Strontium supplement pills for osteoporosis, benefits and side effects, review
August 17 2018 by
Ray Sahelian, M.D.

 

Lately strontium supplements have been marketed as a treatment for osteoporosis. Are they effective for osteoporosis prevention or treatment? Are strontium supplements an alternative to calcium and vitamin D? As of 2018, I do not know for certain if strontium supplements offer benefits to bone health not obtained by calcium, vitamin D, and exercise. We need more research to have a better understanding of the role of this mineral in health and disease and to determine the long term benefits and risks and whether it is safe when combined with standard osteoporosis natural treatments.

 

Q. Could you please give your opinion / comments on using strontium to treat osteoporosis? It is used in Europe, but not in the US. I am interested in: how much to take, how to take it, how long to take it?
   A. These are all good questions but there have not been enough long term studies with strontium citrate supplement and therefore it may be a good idea to limit the use of this mineral to a few times a week until more research is available. It often takes decades of study to determine the full benefits and dangers of a medication or supplement.

 

Q. I came across your very informative web site loaded with lots of good information while I was looking for info on natural way to treat osteoporosis. In spite of all I did last 2 years my T-scores dropped specially on my spine area and my doctor wanted to put me on Bisphosphonate medication that I do not want to take. I am reading about AlgaeCal Plus and Strontium Boost combo supplements. They say it is all natural and they guarantee that is will increase the numbers in 6 months. But, I am also reading some controversial articles on the use of Strontium. Some articles says small amount like 340mg is safe but the Strontium Boost has a serving size of 680mg. Also, some are talking not enough research has been done on the effectiveness or even side effects of it. Dr. Sandra Cabot talks about half the doze of 340 mg per day for 2-3 months in a year and repeat it if the bone density starts to decline again. Laura Pizzorno, osteoporosis specialist and a medical writer, talks about it so positively based on her own experience. She works for AlgaeCal Company, I believe. I would appreciate if you advise me on this since I am so confused and would like to make an educated decision.
   A. I wish there were long term studies (5 years or longer) regarding the benefits, harm, and appropriate dosage and length of use of this mineral, but there just aren't enough for us to know for certain the answers to these questions.

 

Strontium and bone mineral density, as a treatment for osteoporosis

Strontium ranelate has been shown to stimulate bone formation while inhibiting bone resorption. Strontium is used in the treatment of osteoporosis as a ranelate compound, and in the treatment of painful scattered bone metastases as isotope. Treatment with strontium ranelate safely reduces the risk of vertebral and nonvertebral fractures in older women with osteoporosis. In vitro, strontium ranelate increases collagen and non-collagenic proteins synthesis by mature osteoblast enriched cells. Strontium ranelate appears to be an effective treatment of vertebral and non-vertebral osteoporosis, however long term risks are not fully known. But are strontium supplements better than calcium and vitamin D as a treatment for osteoporosis? It appears that strontium supplements are effective for increasing bone strength but it is not clear whether they offer any advantages over calcium and vitamin D, and especially exercise, and whether all three supplements can be combined, and if so, what the appropriate dosages would be.

 

I have listed some of the recent studies with this mineral supplement and it is up to the reader, in consultation with their physician, to determine whether to use it or not.

 

Clin Endocrinol (Oxf). 2008. No difference between strontium ranelate and calcium / vitamin D on bone turnover markers in women with established osteoporosis previously treated with teriparatide: a randomized controlled trial. Anastasilakis AD, Goulis DG, Polyzos SA, Efstathiadou Z. Department of Endocrinology, Hippocration General Hospital, Thessaloniki, Greece.
To evaluate the effect of strontium ranelate on bone turnover markers in women with established osteoporosis previously treated with teriparatide (TPTD - recombinant human parathyroid hormone 1-34). Twenty-two postmenopausal Caucasian women with established osteoporosis previously treated with TPTD 20 mug daily for 18 months were randomly assigned to receive either strontium ranelate or calcium and vitamin D (control group). Measurements: Blood samples for serum N-terminal propeptide of type 1 collagen (P1NP), C-terminal telopeptide of type 1 collagen (CTx) and total alkaline phosphatase were obtained from all women before (pre-TPTD) and after (post-TPTD) administration, as well as six months after strontium ranelate or calcium / vitamin D administration (post-SR/Ca). Results: Serum P1NP, CTx and total ALP increased significantly after TPTD treatment and decreased at the end of the study in both strontium ranelate and control groups, with no difference between them. Strontium ranelate following TPTD administration acts predominantly as an anti-resorptive agent with no evidence of additional osteoanabolic action. In this setting, strontium ranelate is not more effective than Calcium / vitamin D as far as bone turnover markers are concerned.

