Strontium supplement by Ray Sahelian, M.D. Health benefit of strontium supplement

Strontium is a chemical element in the periodic table that has the symbol Sr and the atomic number 38. An alkaline earth metal, strontium is a soft silver-white or yellowish metallic element that is highly reactive chemically. The metal turns yellow when exposed to air. Lately strontium supplements have been marketed as a treatment for osteoporosis. Are strontium supplements effective for osteoporosis prevention or treatment? Are strontium supplements an alternative to calcium and vitamin D?

Where is Strontium found?
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.

Strontium Bone Maker, 340 mg
Doctor's Best

Dietary Supplement

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.

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Strontium Supplement Facts:
Strontium (as strontium citrate) - 340 mg *
Suggested Use: 1 strontium capsule with breakfast a few times a week or as directed by your health care provider. Do not use if you have kidney disease.
* Strontium daily value not established.
Note: Long term studies with strontium citrate supplement are not available 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.

Strontium and Bone

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 whether all three supplements can be combined, and if so, what the appropriate dosages would be.

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.
Clin Endocrinol (Oxf). 2008 July. Anastasilakis AD, Goulis DG, Polyzos SA, Gerou S, Ballaouri I, Efstathiadou Z, Kita M, Avramidis A.
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 (n = 11) or calcium and vitamin D (control group, n = 11). 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 (ALP) were obtained from all women before (pre-TPTD) and after (post-TPTD) 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. Conclusions: 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 Ca / vitamin D as far as bone turnover markers are concerned.

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. Arthritis Rheum 2008;58:1687-1695.

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

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.

Strontium Research

Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older.
J Bone Miner Res. 2006 Jul;21(7):1113-20. Seeman E, Vellas B, Benhamou C, Aquino JP, Semler J, Kaufman JM, Hoszowski K, Varela AR, Fiore C, Brixen K, Reginster JY, Boonen S.
Strontium ranelate produces an early and sustained reduction of both vertebral and nonvertebral fractures in patients >/=80 years of age. Introduction: 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 >50 years of age, also reduces fractures in the elderly.

Strontium 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.

Q. 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.
   A. 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.