Article Contents
- 1. NAME OF THE MEDICINAL PRODUCT
- 2. QUALITATIVE AND QUANTITATIVE COMPOSITION
- 3. PHARMACEUTICAL FORM
- 4. CLINICAL PARTICULARS
- 4.1 Therapeutic indications
- 4.2 Posology and method of administration
- 4.3 Contraindications
- 4.4 Special warnings and precautions for use
- 4.5 Interaction with other medicinal products and other forms of interaction
- 4.6 Fertility, pregnancy and lactation
- 4.7 Effects on ability to drive and use machines
- 4.8 Undesirable effects
- 4.9 Overdose
- 5. PHARMACOLOGICAL PROPERTIES
- 6. PHARMACEUTICAL PARTICULARS
- 7. MARKETING AUTHORISATION HOLDER
- 8. MARKETING AUTHORISATION NUMBER(S)
- 9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
- 10. DATE OF REVISION OF THE TEXT
This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 for how to report adverse reactions.
1.NAME OF THE MEDICINAL PRODUCT
OSSEOR 2 g granules for oral suspension
2.QUALITATIVE AND QUANTITATIVE COMPOSITION
Each sachet contains 2 g of strontium ranelate.
Excipient with known effect:
Each sachet also contains 20 mg of aspartame (E951).
For the full list of excipients, see section 6.1.
3.PHARMACEUTICAL FORM
Granules for oral suspension
Yellow granules
4.CLINICAL PARTICULARS
4.1Therapeutic indications
Treatment of severe osteoporosis:
-in postmenopausal women,
-in adult men,
at high risk of fracture, for whom treatment with other medicinal products approved for the treatment of osteoporosis is not possible due to, for example, contraindications or intolerance. In postmenopausal women, strontium ranelate reduces the risk of vertebral and hip fractures (see section 5.1).
The decision to prescribe strontium ranelate should be based on an assessment of the individual patient's overall risks (see sections 4.3 and 4.4).
4.2Posology and method of administration
Treatment should only be initiated by a physician with experience in the treatment of osteoporosis.
Posology
The recommended dose is one 2 g sachet once daily by oral administration.
Due to the nature of the treated disease, strontium ranelate is intended for
The absorption of strontium ranelate is reduced by food, milk and derivative products and therefore, OSSEOR should be administered
Patients treated with strontium ranelate should receive vitamin D and calcium supplements if dietary intake is inadequate.
Elderly
The efficacy and safety of strontium ranelate have been established in a broad age range (up to 100 years at inclusion) of adult men and postmenopausal women with osteoporosis. No dose adjustment is required in relation to age.
Renal impairment
Strontium ranelate is not recommended for patients with severe renal impairment (creatinine clearance below 30 ml/min) (see sections 4.4 and 5.2). No dose adjustment is required in patients with
Hepatic impairment
No dose adjustment is required in patients with hepatic impairment(see section 5.2).
Paediatric population
The safety and efficacy of OSSEOR in children aged below 18 years have not been established. No data are available.
Method of administration For oral use.
The granules in the sachets must be taken as a suspension in a glass containing a minimum of 30 ml (approximately one third of a standard glass) of water.
Although
4.3Contraindications
-Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
-Current or previous venous thromboembolic events (VTE), including deep vein thrombosis and pulmonary embolism.
-Temporary or permanent immobilisation due to e.g.
-Established, current or past history of ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease.
-Uncontrolled hypertension.
4.4Special warnings and precautions for use
Cardiac ischaemic events
In pooled randomised
Before starting treatment, patients should be evaluated with respect to cardiovascular risk. Patients with significant risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking) should only be treated with strontium ranelate after careful consideration (see sections 4.3 and 4.8).
During OSSEOR treatment, these cardiovascular risks should be monitored on a regular basis generally every 6 to 12 months.
Treatment should be stopped if the patient develops ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or if hypertension is uncontrolled (see section 4.3).
Venous thromboembolism
In phase III
- Protelos - strontium ranelate
Prescription drugs listed. Substance: "Strontium ranelate"
past history of venous thromboembolic events (see section 4.3) and should be used with caution in patients at risk of VTE.
When treating patients over 80 years at risk of VTE, the need for continued treatment with OSSEOR should be
OSSEOR should be discontinued as soon as possible in the event of an illness or a condition leading to immobilisation (see section 4.3) and adequate preventive measures taken. Therapy should not be restarted until the initiating condition has resolved and the patient is fully mobile. When a VTE occurs, OSSEOR should be stopped.
