In a study performed in elderly women, strontium ranelate did not affect global primary and secondary haemostatic parameters [37]. In the present study, there was no statistically significant difference in the incidence of VTE between

osteoporotic patients treated with strontium ranelate and the untreated osteoporotic cohort. These results are in accordance with a recent study using a self-controlled case series method in the GPRD that did not show a greater association of VTE with strontium ranelate selleckchem treatment [20]. In our study, we have included larger population with a longer follow-up, and thus, results are more informative and strengthened. Furthermore, the incidence of VTE with strontium ranelate is very similar to that for osteoporotic patients treated with alendronate sodium, a treatment for which a greater association with VTE has never been shown [38–40]. This study has some limitations since it

is a retrospective study cohort with no randomisation process to define the populations and with incomplete or unmeasured confounding factors find more such as severity of osteoporosis, immobilisation, prolonged travel, and family history of VTE. To take into account differences between treated and untreated groups, multiple adjustments on risk factors of VTE have been performed. However, even if the main risk factors have been taken into account, we cannot rule out residual confounding effect. In addition, as strontium ranelate is a new anti-osteoporotic treatment the population treated with strontium ranelate is smaller, and the mean follow-up duration is shorter when compared to alendronate IWR-1 order sodium cohort studied. For these reasons, a certain imbalance in analyses could not be excluded, and therefore, this study does not provide the same level of proof than double-blinded placebo controlled clinical

trials. However, we should HSP90 note that the population profile of this study is in conformity with what might be expected in terms of characteristics and observed increased risk for VTE with age. Furthermore, the fact that our study did not show an association between strontium ranelate treatment and increased risk for VTE, when compared with untreated patients, is reinforced by robustness analyses demonstrating no difference between current users and non-users. Finally, the rates of mortality were similar in the two treated cohorts (2.9% in the strontium ranelate cohort and 4.0% in the alendronate sodium cohort) avoiding any doubts regarding the potential under-reporting of VTE leading to death and therefore, removing the bias of not diagnosed VTE. In conclusion, this study shows for the first time that osteoporosis is associated with increased risk for VTE, probably related to the osteoporotic disease itself and its associated comorbidities.