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Strontium: bone drug or nutrient?

Quite frequently women write me to ask: what is strontium and why do you include it  in your Better Bones Builder product?

Well, there’s a short answer and a long answer to that question. Here’s the short answer: Strontium is an element very much like calcium and naturally present in our food and water. A common diet might contain anywhere from one to more than 10 mg of strontium per day. The reason it’s in the Better Bones Builder is that the elemental form (that is to say, the non-radioactive version found in nature) has been shown to promote formation of healthy teeth and bones. So it makes sense to include dietary doses of strontium in comprehensive bone-building formulas such as our Better Bones Builder supplement, because low-dose strontium is a companion nutrient that works with calcium and other minerals to promote bone health.

Now let’s get to the long answer. Where confusion sets in is when people hear about strontium being used by itself to build bone. What most people don’t realize when they read about strontium as “the” solution for bone health is that such talk isn’t referring to dietary doses of elemental strontium — most often, it’s referring to the extremely high-dose strontium that has been developed and patented as a drug therapy for osteoporosis in Europe. This drug, known as Protelos®, contains 680 mg of elemental strontium in 2 grams of strontium ranelate, a synthetic salt that combines strontium with ranelic acid.

Elemental strontium is different

Elemental strontium is a natural part of the earth’s crust and is very different from “strontium 90” which is a hazardous radioactive nuclear fallout product from aboveground nuclear testing. All strontium used in bone-building health products is elemental strontium.

One goal of  Protelos is for a small number of strontium atoms to displace calcium atoms in bone. For this effect it is necessary that the strontium drug be taken at least two hours apart from calcium. (This is not necessary for lower dose strontium that is used as a nutrient aiding the development of healthy bones.) Unlike lower doses of strontium, a higher dose may come with side effects like nausea, diarrhea, and, very rarely, memory problems and venous clots. Nonetheless, high-dose strontium osteoporosis therapy has a much better safety record than the bisphosphonate drugs used the U.S. and Canada.

Although Protelos is not available in the U.S. or Canada, we can purchase equally high dose natural forms of strontium as strontium citrate or strontium carbonate — but I hasten to add that you shouldn’t start taking high doses of strontium (or anything else!) without consulting your doctor first!  Keep in mind that high-dose strontium is a bone drug, and, as with all bone drugs, it should only be used when there is a clear high risk of fracture. High risk is defined as a 20% likelihood of a major osteoporotic fracture over the next 10 years.

Some clinicians suggest that strontium citrate (or carbonate) is as effective as the strontium-based drug, but further research needs to be done. Similar to bisphosphonates, we do not know the long-term impact of high-dose strontium on bone and fracture risk. Currently, clinical trials of strontium ranelate have only extended to five years, and the fracture risk efficacy at five years is substantially less than that at two or three years. We do know that high-dose strontium is the safest of all osteoporosis drugs, although not the most potent. So it’s worth talking to your doctor about using strontium if you are at high risk for fracture.

I hope this helps clear up the confusion when it comes to strontium. I will be writing more on strontium in the future, so stay tuned!

Best wishes to everyone.

 

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.

Comments

April 7. 2011 20:32

I would like very much to read any information you have to offer as being an instructor, Personal trainer, I feel your knowledge will help me to become better and more informed and updated to the Fitness and Wellness Center.  Thank you

Rosemarie Sanfilippo

April 8. 2011 09:56

Dear Rosemarie,

By coincidence, I just sent the following article to my own personal trainer yesterday: betterbones.com/healthylifestyle/exercise-bonesandosteoporosis.aspx. We had been talking about the benefits of weight-bearing exercise for bone health and she confessed that she wasn't sure what to suggest for her older clients who were concerned about their bones. I would also suggest that you look through the Nutrition & Bone Health section of the web site (betterbones.com/bonenutrition/default.aspx) and the Alkaline for Life section too (betterbones.com/alkalinebalance/default.aspx)

Managing Editor

April 9. 2011 19:08

Dr. Brown, You state, "Currently, clinical trials of strontium ranelate have only extended to five years, and the fracture risk efficacy at five years is substantially less than that at two or three years."