Use in patients with renal impairment
In the absence of bone safety data in patients with severe renal impairment treated with strontium ranelate, OSSEOR is not recommended in patients with a creatinine clearance below 30 ml/min (see section 5.2). In accordance with good medical practice, periodic assessment of renal function is recommended in patients with chronic renal impairment. Continuation of treatment with OSSEOR in patients developing severe renal impairment should be considered on an individual basis.
Skin reactions
Patients should be advised of the signs and symptoms and monitored closely for skin reactions. The highest risk for occurrence of SJS or TEN is within the first weeks of treatment and usually around
If symptoms or signs of SJS or TEN (e.g. progressive skin rash often with blisters or mucosal lesions) or DRESS (e.g. rash, fever, eosinophilia and systemic involvement (e.g. adenopathy, hepatitis, interstitial nephropathy, interstitial lung disease) are present, OSSEOR treatment should be discontinued immediately.
The best results in managing SJS, TEN or DRESS come from early diagnosis and immediate discontinuation of any suspect drug. Early withdrawal is associated with a better prognosis. The outcome of DRESS is favorable in most cases upon discontinuation of OSSEOR and after initiation of corticosteroid therapy when necessary. Recovery could be slow and recurrences of the syndrome have been reported in some cases after discontinuation of corticosteroid therapy.
If the patient has developed SJS, TEN or DRESS with the use of OSSEOR, OSSEOR must not be
A higher incidence, although still rare, of hypersensitivity reactions including skin rash, SJS or TEN in patients of Asian origin has been reported (see section 4.8).
Interaction with laboratory test
Strontium interferes with colorimetric methods for the determination of blood and urinary calcium concentrations. Therefore, in medical practice, inductively coupled plasma atomic emission spectrometry or atomic absorption spectrometry methods should be used to ensure an accurate assessment of blood and urinary calcium concentrations.
Excipient
OSSEOR contains aspartame, a source of phenylalanine, which may be harmful for people with phenylketonuria.
4.5Interaction with other medicinal products and other forms of interaction
Food, milk and derivative products, and medicinal products containing calcium may reduce the bioavailability of strontium ranelate by approximately
As divalent cations can form complexes with oral tetracycline (e.g. doxycycline) and quinolone antibiotics (e.g. ciprofloxacin) at the
An in vivo clinical interaction study showed that the administration of aluminium and magnesium hydroxides either two hours before or together with strontium ranelate caused a slight decrease in the absorption of strontium ranelate
No interaction was observed with oral supplementation of vitamin D.
No evidence of clinical interactions or relevant increase of blood strontium levels with medicinal products expected to be commonly prescribed concomitantly with OSSEOR in the target population were found during clinical trials. These included: nonsteroidal
4.6Fertility, pregnancy and lactation
Pregnancy
There are no data from the use of strontium ranelate in pregnant women.
At high doses, animal studies have shown reversible bone effects in the offspring of rats and rabbits treated during pregnancy (see section 5.3). If OSSEOR is used inadvertently during pregnancy, treatment must be stopped.
Fertility
No effects were observed on males and females fertility in animal studies.
4.7Effects on ability to drive and use machines
Strontium ranelate has no or negligible influence on the ability to drive and use machines.
4.8Undesirable effects
Summary of the safety profile
OSSEOR has been studied in clinical trials involving nearly 8,000 participants.
75 years at inclusion and 23% of the patients enrolled were 80 to 100 years of age.
In a pooled analysis of randomised
There were no differences in the nature of adverse reactions between treatment groups regardless of whether patients were aged below or above 80 at inclusion.
Tabulated list of adverse reactions
The following adverse reactions have been reported during clinical studies and/or post marketing use with strontium ranelate.
Adverse reactions are listed below using the following convention : very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).