 

Arthritis Rheum 2008. Long-term strontium ranelate treatment reduces the risk of nonvertebral and vertebral fractures in women with postmenopausal osteoporosis when given over a 5 year period. Dr. Jean-Yves Reginster, from the University of Liege, gave strontium ranelate to 4935 postmenopausal women with osteoporosis participating in the Treatment of Peripheral Osteoporosis Study. The risk of new nonvertebral osteoporotic fractures over 5 years was 15% lower in the strontium group than in the placebo group. Strontium significantly reduced the risk of new major nonvertebral osteoporotic fractures (by 18%) and hip fractures (by 43%), as well as the risk of vertebral fractures (by 24%). Dr. Jean-Yves Reginster is currently doing an 8-year open label extension study, and also a study for osteoporosis in males.

Ginecol Obstet Mex. 2009; Efficacy of strontium ranelate for the mineralization of bone in postmenopausal women. Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano Seguro Social, México. Most medication used for the treatment of osteoporosis are antiresorptive; however strontium therapy in postmenopausal women has shown a double effect on resorption and bone formation. To evaluate the effect of strontium on bone mineral density (BMD) and circulating biochemical markers of bone turnover in postmenopausal women who had a decreased BMD. A prospective study was carried out in 23 postmenopausal women who had decreased BMD, who received daily strontium orally by night during 12 months. Evaluation of bone mineral density at lumbar spine and hip as well as biochemical markers in blood for bone turnover before and during therapy. BMD at the spine and hip increased significantly after 12 months of treatment. Bone turnover markers showed a decrement of osteocalcin, by contrast the specific alkaline phosphatase increased after 6 months of therapy; however C-terminal telopeptide of type 1 collagen was not modified. Strontium ranelate increased significantly BMD at the spine and at the hip in postmenopausal women and simultaneously improved bone turnover estimated by circulating bone markers.

 

J Reprod Med. 2013. Effect of strontium ranelate on serum leptin and bone turnover markers in women with established postmenopausal osteoporosis. Our data supports a positive effect of leptin on bone metabolism in favor of bone resorption inhibition in postmenopausal osteoporotic women on strontium treatment.

 

J Endocrinol Invest. 2015. Vitamin D and bone mineral density changes in postmenopausal women treated with strontium ranelate. Optimal vitamin D repletion was previously shown to maximize the efficacy of anti-resorptive agents. The aim of our study was to investigate the BMD response to SrR in accordance with change of vitamin D status. Women were treated with SrR (2 g/day), with cholecalciferol (25,000 IU biweekly) and calcium carbonate as appropriate. SrR was associated with improvement of BMD at lumbar spine. Only subjects with Δ25(OH)D > 6 %, reported a significant BMD gain at femoral neck. Improvement of vitamin D status was associated with enhancement of BMD response to SrR in women with postmenopausal osteoporosis, in particular, at femoral neck.

 

Osteoporos Int. 2015. The position of strontium ranelate in today's management of osteoporosis. The efficacy of strontium ranelate in patients complying with the new prescribing information (i.e. severe osteoporosis without contraindications) has been explored in a multivariate analysis of clinical trial data, which concluded that the antifracture efficacy of strontium ranelate is maintained in patients with severe osteoporosis without contraindications and also demonstrated how the new target population mitigates risk. Strontium ranelate is therefore an important alternative in today's management of osteoporosis, with a positive benefit-risk balance, provided that the revised indication and contraindications are followed and cardiovascular risk is monitored.

