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Strontium ranelate is a small molecule drug used primarily for the management of severe osteoporosis in postmenopausal women and adult men at high risk of fracture. It is a strontium(II) salt of ranelic acid. The drug exhibits a dual mechanism of action on bone metabolism by both increasing bone formation through stimulation of osteoblast activity and reducing bone resorption by inhibiting osteoclast differentiation and activity. This "dual action bone agent" effect leads to improved bone density, microarchitecture, and strength, thereby reducing the risk of vertebral, peripheral, and hip fractures. Strontium ranelate also stimulates osteoblasts to secrete osteoprotegerin while decreasing Receptor activator of nuclear factor kappa-B ligand (RANKL) expression, further inhibiting osteoclastogenesis[1][4][6]. The product was developed and marketed by Servier under the brand names Protelos or Protos[4].
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