System Organ Class | Frequency |
| Adverse reaction |
Blood and lymphatic disorders | Uncommon |
| Lymphadenopathy (in association with |
|
|
| hypersensitivity skin reactions) |
| Rare |
| Bone marrow failure# |
|
|
| Eosinophilia (in association with |
|
|
| hypersensitivity skin reactions) |
Metabolism and nutrition | Common |
| Hypercholesterolaemia |
disorders |
|
|
|
Psychiatric disorders | Common |
| Insomnia |
| Uncommon |
| Confusion |
Nervous system disorders | Common |
| Headache |
|
|
| Disturbances in consciousness |
|
|
| Memory loss |
|
|
| Dizziness |
|
|
| Paraesthesia |
| Uncommon |
| Seizures |
Ear and labyrinth disorders | Common |
| Vertigo |
Cardiac disorders | Common |
| Myocardial infarction |
Vascular disorders | Common |
| Venous thromboembolism (VTE) |
Respiratory, thoracic and | Common |
| Bronchial hyperreactivity |
mediastinal disorders |
|
|
|
Gastrointestinal disorders | Common |
| Nausea |
|
|
| Diarrhoea and Loose stools |
|
|
| Vomiting |
|
|
| Abdominal pain |
|
|
| Gastrointestinal pain |
|
|
| Gastrooesophageal reflux |
|
|
| Dyspepsia |
|
|
| Constipation |
|
|
| Flatulence |
| Uncommon |
| Oral mucosal irritation (stomatitis and/or |
|
|
| mouth ulceration) |
|
|
| Dry mouth |
Hepatobiliary disorders | Common |
| Hepatitis |
| Uncommon |
| Serum transaminase increased (in |
|
|
| association with hypersensitivity skin |
|
|
| reactions) |
Skin and subcutaneous tissue | Very common |
| Hypersensitivity skin reactions (rash, |
disorders |
|
| pruritus, urticaria, angioedema)§ |
|
|
|

| Common | Eczema |
| Uncommon | Dermatitis |
|
| Alopecia |
| Rare | Drug Reaction with Eosinophilia and |
|
| Systemic Symptoms (DRESS) (see section |
|
| 4.4)# |
| Very rare | Severe cutaneous adverse reactions |
|
| (SCARs): |
|
| toxic epidermal necrolysis* (see section |
|
| 4.4)# |
Musculoskeletal and connective | Very common | Musculoskeletal pain (muscle spasm, |
tissue disorders |
| myalgia, bone pain, arthralgia and pain in |
|
| extremity)§ |
General disorders and | Common | Peripheral oedema |
administration site conditions | Uncommon | Pyrexia (in association with |
|
| hypersensitivity skin reactions) |
|
| Malaise |
Investigations | Common | Blood Creatine phosphokinase (CPK) |
|
| increaseda |
§ Frequency in Clinical Trials was similar in the drug and placebo group. * In Asian countries reported as rare
# For adverse reaction not observed in clinical trials, the upper limit of the 95% confidence interval is not higher than 3/X with X representing the total sample size summed up across all relevant clinical trials and studies.
a
Description of selected adverse reactions
Venous thromboembolism
In phase III studies, the annual incidence of venous thromboembolism (VTE) observed over 5 years was approximately 0.7%, with a relative risk of 1.4 (95% CI = [1.0 ; 2.0]) in strontium ranelate treated patients as compared to placebo (see section 4.4).
Myocardial infarction
In pooled randomised
- Protelos - Les Laboratoires Servier
- Valdoxan - Les Laboratoires Servier
- Corlentor - Les Laboratoires Servier
- Lonsurf - Les Laboratoires Servier
- Procoralan - Les Laboratoires Servier
Prescription drugs listed. Manufacturer: "Les Laboratoires Servier"
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.
4.9Overdose
Symptoms
Good tolerance was shown in a clinical study investigating the repeated administration of 4 g strontium ranelate per day over 25 days in healthy postmenopausal women. Single administration of doses up to 11 g in healthy young male volunteers did not cause any particular symptoms.
Management
Following episodes of overdoses during clinical trials (up to 4 g/day for a maximal duration of 147 days), no clinically relevant events were observed.
Administration of milk or antacids may be helpful to reduce the absorption of the active substance. In the event of substantial overdose, vomiting may be considered to remove unabsorbed active substance.
5.PHARMACOLOGICAL PROPERTIES
5.1Pharmacodynamic properties
Pharmacotherapeutic group: Drugs for the treatment of bone diseases - Other drugs affecting bone structure and mineralisation, ATC code: M05BX03.
Mechanism of action
In vitro, strontium ranelate:
-increases bone formation in bone tissue culture as well as osteoblast precursor replication and collagen synthesis in bone cell culture.
-reduces bone resorption by decreasing osteoclast differentiation and resorbing activity.