 

J Bone Miner Metab. 2016. Effects of strontium ranelate on bone mass and bone turnover in women with thalassemia major-related osteoporosis. Twenty-four TM osteoporotic women were randomized to receive daily SrR 2 g or placebo in addition to calcium carbonate (1,000 mg) and vitamin D (800 IU). SrR treatment improved BMD and normalized bone turnover markers, as well as lowering sclerostin serum levels.

 

Altern Ther Health Med. 2016. Use of Strontium Chloride for the Treatment of Osteoporosis: A Case Report. Strontium ranelate is an approved prescription medication for the treatment of osteoporosis in Europe. In the United States, the only available forms of strontium are those that are nonprescription, dietary supplements. Currently, no controlled trials have been conducted on the effectiveness of the supplements for treating osteoporosis. The woman in the case study was a patient in an academic urban women's health clinic in Minneapolis, MN, USA. The participant was a postmenopausal woman with a history of vertebral fracture. Intervention. She took 680 mg daily of strontium chloride for 2.5 years. The patient had begun receiving dual-energy X-ray absorptiometry (DXA) scans in 2004 and continued to receive follow-up scans every 2 y. After beginning strontium therapy in 2011, she received DXA scans in 2012 and 2014. During the study, the analysis of the patient's DXA scans showed a positive increase in the bone mineral density (BMD) of her vertebrae and her right hip and maintenance of her BMD in her left hip. Although the current case report does not provide enough evidence to conclude that US dietary supplements of strontium are effective in preventing fractures, it demonstrates a positive experience for one patient.

 

Aging (Albany NY). 2017. Melatonin-micronutrients Osteopenia Treatment Study (MOTS): a translational study assessing melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7) on bone density, bone marker turnover and health related quality of life in postmenopausal osteopenic women following a one-year double-blind RCT and on osteoblast-osteoclast co-cultures. This one-year double blind randomized control trial assessed the effects of nightly melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7; MSDK) on bone mineral density (BMD) and quality of life (QOL) in postmenopausal osteopenic women (ages 49-75). Compared to placebo, MSDK treatment increased BMD in lumbar spine (4%) and left femoral neck (2%). MSDK increased serum P1NP levels and reduced bone turnover. Psychometric analyses indicated that mood and sleep quality improved for the MSDK group. MSDK-exposed human mesenchymal stem cells (hMSCs) and human peripheral blood monocytes (hPBMCs) plated in transwells or layered demonstrated increases in osteoblastogenesis, decreases in osteoclastogenesis. These findings provide both clinical and mechanistic support for the use of MSDK for the prevention or treatment of osteopenia, osteoporosis or other bone-related diseases.

 

Clin Interv Aging. 2017. Strontium ranelate treatment in a postmenopausal woman with osteonecrosis of the jaw after long-term oral bisphosphonate administration: a case report. We describe the case of a postmenopausal woman who took oral alendronate for >3 years for osteoporosis. The patient presented at the clinic with sharp jaw pain and swelling on the left mandible 4 months after extraction of the third molar. Clinical examinations identified an inflamed mucosal opening with pus over an area of necrotic bone. Initial images of cone beam computed tomography revealed a sequestrum at the extracted socket. The condition did not improve after 1 week of antibiotic treatment; therefore, the alendronate treatment was terminated and the patient was prescribed strontium ranelate instead. The patient gradually recovered and, at the 2-year follow-up, the site of bisphosphonate-related osteonecrosis of the jaw healed completely as determined by both clinical and cone beam computed tomography measures. The bone mineral densities in the femoral neck and lumbar spine improved after 1 year, and were maintained at the 3-year follow-up. This case supports the use of strontium ranelate as an alternative treatment for postmenopausal women who receive long-term oral BP treatments and are at risk for serious complications of BP-related osteonecrosis of the jaw.

