Strontium Ranelate Toxicity - Causes, Health Effects, Diagnosis, and Treatment

Introduction:

Strontium ranelate is a medication made up of two elements; strontium and ranelic acid with the chemical formula of C12H6N2O8SSr2. Strontium is a metallic element that is similar in properties to calcium, which is an essential mineral for healthy bones. Ranelic acid is a synthetic compound that is used to deliver strontium to the body. It is used in the treatment of osteoporosis, a condition where bones deteriorate and turn brittle. The alternative names of strontium ranelate are Protelos, Distrontium renelate, and Osseor.

This agent has a distinctive mode of action, as it promotes the deposition of new bone by osteoblasts while inhibiting the resorption of bone by osteoclasts. This unique property has led to its promotion as a dual-action bone agent (DABA), specifically intended for treating severe osteoporosis. Moreover, several clinical investigations have shown that strontium ranelate can enhance the intrinsic quality and microstructure of bone tissue in osteoporosis through different cellular and microstructural changes, resulting in increased anti-fracture efficacy.

What Are the Uses of Strontium Ranelate?

Strontium ranelate is a medication used to treat osteoporosis (a condition characterized by insufficient bone mass and an increased risk of fractures). Strontium ranelate is usually taken orally in the form of a tablet.

• The medication works by increasing bone density and reducing the risk of fractures, especially in postmenopausal women who are at high risk of osteoporotic fractures.
• It is prescribed for postmenopausal women with osteoporosis or who have a high risk of osteoporotic fractures. Studies have demonstrated that the medication effectively lowers the likelihood of both vertebral and non-vertebral fractures and improves bone mineral density.
• Several studies have explored the potential application of strontium ranelate in treating additional conditions, including osteoarthritis and bone pain associated with cancer. However, additional research is necessary to evaluate the effectiveness and safety of strontium ranelate specifically for these conditions.

What Is Strontium Ranelate Toxicity?

Strontium ranelate toxicity refers to the potentially harmful effects of strontium ranelate developed while using this medication in the treatment of osteoporosis. Cardiovascular events stand out as one of the most alarming adverse effects associated with the use of strontium ranelate. Several studies have found that the medication can elevate the risk of stroke and heart attack.

What Are the Causes of Strontium Ranelate Toxicity?

The following are the factors that cause strontium ranelate toxicity:

• Overdose: Taking too much strontium ranelate can lead to toxicity. This can occur if the medication is not taken as prescribed, or if multiple doses are taken at once.
• Impaired Kidney Function: Strontium ranelate is primarily eliminated from the body through the kidneys. Patients with impaired kidney function may be at higher risk for toxicity, as the medication may build up in the body.
• Cardiovascular Disease: This medication is not used in patients with higher blood pressure and patients with a previous and present history of heart disease. As the chance of developing toxicity is high in such individuals.
• Interactions With Other Medications: Strontium ranelate may interact with other medications, such as calcium supplements or certain antibiotics, leading to toxicity.
• Genetics: Some patients may be more susceptible to strontium ranelate toxicity due to genetic factors.
• Prolonged Use: Long-term use of strontium ranelate may increase the risk of toxicity, as the medication may accumulate in the body over time.

What Are the Health Effects of Strontium Ranelate Toxicity?

Strontium ranelate has been withdrawn globally due to its increased risk of adverse cardiac effects, venous thromboembolism (VTE), and life-threatening allergic reactions.

The symptoms of strontium ranelate toxicity can include the following:

1. Strontium ranelate has been associated with symptoms that can include chest pain, dizziness, respiratory distress, and loss of consciousness.
2. Some patients may experience skin rashes, itching, or other allergic reactions while taking strontium ranelate. These symptoms may be accompanied by swelling, redness, or blistering of the skin.
3. Strontium ranelate treatment was also associated with an increase in the annual incidence of VTE, including pulmonary embolism, particularly in elderly patients or those at risk of immobilization.
4. Studies have shown that post-menopausal patients who were treated with this compound had a significant increase in myocardial infarction rate. Patients with risk factors for cardiovascular events were even more susceptible to such events.
5. Life-threatening cutaneous reactions like Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS) have been reported with the use of strontium ranelate, especially in Asian patients.
6. Strontium ranelate can cause digestive disorders, such as nausea, vomiting, abdominal pain, and diarrhea. These symptoms can be mild or severe and may require medical attention.
7. The use of strontium ranelate has been associated with bone abnormalities, such as osteomalacia, a condition in which bones become soft and weak. Strontium accumulation in the bone can lead to the development of this condition in patients with impaired renal function.

How Can Strontium Ranelate Toxicity Be Diagnosed?

Doctors may thoroughly evaluate the symptoms to assess any potential symptoms or side effects that the patient may be experiencing, including cardiovascular complications, skin reactions, digestive issues, bone irregularities, and the development of strontium-containing crystals in bone tissue. Strontium ranelate toxicity can be diagnosed with the help of the following methods:

• Blood Tests: These tests are capable of assessing the concentrations of strontium in patients' blood, which can help determine if they are taking too much of the medication. Doctors may also perform other blood tests to evaluate the overall health and monitor for any potential side effects or complications.
• Electrocardiogram (ECG): An electrocardiogram (a test used to evaluate the electrical activity of the heart) can help detect any abnormalities in heart function that may be associated with strontium ranelate toxicity.
• Imaging Tests: X-rays or bone scans, can help evaluate the health of an individual's bones and detect any potential abnormalities or complications associated with strontium ranelate use.

What Is the Treatment for Strontium Ranelate Toxicity?

The treatment options for Strontium ranelate toxicity include:

• Stopping the Medication: The first step in treating strontium ranelate toxicity is to discontinue the medication. This can help prevent further accumulation of strontium within the human body and minimize the risk of additional symptoms or complications.
• Supportive Care: Depending on the symptoms that patients are experiencing, doctors may recommend supportive care, such as pain management or treatment for nausea and vomiting. If patients are experiencing bone abnormalities, doctors may recommend additional treatments, such as calcium and vitamin D supplementation or medications to help strengthen the bones.
• Monitoring: Healthcare professionals may also recommend regular monitoring and observation to evaluate patients' symptoms and track their progress. This may involve blood tests to measure strontium levels and evaluate any potential complications or side effects.
• Activated Charcoal: Activated charcoal may be used to help absorb excess strontium in the stomach and intestines, reducing the amount that is absorbed into the bloodstream.
• Chelation Therapy: Chelation therapy involves the use of medications that bind to certain minerals in the body, including strontium. This can help reduce the amount of strontium in the bloodstream and promote its excretion from the body.

Conclusion:

The incidence of strontium ranelate toxicity is comparatively higher in certain populations, including patients with kidney disease, heart disease, or those taking medications that interact with strontium ranelate. Adhere to the recommended dosage instructions and be aware of the potential side effects associated with this medication. Individuals should thoroughly assess the risks and benefits of strontium ranelate before starting treatment, and be closely monitored for signs of toxicity while taking the medication. The use of strontium ranelate has been closely monitored by regulatory agencies, and the medication has been suspended in some countries due to safety concerns.