This results in a rebalance of bone turnover in favour of bone formation.
The activity of strontium ranelate was studied in various
In bone tissue of treated animals and humans, strontium is mainly adsorbed onto the crystal surface and only slightly substitutes for calcium in the apatite crystal of newly formed bone. Strontium ranelate does not modify the bone crystal characteristics. In iliac crest bone biopsies obtained after up to 60 months of treatment with strontium ranelate 2 g/day in phase III trials, no deleterious effects on bone quality or mineralisation were observed.
The combined effects of strontium distribution in bone (see section 5.2) and increased
In phase III studies, as compared to placebo, biochemical markers of bone formation
Secondary to the pharmacological effects of strontium ranelate, slight decreases in calcium and parathyroid hormone (PTH) serum concentrations, increases in blood phosphorus concentrations and in total alkaline phosphatase activity were observed, with no observed clinical consequences.
Clinical efficacy
Osteoporosis is defined as BMD of the spine or hip 2.5 SD or more below the mean value of a normal young population. A number of risk factors are associated with postmenopausal osteoporosis including low bone mass, low bone mineral density, early menopause, a history of smoking and a family history of osteoporosis. The clinical consequence of osteoporosis is fractures. The risk of fractures is increased with the number of risk factors.

Treatment of postmenopausal osteoporosis:
The
BMD and prevalent fracture in more than half of them) and a mean age of 77 years. Together, SOTI and TROPOS enrolled 1,556 patients over 80 years at inclusion (23.1% of the study population). In addition to their treatment (2 g/day strontium ranelate or placebo), the patients received adapted calcium and vitamin D supplements throughout both studies.
OSSEOR reduced the relative risk of new vertebral fracture by 41% over 3 years in the SOTI study (table 1). The effect was significant from the first year. Similar benefits were demonstrated in women with multiple fractures at baseline. With respect to clinical vertebral fractures (defined as fractures associated with back pain and/or a body height loss of at least 1 cm), the relative risk was reduced by 38%. OSSEOR also decreased the number of patients with a body height loss of at least 1 cm as compared to placebo. Quality of life assessment on the QUALIOST specific scale as well as the General Health perception score of the
Efficacy of OSSEOR to reduce the risk of new vertebral fracture was confirmed in the TROPOS study, including for osteoporotic patients without fragility fracture at baseline.
Table 1: Incidence of patients with vertebral fracture and relative risk reduction
Study | Placebo | OSSEOR | Relative Risk Reduction vs. |
|
|
| placebo (95%CI), p value |
|
|
|
|
SOTI | N=723 | N=719 |
|
New vertebral fracture | 32.8% | 20.9% | 41% |
over 3 years |
|
|
|
New vertebral fracture | 11.8% | 6.1% | 49% |
over the 1st year |
|
|
|
New clinical vertebral | 17.4% | 11.3% | 38% |
fracture over 3 years |
|
|
|
|
|
|
|
TROPOS | N=1823 | N=1817 |
|
New vertebral fracture | 20.0% | 12.5% | 39% |
over 3 years |
|
|
|
|
|
|
|
In patients over 80 years of age at inclusion, a pooled analysis of SOTI and TROPOS studies showed that OSSEOR reduced the relative risk of experiencing new vertebral fractures by 32% over 3 years (incidence of 19.1% with strontium ranelate vs. 26.5% with placebo).
In an
An

Table 2: Incidence of patients with hip fracture and relative risk reduction in patients with BMD ≤
Study | Placebo | OSSEOR | Relative Risk Reduction vs. |
|
|
| placebo (95%CI), p value |
|
|
|
|
TROPOS | N=995 | N=982 |
|
Hip fracture over 3 years | 6.4% | 4.3% | 36% |
|
|
|
|
Treatment of Osteoporosis in men:
The efficacy of OSSEOR was demonstrated in men with osteoporosis in a
All patients received daily supplemental calcium (1000 mg) and vitamin D (800 UI).
Statistically significant increases in BMD were observed as early as 6 months following initiation of OSSEOR treatment versus placebo.
Over 12 months, a statistically significant increase in mean lumbar spine BMD, main efficacy criteria (E (SE) = 5.32% (0.75); 95%CI = [3.86 ; 6.79]; p<0,001), similar to that observed in the pivotal
Statistically significant increases in femoral neck BMD and total hip BMD (p<0,001) were observed after 12 months.
