Background/Purpose: This study aimed to evaluate in a subpopulation of osteoarthritis (OA) patients from the SEKOIA Phase III trial the disease-modifying (DMOAD) effect of strontium ranelate (SrRan) on the changes in knee OA cartilage volume and bone marrow lesions (BML) using magnetic resonance imaging (MRI).

Methods: Patients with knee OA (n=300) received placebo (n=112) or SrRan at 1 g/day (n=113) or at 2 g/day (n=105). The study included all randomised patients who received at least one dose of treatment and had at least two MRI examinations. MRI was performed at baseline and at 12, 24, and 36 months. The changes in cartilage volume loss and BML were assessed in the global knee and subregions. Missing values were imputed and the analyses were adjusted according to Bonferroni.

Results: Data showed no between-group differences at baseline with regard to demographics, clinical symptoms, or imaging characteristics. Treatment with SrRan at 2 g/day significantly decreased cartilage volume loss on the tibial plateau as early as 12 months (p=0.002), which persisted up to 36 months (p=0.003). The urinary CTX-II was found to be significantly decreased in both SrRan groups at 36 months. At baseline, the BML were detected mainly in the medial compartment where they were found at increased prevalence in the femur compared to the plateau. At 36 months, SrRan treatment at both 1 and 2 g/day significantly reduced the BML score change in the medial compartment (p=0.002 and p=0.001, respectively). Interestingly, patients treated with SrRan 2 g/day showed no increase in BML score in the medial femur, central condyle or plateau, and those treated with SrRan 1g/day showed no increase in the medial central condyle or plateau, while an increase (39%, 40%, and 17%, respectively) in BML score was found in the placebo group. In those patients with BML at baseline, SrRan 2 g/day significantly (p=0.023) decreased the cartilage loss at 36 months in the medial plateau.

Conclusion: In knee OA patients, treatment with SrRan 2 g/day was found to have a beneficial effect on both cartilage and subchondral bone by significantly reducing the cartilage volume loss in the tibial plateau and the progression of BML in the medial compartment. In turn, the decrease in BML in the medial tibial plateau was associated with a marked and significant reduction in cartilage volume loss at SrRan 2 g/day. These results from the MRI study support the DMOAD effect of SrRan reported using X-rays.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-knee-osteoarthritis-patients-with-strontium-ranelate-reduces-the-loss-of-cartilage-volume-and-bone-marrow-lesions-as-assessed-by-magnetic-resonance-imaging-data-from-the-phase-iii-stront/