Here is an explanation from at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744775/?tool=pmcentrez
in a paper entitled "Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis" 2009:

T"he reduction in risk of vertebral fractures of 33% over 4 years in the present study is smaller than that seen in the corresponding analysis over 3 years (41%) [14]. An apparent decrease in the size of risk reduction achieved with greater treatment duration has been reported in previous studies of other anti-osteoporotic drugs. For risedronate, risk reductions of 65% and 61% seen at 1 year decreased to 41% and 49%, respectively, over 3 years [29, 30]. Comparisons of cumulative endpoints at different times during a long-term study must therefore be interpreted with caution. The patients at risk of a given endpoint, although well balanced between treatment groups in terms of disease characteristics and level of risk at randomization, become progressively unbalanced (for example, due to censoring of fracture cases, attrition of more severely affected patients, and introduction of concomitant osteoporosis medication) over time if treatments differ in efficacy. Attrition of high-risk patients will be more rapid in the low efficacy (generally placebo) group.In the later parts of the study, therefore, the placebo group will effectively contain fewer high-risk patients than the active treatment group, and the effects of active treatment will appear to be reduced."  More discussion follows, but the protection continues in all likelihood.

Mom of three

April 10. 2011 14:50

A recent conference on osteoporosis in Spain had results of a biopsy study on women receiving Strontium Ranelate: http://www.newswire.ca/en/releases/archive/March2011/24/c5736.html

I note it says "Anti-fracture efficacy sustained over 10 years" !

I'm from the UK and have now been on Strontium Ranelate for four years with no side effects at all I'm happy to say.

Largest-Ever Biopsy Study in Osteoporosis Demonstrates Superior Bone Forming Activity With Protelos(R) (Strontium Ranelate) Versus Bisphosphonates
VALENCIA, Spain, March 24 /CNW/ - Protelos(R) (strontium ranelate) has significantly greater bone-forming activity than the commonly prescribed bisphosphonate, alendronate, according to results of the largest-ever biopsy study in post-menopausal women presented today at the European Congress on Osteoporosis and Osteoarthritis (ECCEO011-IOF) in Valencia.[i] Through its unique dual impact on both bone formation and resorption, Protelos substantially reduces fracture risk, the primary goal of osteoporosis treatment.

Bone biopsy is the gold standard technique used to examine the effect of osteoporosis treatments on bone. Bone biopsies involve taking a cylindrical sample of real bone from the upper part of the pelvis called the iliac crest. Biopsies allow the identification of non-mineralized (osteoid tissue) and mineralized subparts of the bone matrix and can be used to measure bone formation rates and other parameters. Bone formation is measured by examining mineralizing surface, the proportion of bone surface on which new mineralized bone is being deposited.

In this international, double blind study of 268 women, Protelos has a significantly greater effect on mineralizing surface compared to alendronate. After six months, mineralizing surface, expressed as a percentage of bone surface (the study's primary endpoint) was 2.94% in Protelos patients compared to 0.20% in patients receiving alendronate (p<0.001). This superior effect on bone formation was further amplified after 12 months of treatment. Protelos also significantly increased both the bone formation rate and the mineral apposition rate compared to alendronate over six and 12 months of treatment. The superior bone-forming efficacy of Protelos is linked to its innovative dual mechanism of action which rebalances bone turnover in favour of the formation of newer and stronger bone. This is not the case with bisphosphonates as they have been shown to actually suppress the bone forming-surface.[ii]

"The results of the study show that Protelos preserves a higher bone forming activity compared with alendronate," notes study investigatorProfessor Roland Chapurlat from the Hôpital Edouard Herriot, Service de Rhumatologie et Pathologie Osseuse, Lyon, France.

"The bone-forming activity seen here can be attributed to strontium ranelate's unique mechanism of action which, unlike bisphosphonates that block bone resorption and formation, combines the dual effects of increasing or maintaining bone formation and decreasing bone resorption," points out study investigator Professor PG Ste- Marie from the Centre Hospitalier de l'Université de Montréal, Canada.

This new trial conducted in 268 post-menopausal women with osteoporosis is the largest biopsy study ever. It sets a new standard in the assessment of the effects of different osteoporosis treatments on bone. It is also the second head to head study in which Protelos demonstrates superiority versus alendronate. In the previous trial, which used a non-invasive technique (High Resolution peripheral Quantitative Computerized Tomography), Protelos was shown to be more effective than alendronate on bone microarchitecture at both cortical and trabecular level.[iii],[iv]

Over the course of both studies, the occurrence of adverse events was similar for each treatment group.

