The Spinal Osteoporosis Therapeutic Intervention (SOTI) study was aimed at assessing the effect of strontium ranelate on the risk of vertebral fractures [122]. The Treatment of Peripheral Osteoporosis (TROPOS) trial aimed to evaluate the effect of strontium ranelate on peripheral (nonspinal) fractures [129]. Both studies were multinational, randomized, double-blind, and placebo-controlled, with two parallel groups (strontium ranelate 2 g/day, taken orally 2 h apart from the meals vs. placebo) [122, 129]. The study duration was 5 years, with main statistical analysis planned after 3 years Anlotinib of follow-up. One thousand six hundred forty-nine

patients were included in SOTI (mean age 70 years), and 5,091 patients were included in TROPOS (mean age 77 years) [130]. The primary analysis of SOTI [122] (ITT, n = 1,442), evaluating the effect of strontium ranelate 2 g/day on vertebral fracture rates, revealed a 41% reduction in RR of experiencing a new vertebral fracture (semiquantitative DihydrotestosteroneDHT mouse assessment) with strontium ranelate throughout the 3-year study compared with placebo (139 patients with vertebral fracture vs. 222, respectively (RR, 0.59; 95% CI, 0.48–0.73; p < 0.001). The RR of experiencing a new vertebral fracture was significantly reduced ��-Nicotinamide supplier in the strontium ranelate

group as compared with the placebo group for the first year. Over the first 12 months, RR reduction was 49% (RR, 0.51; 95% CI, 0.36–0.74; Cox model p < 0.001). The primary analysis of TROPOS (ITT, n = 4,932), evaluating the effect of strontium ranelate 2 g/day on nonvertebral fracture, showed a 16% RR reduction in all

nonvertebral fractures over a 3-year follow-up period (RR, 0.84; 95% CI, 0.702–0.995; p = 0.04) [129]. Strontium Smoothened ranelate treatment was associated with a 19% reduction in risk of major nonvertebral osteoporotic fractures (RR, 0.81; 95% CI, 0.66–0.98; p = 0.031). In the high-risk fracture subgroup (n = 1,977; women; mean age ≥ 74 years; femoral-neck BMD T-score of less than or equal to −2.4 according to National Health and Nutrition Examination Survey normative value), treatment was associated, in a post hoc analysis requested by the European regulatory authorities, with a 36% reduction in risk of hip fracture (RR, 0.64; 95% CI, 0.412–0.997; p = 0.046). Of the 5,091 patients, 2,714 (53%) completed the study up to 5 years [130]. The risk of nonvertebral fracture was reduced by 15% in the strontium ranelate group compared with the placebo group (RR, 0.85; 95% CI, 0.73–0.99). The risk of hip fracture was decreased by 43% (RR, 0.57; 95% CI, 0.33–0.97), and the risk of vertebral fracture was decreased by 24% (RR, 0.76; 95% CI, 0.65–0.88) in the strontium ranelate group. After 5 years, the safety profile of strontium ranelate remained unchanged compared with the 3-year findings [131].