 

Braz J Med Biol Res. 2018. Strontium ranelate as a possible disease-modifying osteoarthritis drug: a systematic review. Strontium ranelate (SrRan) is a drug usually prescribed to treat osteoporosis, with proven effects in decreasing the risk of fractures and possible effect in reducing the progression of OA. Despite limited number of studies, the results suggest a positive effect of SrRan in patients with OA, through changes in functional capacity and reduction of progression of morphological parameters and joint degradation, with moderate quality of evidence for those clinical outcomes.

 

Q. Since some studies have shown that excess calcium intake through supplementation may increase the risk for heart attacks, wouldn't then be more prudent to take strontium than it would calcium?
   A. Even less is known about the long term effects of strontium supplementation than of calcium.

 

Strontium and spinal osteoarthritis pain
Strontium ranelate may help with back pain in women with osteoporosis and osteoarthritis of the spine.  Dr. Olivier Bruyere from University of Liege, Belgium reviewed the effects of 3 years treatment with strontium ranelate on the clinical and structural progression of spinal osteoarthritis in 1105 women. About half of the women received strontium ranelate and 539 had received placebo. The proportion of women with worsening overall spinal osteoarthritis symptoms was reduced by 42 percent in the strontium ranelate group relative to the placebo group. More women in the strontium ranelate group saw improvement in back pain after 3 years compared with placebo. There were no significant between-group differences in health-related quality of life, however. The study was supported by a research grant from French pharmaceutical company Servier, which manufactures strontium ranelate. Annals of the Rheumatic Diseases, March 2008.
   Comments: I do not know if strontium citrate would be more, less, or as effective as strontium ranelate.

 

Strontium side effects, danger, safety

At very high doses and in certain conditions, strontium can lead to side effects such as osteomalacia characterized by impairment of bone mineralization. The osteomalacia symptoms resemble those of hypophosphatasia, a rare inherited disorder associated with mutations in the gene encoding for tissue-nonspecific alkaline phosphatase (TNAP). Human alkaline phosphatases have four metal binding sites-two for zinc, one for magnesium, and one for calcium ion-that can be substituted by strontium.

 

More than 15 cases of DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) have been reported in Europe, including 2 deaths related to strontium ranelate, prompting European health authorities in 2011 to publish a warning concerning the risk of strontium ranelate-induced DRESS. Whether the citrate form has the same risk is difficult to know at this time.

 

Prescrire Int. 2013. Strontium ranelate for osteoporosis in men. More dangerous than beneficial. Increasingly numerous and potentially serious adverse effects have been reported since market release. There was no preventive effect on symptomatic fractures in a trial with 261 men.

 

Ann Rheum Dis. 2014. Use of strontium ranelate and risk of acute coronary syndrome: cohort study. Data of antiosteoporotic drug users do not support a significant association between use of strontium ranelate and acute coronary syndrome.

 

BMJ Open. 2014. A comparison of adverse event and fracture efficacy data for strontium ranelate in regulatory documents and the publication record. Recently, the European Medicines Agency reported that strontium ranelate increases myocardial infarction risk in postmenopausal women, 8.5 years after it was registered for use in osteoporosis. Unreported serious adverse events in clinical trials for other pharmaceuticals have been described in recent years. We assessed reporting of adverse events and fracture efficacy of strontium. We compared data on adverse effects (myocardial infarction, venous thromboembolism and pulmonary embolism) and fracture efficacy of strontium in publicly available regulatory documents with data in publications retrieved from searching PubMed. Based on all available data from primary publications and regulatory documents, the number of fractures prevented by strontium use is similar to the number of extra cases of venous thromboembolism, pulmonary embolism and myocardial infarction caused by strontium use. The risks of strontium use are similar to the benefits. Full disclosure of the clinical trial data and regulatory documents would allow clinicians and their patients to decide whether use of the drug is worthwhile.

