Quite frequently women write me to ask: What is strontium and why do you include it in your Better Bones Builder?
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. If you are eating a typical diet, you might getting anywhere from 1 mg 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 because low-dose strontium is a companion nutrient that works with calcium and other minerals to promote bone health.
Low-dose vs. high-dose strontium
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 — rather, 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 and two grams of strontium ranelate, a synthetic salt that combines strontium with ranelic acid.
Risks of high-dose strontium
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 separation of calcium from strontium is not necessary for low-dose strontium (22 mg) like that in my bone-building formula, which is used as a nutrient to aid the development of healthy bones. Unlike dietary strontium, the strontium drug has been found to have various adverse side effects including nausea, diarrhea, and, more rarely, memory problems, serious skin rashes, and venous clots. For the first 10 years of its use as an osteoporosis drug, however, more serious drug-induced problems were detected as the strontium drug (Protelos®) was found to substantially increase the risk of heart problems, including heart attack. In 2014, the European Medicines Agency Pharmacovigilance Risk Assessment Committee (PRAC) concluded that the risks of the strontium drug outweighed the benefits and they recommended suspension of its use.
Specifically, PRAC reported in 2014 that:
- For every 1,000 patient years of use of the strontium drug (Protelos®) there were 4 more cases of serious heart problems and 4 more cases of blood clots or blockages of blood vessels than there were with the placebo.
- As for benefits, the strontium drug had only a modest effect in osteoporosis, preventing 5 non-spinal fractures, 15 new spinal fractures, and 0.4 hip fractures for every 1,000 patient years.
Later in 2014 this same European committee revised its recommendation allowing the strontium drug to be used by patients who could not be treated for osteoporosis by other bone medicines, but requiring that patients using the strontium drug be carefully monitored. In addition, those with a history of heart or circulatory problems were not allowed to use this medication.
The high-dose strontium drug is not available in the U.S.
Keeping strontium in perspective
To avoid any confusion, let me be perfectly clear: In the U.S. the strontium drug Protelos® is not approved for use as a bone drug, and it is not available here for purchase. In the U.S. and Canada, however, one can purchase equally high dose natural forms of strontium as strontium citrate or strontium carbonate and some companies promote bone support formulas with 680 mg elemental strontium (the same strontium dose as in the Protelos® strontium drug formula). Keep in mind that this high-dose strontium, be it natural strontium as sold in the U.S. or synthetic as in Protelos®, is best viewed as a “bone drug,” and, as with all bone drugs, it should be used with great caution. While the synthetic strontium drug (Protelos®) has been shown to carry serious adverse effects, to date there have been no studies on the safety or efficacy of high-dose (680 mg) natural strontium as sold here in the U.S.
Here at the Center for Better Bones our mission is to explore the full human potential for natural, life-long bone health. We strive to work with nature and in accord with nature when at all possible. The Better Bones, Better Body program includes small low doses of supplemental strontium, while not generally recommending the use of high-dose strontium (680 mg) or conventional bone drugs.
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.
2014 European Medicines Agency. PRAC recommends suspending use of Protelos/Osseor (strontium ranelate),Jan 10. EMA/10206/2014 http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/01/news_detail_002005.jsp&mid=WC0b01ac058004d5c1
2014 European Medicines Agency. PRAC. Protelos/Osseor to remain available but with further restrictions. April 14, EMA 235924/2014 http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/02/news_detail_002031.jsp&mid=WC0b01ac058004d5c1
I love cooking with turmeric because it adds a brilliant yellow color and pungent taste to so many foods. Plus, its active compound, curcumin, has been extensively studied and displays an impressive list of benefits, including anti-inflammatory and antioxidant effects that are important to bone health.
Used in foods, turmeric can deliver a significant amount of curcumin. You may be most familiar with turmeric as a key ingredient in curry powder and other savory dishes. I like to use it whenever I can. Here are some of my favorite recipes using turmeric:
1. Turmeric-spiked ghee
Turmeric is fat-soluble, and in traditional Indian cuisine, it’s generally cooked in ghee (clarified butter) or oil. Heat 1 Tbsp of ghee, add ½ tsp of turmeric powder and lightly sauté it for a few minutes. Store your “turmeric ghee” refrigerated in a jar and use it as a colorful and healthy oil for sautéing vegetables, nuts and seeds.
2. Beautiful yellow rice
Use the same turmeric ghee as nutritious condiment when cooking rice. Put 1 Tbsp turmeric ghee in a saucepan, along with ¼ tsp cumin seeds and a pinch of black pepper and salt. Sauté this spice mix a few moments before adding to the rice cooking water.
3. Turmeric-ginger tea
Bring 2 cups of water to boil in a saucepan. Put in ½ to 1 tsp turmeric powder, 1/4 tsp ginger powder, 1/8 tsp ground cinnamon, and a pinch of pepper. Simmer this for 15 minutes, then let settle, strain, and drink hot or cold with sweetener if desired.
4. Golden milk
In a saucepan, mix and bring to a light boil the following:
- 2 cups of any “milk” you choose (dairy, soy, rice, almond, or ½ almond and ½ coconut milk)
- 1 Tbsp of ground turmeric (feel free to start with less)
- 1 tsp powdered or fresh ginger
- ½ tsp ground cinnamon
- ¼ tsp ground cardamom
- ¼ tsp nutmeg
- 1 Tbsp sweetener (maple syrup, sucanat, etc.)
- Pinch of black pepper
5. Chicken curry salad
- Dress shredded chicken or chopped tofu with a mixture of turmeric, curry powder, cumin, mayonnaise, salt and pepper.
- Add chopped celery or red pepper, raisins, chopped walnuts, minced garlic and a pinch of cayenne pepper and black pepper to taste.
