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PRACTICE: María Sainz, Javier García del Pozo, Luis H Martín Arias, and Alfonso Carvajal Strontium ranelate may cause alopecia BMJ 2009; 338: b1494 [Full text]

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Answer to Sainz et al article

Philippe MUSETTE   (20 May 2009)

Answer to Sainz et al article 20 May 2009
Philippe MUSETTE, Professor Dermatologist Rouen 76031 Send response to journal: Re: Answer to Sainz et al article	Dear Editor, I read with interest the article Strontium ranelate may cause alopecia, by Sainz et al, which recently appeared in the BMJ (published online 22 April 2009). Alopecia is often diagnosed during dermatological consultation, but it may be difficult to distinguish from seasonal hair loss and identify the cause in a single individual, particularly in the absence of objective measures. Alopecia is frequently described and is reported in between 15% to 30% of women aged over 30 (1) and nearly 50% of women aged over 50 years (2). Indeed, alopecia has a number of known causes, which include menopause, nutritional disorders, thyroid disorders, anemia, iron deficiency, psychological stress, and alopecia areata, which may be spontaneously reversible. Moreover, hair loss is associated with a considerable number of widely used medications: anticoagulants, cholesterol-lowering drugs (fibrates, statins), ACE inhibitors, Beta- blockers, digitalics, antidepressants, antiepileptics, proton pump inhibitors, NSAIDs, bronchodilators, antibiotics, benzodiazepines (3), and recently 1720 spontaneous adverse reaction reports of alopecia in association with alendronate were reported between July 1993 and January 2008 (4,5). As the cause of alopecia is very difficult to determine due to the many possible etiologies, the relationship with strontium ranelate speculated in the above mentioned article needs to be confirmed by further studies. In addition alopecia cannot be considered as a sign of the syndrome of drug-induced hypersensitivity (6), which involves generalized drug rash, fever, lymph node enlargement, and systemic involvement. In conclusion, alopecia has been reported as a side effect of many drugs, including antiosteoporotic treatments, though causality is often difficult to establish; it cannot be considered as a symptom of drug- induced hypersensitivity. Yours sincerely, P. Musette, MD, phD Dermatologist department, Rouen University hospital, France References: (1). Birch MP, Lalla SC, Messenger AG. Female pattern hair loss. Clin Exp Dermatol. 2002;27:383-8. (2). Rogers NE, Avram MR. J Am Acd Dematol. 2008;59:547-66. (3). Litt JZ. Drug Eruption Reference Manual. 14th ed. Informa Healthcare. 2008. (4). European Medicines Agency. Fosavance. Summary of product characteristics. Available at: http://www.emea.europa.eu. Accessed: 14 May 2009. (5). European Public Assessment report revision 6- published 16.12.2008, procedural steps taken after authorization (6). Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Safety. 2007;30:1011-30. Competing interests: None declared