 

Endocrine. 2016. Effects of strontium ranelate on markers of cardiovascular risk in postmenopausal osteoporotic women. Recent pooled analyses have shown that strontium ranelate increases the incidence of venous thromboembolism and non-fatal myocardial infarction, but no explanations were given. The aim of our study was to assess the effects a 12-month treatment with strontium ranelate on hemostasis factors and markers of cardiovascular risk in postmenopausal osteoporotic women. Forty osteoporotic postmenopausal women received orally strontium ranelate 2 g daily, plus calcium and colecalcipherol for 12 months. Forty postmenopausal osteopenic women matched for age, menopausal age, and body mass index served as controls and received orally calcium and colecalcipherol for 12 months. Biochemical cardiovascular risk factors and hemostatic indices were assayed prior to treatment, and after 3, 6, and 12 months of therapy. These indices included fibrinogen, fasting glucose, total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, plasma levels of D-dimer, homocysteine, partial thromboplastin time, and prothrombin time. In addition, we evaluated possible changes in blood pressure and occurrence of venous thromboembolic events. At baseline, no statistically significance was observed between the two groups except for bone mineral density at lumbar spine, femoral neck, and total femur, which was lower in strontium ranelate group. After 12 months of treatment, there was no statistically significant change in cardiovascular risk factors and hemostatic parameters. None of the 40 women developed any clinical venous thromboembolic event. A 12-month treatment with strontium ranelate did not alter hemostasis factors or markers of cardiovascular risk, suggesting that reported increased risk of venous thromboembolism and myocardial infarction with strontium is mediated by other factors.

 

Osteoporos Int. 2016. Increased risk of strontium ranelate-related SJS/TEN is associated with HLA. Severe adverse drug reactions (ADR) of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in some patients receiving strontium ranelate have been reported, but the risk factors are unclear. We show that HLA-A*33:03 and B*58:01 are significantly associated with patients who developed SJS/TEN; and provide the first evidence that genetic risk factors are involved in strontium ranelate-associated SJS/TEN.

 

Strontium research studies

Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older.
J Bone Miner Res. 2006.
Strontium ranelate produces an early and sustained reduction of both vertebral and nonvertebral fractures in patients greater than 80 years of age. The aim of this study was to determine whether strontium ranelate, an agent that reduces the risk of vertebral and nonvertebral fractures in postmenopausal women greater than 50 years of age, also reduces fractures in the elderly.

 

Where is it found?
Strontium is a chemical element in the periodic table that has the symbol Sr and the atomic number 38. An alkaline earth metal, it is a soft silver-white or yellowish metallic element that is highly reactive chemically. The metal turns yellow when exposed to air. Strontium occurs naturally in the minerals celestite and strontianite. The 90Sr isotope is present in radioactive fallout and has a half-life of 28.90 years. Due to its extreme reactivity to air, this element occurs naturally only in compounds with other elements, as in the minerals strontianite, celestite, etc. Strontium is isolated as a yellowish metal and is somewhat malleable. Strontium is chiefly employed (as in the nitrate) to color pyrotechnic flames red.

 

Questions

Q. Since you had an article on osteoporosis in your newsletter today, I thought I'd write and alert you about a strontium product I've been taking for the last year or so, which you may want to research. It's certainly less expensive than Fosamax and probably less dangerous. There is also some concern that Fosamax builds more brittle bone than is natural, which doesn't seem to be the case with strontium. Anyway, if it works, there are a lot of people who could benefit by it. The strontium product is Doctor's Best, Strontium Bone Maker, 340 mg, 60 VCap. Description: Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton. Strontium has an affinity for bone and is taken up at the bone matrix crystal surface. The influence of strontium on the bone metabolism has been researched since the 1950's. Studies indicate that strontium positively effects bone metabolism to promote bone formation and decrease bone resorption, leading to normalized bone density. Strontium helps maintain strong, healthy bones.
   A. I have not seen any long term human studies with strontium and therefore cannot be certain whether the benefits of strontium supplementation outweigh the potential risks of strontium overdose or toxicity since ideal strontium supplement doses are not known at this time.

