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Submitted on December 13, 2006
Accepted on May 31, 2007
WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders, University of Liège, Liège, BELGIUM; University of Paris, Hôpital Cochin, Department of Rheumatology, Paris, FRANCE; Clinique Générale Beaulieu, Genève, SWITZERLAND; St Thomas Hospital, Department of Rheumatology, London, UNITED KINGDOM; Hôpital Nord, Service de Rhumatologie, Amiens, FRANCE, Odense University Hospital, Odense, DENMARK; Université Catholique de Louvain, Saint-Luc University Hospital, Brussels, BELGIUM, Fundacion Jimenez Diaz, Servicio de Medicina Interna,; Unidad de Metabolismo Oseo, Madrid, SPAIN; University of Rome La Sapienza, Roma, ITALY; Gent University Hospital, Gent, BELGIUM; Hillerod Hospital, Dpt of Clinical Physiology, Hillerod, DENMARK
* To whom correspondence should be addressed. E-mail: olivier.bruyere{at}ulg.ac.be.
Objective: To analyze the relation between bone mineral density (BMD) changes and fracture incidence during 3-year treatment with strontium ranelate.
Patients: Women from the strontium ranelate arm of the Spinal Osteoporosis Therapeutic Intervention study (SOTI) and the TReatment Of Peripheral OSteoporosis study (TROPOS).
Outcome Measures: BMD at the lumbar spine, femoral neck, and total proximal femur assessed at baseline and after a follow-up of 1 and 3 years. Semiquantitative visual assessment of vertebral fractures. Non-vertebral fractures based on written documentation.
Results: After 3 years of strontium ranelate treatment, each percentage point increase in femoral neck and total proximal femur BMD was respectively associated with a 3% (95% adjusted CI 1%-5%) and 2% (1%-4%) reduction in risk of a new vertebral fracture. The 3-year changes in femoral neck and total proximal femur BMD explained 76% and 74%, respectively, of the reduction in vertebral fractures observed during the treatment. Three-year changes in spine BMD were not statistically associated with the incidence of new vertebral fracture (P=0.10). No significant associations were found between 3-year changes in BMD and incidence of new non-vertebral fractures, but a trend was found for femoral neck BMD (P=0.09) and for total proximal femur BMD (P=0.07). An increase in femoral neck BMD after 1 year was significantly associated with the reduction in incidence of new vertebral fractures observed after 3 years (P=0.04).
Conclusion: During 3 years of strontium ranelate treatment, an increase in femoral neck BMD was associated with a proportional reduction in vertebral fracture incidence.
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