Normalization of bone mineral density after five years of treatment with strontium ranelate.

E.F., female, age 58, mother of 4 children and otherwise healthy, had gone into menopause when she was 42. She had received hormone replacement therapy during 8 years. Due to low bone mass she had been treated with oral alendronate during 7 years. She had a normal calcium intake in her diet and engaged in regular physical activity. She did not smoke, and drank alcohol only occasionally. Her mother had sustained a hip fracture at age 90. Bone densitometry of her lumbar spine by DXA showed a T-score of -3.0; standardized bone mineral density (sBMD) had decreased by 11% in the previous 3 years. She was advised to start treatment with strontium ranelate (SrR) 2 g/day, plus oral cholecalciferol (1,000 IU/day). Three months later serum alkaline phosphatase had increased 10%, and serum osteocalcin was 18.9 ng/ml (upper normal limit 13.7). One year later her lumbar BMD had increased by 13.5%. After five years of treatment the BMD value was normal (1.357 g/cm(2); T-score -0.3). The case presented here is noteworthy for two reasons. Firstly, the patient maintained low bone mass after several years of combined treatment with alendronate and hormone replacement; this combination usually induces greater densitometric responses than either treatment given alone. Secondly, she responded promptly and significantly to SrR in spite of the previous long exposure to alendronate. SrR is widely used for the treatment of osteoporosis. It is an effective and safe drug, provided the patients are properly selected. As shown here, it can help some patients to achieve a normal BMD.