 

Q. My girlfriend (age 51) was diagnosed with early stages of osteoporosis (no fractures). Recently she heard about Protelos (strontium ranelate) manufactured by French manufacturer Servier). Apparently Protelos recently received market approval in the Europe Union, but it is not yet available in the U.S. pending FDA approval. From the Protelos research I can't find any downsides to it. I searched the internet and found a study, " Strontium Ranelate Produces Stable Bone in Patients With Osteoporosis," by Linda Little. Strontium ranelate is one of the first drugs to have a dual action that both decreases bone resorption and increases bone formation, according to a study presented here at the American Society for Bone and Mineral Research (ASBMR) 27th annual meeting. "Strontium ranelate decreased bone resportion and increased formation," said Pierre D. Delmas, MD, PhD, a professor of medicine and rheumatology at the University Claude Bernard in Lyon, France, during a press conference. "There was a decrease in osteoclasts and an increase in osteoblasts."
   I was hoping to find a company that would export it, but so far have turned up blank on that account. My question to you is if you have heard any downside? I did read your page on Osteoporosis which we for the most part already knew.
   A. I have not seen any long term human studies with strontium and therefore cannot be certain whether the benefits of strontium supplementation outweigh the potential risks of strontium overdose or toxicity since ideal strontium supplement doses are not known at this time. As it happens too often in the medical and nutritional industry, a product is marketed for long term use without fully realizing all the upsides and downsides.

 

Q. Are there any other supplements that should not be taken on the days that I take Eyesight Rx? My supplements are all food-based, except strontium 350 mgs that I take for building bone.
   A. We have not had feedback from those who take the combination of strontium and Eyesight Rx. We do not suspect strontium supplement would interfere with the effects of Eyesight Rx.

 

Not wanting to use Fosomax for osteopenia I have used strontium supplement 680mg daily for 3 years. With diet, exercise and strontium pills I have seen a 50% improvement in my dexa scan results after 2 years. Recently I was diagnosed with atrial fibrillation in the ER. Since this has been a sudden onset I am wondering if you feel the strontium supplement could have played a roll. I never drink alcohol, have never smoked, avoid all caffeine and OTC stimulants as I have MVP.
   This is a good question. I am not aware of any long term human studies with strontium mineral and therefore I do not know what the long term benefits and side effects of strontium supplement use would be. One option is to stop the strontium to see if the atrial fibrillation is improved. Much of the long term benefits and risks of supplement use is still not clearly understood.

 

Can strontium effect the esophagus as other osteoporosis medications can? I have been taking Doctor's Best Strontium Bone Maker for about 1 year. I take two per day. By the way, I am 73 years old and do have osteoporosis. My last bond density showed an increase in bone mass (since taking the strontium. My concern is how long can I continue taking it and at what dosage? Should I reduce my intake to 1 capsule only a few times a week instead of two daily? I my readings, I have found different suggestions regarding what time of day to take it. I have continued my calcium and magnesium and vitamin D3 as well. Also, are there any side effects I should be looking for?
    Unlikely since this mineral works in a different way than the medications used for osteoporosis. These are all good questions but there have not been enough long term human studies to give us such answers as to long term safety, proper dosage, and relation to other mineral and supplement intake.

 

I recall reading some time ago that strontium pills should not be taken at the same time as calcium pills because they compete for deposition in bone, bbetter to take them at different times of the day, unfortunately I don't remember the source for this bit of info.
    I have not seen such studies, so I can't say whether it is better to take them together or separately.

 

Nature's Life, Strontium, 680 mg, 60 Tablets
buy Strontium supplement, 340 mg
Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton. Strontium has an affinity for bone and is taken up at the bone matrix crystal surface. The influence of strontium on bone metabolism has been researched since the 1950's. Studies indicate that strontium positively effects bone metabolism to promote bone formation and decrease bone resorption, leading to normalized bone density. Helps maintain strong, healthy bones.

Buy Strontium pills

Supplement Facts
Serving Size: 2 Tablets
Serving Per Container: 30
  Amount Per Serving % Daily Value
Total Carbohydrate 0.5 g <1%†
Dietary Fiber 0.7 g 3%†
Strontium (as Strontium Citrate) 680 mg *
† Percent Daily Value based on a 2,000 calorie diet.
* Daily Value not established

 

Supplement Facts:
Strontium citrate 340 mg
Suggested Use: 1 strontium capsule with breakfast twice a week or as directed by your health care provider. Do not use if you have kidney disease.