Anti-fracture efficacy sustained over 10 years

Better efficacy on bone formation and bone quality are the key determinants for Protelos and explain its well demonstrated efficacy against vertebral, non vertebral and hip fractures. [v, vi, vii] It is also the key determinant explaining why Protelos is the unique treatment which has recently been shown to have sustained anti-fracture efficacy over 10 years, making it a first choice of treatment for postmenopausal osteoporotic women.[viii]

Anne

April 21. 2011 16:44

In your 20 essential bone building nutrients You recommend 3-30 mg
strontium. What I have found to be available is a product that has
340mg strontium citrate capsules and they recommend two capsules
per day for a total of 680mg. I only take 1 capsule a day (340mg)
I'm a 67 year old male and I have Osteoporosis. I was on Actonel for
Two years but had many side effects so I stopped taking it.
Do you think 340mg is to much to be taking each day? I'm taking all the other 19 recommended nutrients in the dosages you recommend.
Should I not take it at all. or take it on a weekly basis?
Thanks

Sumpter

April 21. 2011 23:22

Your "Strontium: Bone Drug of Nutrient" blog is the best explanation I’ve read on the differences between elemental strontium, “strontium 90" and strontium ranelate. Thank-you for discussing it.
Would you happen to know why strontium ranelate is not available in the US?
I’ve heard that strontium can interfere in the measurement of bone density. Could you provide some information about this?
Thanks in advance.
Renee Newman

Renee Newman

April 22. 2011 08:37

Thank you for pointing out the strontium in your formula is NON-RADIOACTIVE.  Given the current need to everyone to detoxify radioactive strontium-90 from the Japan Fukushima nuclear accident fallout, I am curious if the detoxifying agent, known as brown seaweed extract or sodium alginate, will also detoxify the non-radiactive strontium.  

Thank you in advance for your response.  Have a great day!

Dr. Theresa Pantanella, OTD, MPA, OT/L

April 22. 2011 09:23

Renee, to the best of our knowledge the sole reason that strontium ranelate is not available in the US is that the FDA has not yet been presented with sufficient scientific studies performed in the US to consider approval. There is a lot of data from Europe, but FDA tends to want to see at least some home-grown research. (If any of the readers of this blog know of other reasons for the delay in approving the drug, chime in.)

Managing Editor

April 22. 2011 09:55

PS: in doing some cursory research on the question of why Protelos isn't offered in the US, I came across the following post by Sara DeHart, MSN, PhD that may be worth a read. http: //saradehart.com/?page=strontium-and-osteoporosis-ii

Managing Editor

April 22. 2011 11:17

I was grateful for the article on Strontium. My dentist recommended it months ago. I want to understand how to use it correctly.  I have Doctor's Best brand and take two 340 mg. a day. The label says it is elemental (from 1944 mg Strontium citrate.) I was taking it along with orange juice and other calcium supplements (!)but will now take it separately. My bones seem to be leveling off (that is, not losing bone mass) so it must be helping (coupled with an increase in proper exercise.)  Am I on the right track?

Nancy Nimmo

April 22. 2011 14:16

What is considered to be a "high dose"?  I have read that the recommended dose (on the container and from health newsletters) is 687mg or 3 tablets.  I usually manage 2 which would be 2/3 of that amt.  (because of the need to take it away from calcium supps and foods).  Would this be considered a "high dose".  thanks.

Nina

April 22. 2011 14:19

Nina, 3-30 mg is considered a dietary dose; 687 mg would be considered a "high" or medicinal-level dose. See our page on dietary strontium here: www.betterbones.com/bonenutrition/strontium.aspx

Managing Editor

May 3. 2011 23:32

I am taking an Osteoporosis supplement (Osteo-Vi-Min, Allergy Research Group) that has both calcium and strontium in the pill.  There is 100 mg of strontium in each serving taken three times a day = 300 mgs. of Strontium a day.  Is this a big enough dose of strontium that it really should have been taken seperately from the calcium (1,100 mg. daily)?  Is this also a big enough dose that it would be considered a medicinal level dose rather than a dietary dose? Thanks for your help.

Joan Hoffman

May 16. 2011 20:25

My understanding as to why the drug is not approved in the US is that the company has not applied to the FDA for approval.  At least that is what the manufacturer was saying and not that there is not some US evidence.

Steve G

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