Paediatric population
The European Medicines Agency has waived the obligation to submit the results of studies with OSSEOR in all subsets of the paediatric population in osteoporosis (see section 4.2 for information on paediatric use).
5.2Pharmacokinetic properties
Strontium ranelate is made up of 2 atoms of stable strontium and 1 molecule of ranelic acid, the organic part permitting the best compromise in terms of molecular weight, pharmacokinetics and acceptability of the medicinal product. The pharmacokinetics of strontium and ranelic acid have been assessed in healthy young men and healthy postmenopausal women, as well as during long- term exposure in men with osteoporosis and postmenopausal osteoporotic women including elderly women.
Due to its high polarity, the absorption, distribution and binding to plasma proteins of ranelic acid are low. There is no accumulation of ranelic acid and no evidence of metabolism in animals and humans. Absorbed ranelic acid is rapidly eliminated unchanged via the kidneys.
Absorption
The absolute bioavailability of strontium is about 25% (range
3 hours after a meal. Due to the relatively slow absorption of strontium, food and calcium intake should be avoided both before and after administration of OSSEOR. Oral supplementation with vitamin D has no effect on strontium exposure.
Distribution
Strontium has a volume of distribution of about 1 l/kg. The binding of strontium to human plasma proteins is low (25%) and strontium has a high affinity for bone tissue. Measurement of strontium concentration in iliac crest bone biopsies from patients treated for up to 60 months with strontium ranelate 2 g/day indicate that bone strontium concentrations may reach a plateau after about 3 years
of treatment. There are no data in patients to demonstrate elimination kinetics of strontium from bone
- Protelos - M05BX03
Prescription drugs listed. ATC Code: "M05BX03"
Biotransformation
As a divalent cation, strontium is not metabolised. Strontium ranelate does not inhibit cytochrome P450 enzymes.
Elimination
The elimination of strontium is time and dose independent. The effective
Pharmacokinetics in special populations
ElderlyPopulation pharmacokinetic data showed no relationship between age and apparent clearance of strontium in the target population.
Renal impairment
In patients with
There is no pharmacokinetic data in patients with severe renal impairment (creatinine clearance below 30 ml/min).
Hepatic impairment
There is no pharmacokinetic data in patients with hepatic impairment. Due to the pharmacokinetic properties of strontium, no effect is expected.
5.3Preclinical safety data
Chronic oral administration of strontium ranelate at high doses in rodents induced bone and tooth abnormalities, mainly consisting of spontaneous fractures and delayed mineralisation that were reversible after cessation of treatment. These effects were reported at bone strontium levels
Developmental toxicity studies in rats and rabbits resulted in bone and tooth abnormalities (e.g. bent long bones and wavy ribs) in the offspring. In rats, these effects were reversible 8 weeks after cessation of treatment.
Environmental Risk Assessment (ERA)
The environmental risk assessment of strontium ranelate has been conducted in accordance to European guidelines on ERA.
Strontium ranelate does not present a risk for the environment.
6.PHARMACEUTICAL PARTICULARS
6.1List of excipients
Aspartame (E951)
Maltodextrin
Mannitol (E421)
6.2Incompatibilities
Not applicable.
6.3Shelf life
-3 years.
-Once reconstituted in water, the suspension is stable for 24 hours. However, it is recommended to drink the suspension immediately after preparation (see section 4.2)
6.4Special precautions for storage
This medicinal product does not require any special storage conditions.
For storage conditions after reconstitution of the medicinal product, see section 6.3.
6.5Nature and contents of container
Paper/polyethylene/aluminium/polyethylene sachets.
Pack sizes
Boxes containing 7, 14, 28, 56, 84 or 100 sachets.
Not all pack sizes may be marketed.
6.6Special precautions for disposal
No special requirements.
7.MARKETING AUTHORISATION HOLDER
LES LABORATOIRES SERVIER 50, rue Carnot
92284 Suresnes cedex France
8.MARKETING AUTHORISATION NUMBER(S)
EU/1/04/287/001
EU/1/04/287/002
EU/1/04/287/003
EU/1/04/287/004
EU/1/04/287/005
EU/1/04/287/006
9.DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date of first authorisation: 21/09/2004
Date of latest renewal: 22/05/2014
10.DATE OF REVISION OF THE TEXT
Detailed information on this medicinal product is available on the website of the European Medicines Agency http://www.ema.europa.eu
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