A large number of phase 2 and 3 clinical trials have been carried out, including more than 8,000 patients on strontium ranelate with nearly 36,000 patient-years of exposure

[6]. A recent pooled analysis in 7,572 postmenopausal women (3,803 strontium ranelate and 3,769 placebo) indicated an increased risk for myocardial infarction (MI) with strontium ranelate, with estimated annual incidences of 5.7 cases per 1,000 patient-years versus 3.6 cases per 1,000 patient-years with placebo [6]. This translates into an odds ratio (OR) for MI of 1.60 (95 % confidence interval [CI], 1.07–2.38) for strontium ranelate versus placebo (incidences of 1.7 % versus VX-689 clinical trial 1.1 %, respectively) [6]. Among the cases of MI, fatal events were less frequent with strontium

ranelate (15.6 %) than with placebo (22.5 %). In order to reduce the risk in treated patients in routine clinical practice, new contraindications have been proposed for strontium ranelate in patients with a history of cardiovascular disease (history of ischaemic heart disease, peripheral artery disease, and cerebrovascular disease, and uncontrolled hypertension) [7]. Exclusion of patients with these contraindications from the pooled analysis mitigated the risk for MI (OR, 0.99; 95 % CI, 0.48–2.04; data on file). There has been no suggestion of excessive cardiac events in postmarketing surveillance data for strontium ranelate covering more than 3.4 million patient-years of treatment from September 2004 to NVP-AUY922 February 2013. There have been 16 cases of MI spontaneously reported over the 96-month period of monitoring, i.e. a rate of 0.5 cases per 100,000 patient-years [6]. Similarly, an observational prospective cohort study including 12,076 patients on strontium ranelate with 80 % adherence over 2 years did not support increased incidence of cardiac events over the 32.0 ± 9.7 months of

follow-up; there were 33 cases of MI in the cohort (1.3 per 1,000 patient-years) [6, 8]. In this paper, we describe a nested case–control study performed within the UK Clinical selleck chemicals llc practice Research Datalink (CPRD) apparatus to further explore the risk for ischaemic cardiac events associated with the use of strontium ranelate in routine clinical practice in women with postmenopausal osteoporosis. Suplatast tosilate Methods Study population The main data source for this nested case–control study was the CPRD, which comprises anonymous electronic medical records from primary care in the UK and covers about 8 % of the population. Contributing CPRD physicians come from some 640 practices throughout the UK, which must meet specific up-to-standard (UTS) reporting requirements defined by the CPRD. The accuracy and completeness of the CPRD dataset has been confirmed [9, 10], as has the predictive value of the database for cardiac events, including MI [11, 12]. The positive predictive value of the CPRD to detect acute MI, for example, is 93 % (95 % CI, 90–96 %), i.e.