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“Introduction Osteoporosis is a chronic disease requiring chronic treatment. It is therefore BCKDHA essential to evaluate the efficacy and safety of osteoporosis treatments for the longest time possible, i.e. well beyond the 3 to 5 years recommended by the regulatory authorities. Thus, clinical studies for the bisphosphonates zoledronic acid, risedronate, and alendronate have been extended to 6, 7, and 10 years,
respectively [1–3]; the selective estrogen receptor modulator raloxifene has been evaluated up to 8 years [4, 5]; and results at 5 to 6 years are available for the human monoclonal antibody denosumab [6, 7]. These studies generally indicate sustained increases in the surrogate marker of antifracture efficacy, bone mineral density (BMD). The study designs, notably excluding a placebo group for ethical reasons, preclude direct measurement of long-term reductions in fracture incidence. The orally active agent strontium ranelate is indicated for the management of postmenopausal osteoporosis. Its mode of action in osteoporotic bone includes opposite effects on resorption and formation, which is associated with an improvement in the material or structural properties of bone [8].