Is strontium ranelate safe to use for patients with renal impairment?
Strontium is an alkaline earth element similar to calcium that is present in trace amounts in healthy bone. For patients with severe osteoporosis, treatment with strontium ranelate increases the amount of strontium available for incorporation into bone.
Strontium ranelate is not recommended for patients with severe renal impairment (creatinine clearance <30ml/min) or for patients undergoing renal replacement therapy (RRT). In the absence of bone safety and pharmacokinetic data, there are concerns that strontium may accumulate in these patients (clinical trials have shown that steady state strontium concentrations were increased by around 50% when CrCl was below 25ml/min and an inconclusive link between strontium accumulation and bone disease has been identified.
An increased incidence of nervous system disorders has also been reported in those taking strontium ranelate who have severe renal impairment. There is evidence to suggest that naturally occurring dietary strontium may also accumulate in patients with renal impairment and in those undergoing RRT; however, the clinical consequences of this are uncertain.
Strontium ranelate can be given to patients with mild-to-moderate renal impairment (CrCl 30–70ml/min) without a need for dose adjustment. Although periodic assessment of renal function is advised, there are no recommendations on the frequency of monitoring required.
The decision to stop the drug in patients with declining renal function should be considered on an individual basis — taking note of recent changes to its use in cardiovascular disease. Decisions to prescribe strontium ranelate should balance the potential benefits of therapy against the risks.
This FAQ is taken from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from www.evidence.nhs.uk (prepared June 2013). NHS Evidence is provided by the National Institute for Health and Care Excellence and incorporates content formerly held in theNational electronic Library for Medicines
Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11125110
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