- Drizzle with a bit of lemon or lime juice, and serve over salad greens, rice, or use as a colorful sandwich filling.
More ways to use turmeric powder:
- In deviled eggs or chicken soup
- As a natural coloring for bland foods such as mashed potatoes, rice or quinoa
- Sprinkled on avocado or salads
How much turmeric powder to aim for?
To gain health benefits from the spice, the University of Maryland Medical Center recommends taking 1 to 3 grams of dried, powdered turmeric root per day, which is about 1/2 to 11/2 tsp. A small amount of black pepper enhances the bioavailability of curcumin, as does boiling.
With so many ways to use turmeric, no wonder it is one of the most widely used culinary spices worldwide! If you would like to learn more about the benefits of turmeric and curcumin, see my recent blog “New study suggests curcumin helps build bone.”
Are your medications dangerous to your bone health? While we all know that medications have some side effects, we may not recognize that certain medications, especially used long term, can seriously harm your bones.
Let’s look at the 3 most commonly used classes of medications known to increase fracture risk.
Which medications damage bone?
Corticosteroids. This class of drugs interferes with bone formation while simultaneously stimulating bone resorption, thus accelerating bone loss significantly. At one point, scientists estimated that approximately 20% of all osteoporosis in the U.S. was the result of corticosteroid use, and it is estimated that up to 50% of patients using long-term oral corticosteroids will develop bone fractures.
While short-term, very occasional steroid use has less potential to weaken bone, longer-term use of oral and even inhaled steroids clearly jeopardize bone strength and increase fracture risk. Doses as low as 5 mg a day have been shown to increase fracture risk.
It is wise to seek alternatives to steroid therapy, use them when only truly necessary and for the shortest period of time possible, and to fully support your bone health while using them to help offset the drug’s effects.
- Beclomethasone (inhaled)
- Betamethasone (lotion or cream for skin)
- Budesonide (oral capsule, inhaler and nasal spray)
- Ciclesonide (inhaled)
- Cortisone (oral, injection)
- Dexamethasone (oral)
- Ethamethasoneb (oral, injection)
- Flunisolide (inhaled)
- Fluticasone (inhaled)
- Hydrocortisone (spray, liquid, lotion, gel, cream, ointment)
- Methylprednisolone (oral)
- Mometasone (inhaled)
- Prednisolone (oral)
- Prednisone (oral)
- Triamcinolone (oral, injection
Antacids. Proton pump inhibitors such as esomeprazole (Nexium) and lansoprazole (Prevacid) are commonly used antacids. These antacid drugs powerfully reduce the production of stomach hydrochloric acid and thus likely weakened nutrient absorption. Proton pump inhibitors have been repeatedly documented to increase the risk of hip, wrist, and spine fractures.
H2 receptor antagonist drugs like cimetidine (Tagamet) and ranitidine (Zantac) are also used to suppress acid production, which suggests that they might impair nutrient absorption similarly. However, studies have suggested that they do not seem to increase fracture risk as do proton pump inhibitors. One reason may be that they work by blocking the action of histamine — a chemical released in immune responses. Histamine tends to promote bone resorption. So these drugs are less likely, long term, to promote bone loss. Even so, there are studies showing that bone loss occurs in people taking H2 receptor antagonists if they do not have good intake of specific key bone nutrients, such as calcium and vitamin D.
Antidepressants. A specific class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) is associated with a significant increase in fracture risk. One study noted that there are some indicators that the medications have direct effects on bone, but they’re not well determined. However, the impact of SSRIs on balance and alertness are well established.
What it boils down to is this: if you take SSRIs, it’s important to look carefully at your bone health. Even in the absence of a direct effect on bones, falling is the primary cause of fracture in those with weakened bones.
I realize that it’s not always possible to avoid these medications, but there often exist dietary and lifestyle changes and alternative medical approaches that go to the root of the disorder and reduce the need for bone-damaging medications. Also, once you know your medication may harm your bones, you can take steps to protect your skeleton. Plus, by knowing what the medications are, you can talk with your practitioner to determine whether there are less bone-damaging alternatives and support your body’s natural healing processes as much as possible.
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Hodgson SF. Corticosteroid-induced osteoporosis. Endocrinol Metab Clin North Am 1990;19: 95-111.
Jones A, Fay JK, Burr M, et al. Inhaled corticosteroid effects on bone metabolism in asthma and chronic obstructive pulmonary disease. Cochrane Database Syst Rev 1, 2006.
Low Dose Steroids Can Increase Fracture Risk. Medsafe, NewZealand Medicines and Medical Devices Safety authority, 2017 http://www.medsafe.govt.nz/Profs/PUarticles/bone.htm
Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int. 2006 Aug;79(2):76-83. Epub 2006 Aug 15.
Warden SJ, Fuchs RK. Do Selective Serotonin Reuptake Inhibitors (SSRIs) Cause Fractures? Curr Osteoporos Rep. 2016 Oct;14(5):211-8. doi: 10.1007/s11914-016-0322-3.
Wiercigroch M, Folwarczna J. [Histamine in regulation of bone remodeling processes]. Postepy Hig Med Dosw (Online). 2013 Aug 26;67:887-95.
Yu EW, Bauer SR, Bain PA, Bauer DC. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011 Jun; 124(6): 519-526.doi: 10.1016/j.amjmed.2011.01.007
Yu EW, Blackwell T, Ensrud KE, Hillier TA, Lane NE, Orwoll E, Bauer DC. Acid-suppressive medications and risk of bone loss and fracture in older adults. Calcif Tissue Int. 2008 Oct;83(4):251-9. doi: 10.1007/s00223-008-9170-1. Epub 2008 Sep 24.
Zhou B, Huang Y, Li H, Sun W, Liu J. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int. 2016 Jan;27(1):339-347.