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WOMEN'S HEALTH

Short-Term Hemostatic Safety of Strontium Ranelate Treatment in Elderly Women with Osteoporosis

Specialist in Internal Medicine, Fellow in Geriatric Medicine, Medical Faculty, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey

Mustafa Cankurtaran, MD

Specialist and Medical Instructor in Geriatric Medicine, Medical Faculty, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University

Burcu Balam Yavuz, MD

Specialist in Internal Medicine, Fellow in Geriatric Medicine, Medical Faculty, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University

Zekeriya Ulger, MD

Resident in Geriatric Medicine, Medical Faculty, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University

Serhan Piskinpasa, MD

Resident in Internal Medicine, Medical Faculty, Department of Internal Medicine, Hacettepe University

Arzu Gedik, MD

Resident in Internal Medicine, Medical Faculty, Department of Internal Medicine, Hacettepe University

Ibrahim Celalettin Haznedaroglu, MD

Professor, Medical Faculty, Department of Internal Medicine, Division of Haematology, Hacettepe University

Serafettin Kirazli, PhD

Director of Coagulation Laboratory, Medical Faculty, Department of Internal Medicine, Division of Hematology, Hacettepe University

Servet Ariogul, MD

Professor, Medical Faculty, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University

Reprints: Dr. Halil, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Sihhiye, 06100 Ankara, Turkey, fax 90-312-311-7208, meltemhalil{at}yahoo.com

BACKGROUND: Strontium ranelate offers significant clinical benefits in terms of efficacy, tolerability, and ease of administration in the treatment of postmenopausal osteoporosis. However, there are some data revealing an association between strontium ranelate treatment and increased incidence of venous thromboembolism (VTE), suggesting possible adverse prothrombotic effects of the drug.

OBJECTIVE: To assess the effect of strontium ranelate treatment on primary hemostasis, secondary hemostasis, and the natural anticoagulant defense system, together with prothrombotic markers, in elderly women with osteoporosis.

METHODS: This study was designed in a prospective manner. Thirty-five elderly women diagnosed with osteoporosis were included. During a 2 month treatment period, participants received strontium ranelate 2 g. Platelet Function Analyzer-100 (PFA-100) in vitro bleeding time was performed to depict primary hemostasis. Secondary hemostatic parameters including prothrombin time, international normalized ratio, activated partial thromboplastin time, anti-cardiolipine immunoglobulin (Ig) M and IgG, antiphospholipid IgM and IgG, protein C, protein S, antithrombin III, lupus anticoagulant, fibrinogen, thrombin, activated protein C resistance, and plasma levels of D-dimer were assessed. These parameters were tested before and after 2 month treatment with strontium ranelate.

RESULTS: Mean ± SD age of the patients was 72.82 ± 5.69 years. After 60 days of treatment, there was no statistically significant prolongation in PFA-100 in vitro bleeding time and no statistically significant change in the critical hemostatic parameters in patients receiving strontium ranelate that led to discontinuation of the treatment. None of the subjects developed clinical VTE during the 2 month period of strontium ranelate treatment.

CONCLUSIONS: The hemostatic safety of strontium ranelate in the elderly population with osteoporosis was shown over 2 months of treatment; however, its long-term hemostatic safety should be evaluated further.

Key Words: elderly, hemostasis, osteoporosis, strontium ranelate

Published Online, December 19, 2006. www.theannals.com, DOI 10.1345/aph.1H506