换标志物。该试验在 http://www.controlled-trials.com 上注册，编号为 ISRCTN82719233。两组的基线特征相似。锶雷奈酸治疗与平均皮质厚度（CTh，5.3%）、皮质面积（4.9%）和小梁密度（2.1%）的增加相关（均 P＜0.001，皮质面积除外 P=0.013）。阿仑膦酸钠治疗无明显变化。锶雷奈酸治疗的 CTh、皮质面积、BV/TV 和小梁密度均优于阿仑膦酸钠（分别为 P=0.045、0.041、0.048 和 0.035）。锶雷奈酸和阿仑膦酸钠在脊柱（分别为 5.7%和 5.1%）和全髋（分别为 3.3%和 2.2%）的 aBMD 增加程度相似。锶雷奈酸治疗后骨转换标志物无明显变化，而阿仑膦酸钠治疗后则受到抑制。在高分辨率 pQCT 的方法学限制范围内，由于其对不同矿物质 X 射线衰减的敏感性，锶雷奈酸对远端胫骨皮质厚度和小梁体积密度的影响大于阿仑膦酸钠。
