Strontium supplement pills for osteoporosis, benefits and side effects by Ray Sahelian, M.D. Review of research studies

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. 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 2011, I do not know 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.

Where is it 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.

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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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Supplement Facts:
Strontium (as 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.

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 mineral density

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.

Efficacy of strontium ranelate for the mineralization of bone in postmenopausal women
Ginecol Obstet Mex. 2009; Basurto L, Zárate A, Córdova N, Saucedo R, Galván R, Campos S, Hernández M. Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano Seguro Social, México, DF.
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.

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. 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 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) 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.

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.

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?
   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.

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.

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.

Thank you for your very interesting newsletters. I always enjoy reading them as they are very educational. 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, why the medical community doesn't promote it, should they promote it? Are there negative side effects?
   These are all good questions but there have not been enough studies to make any reliable recommendations.

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.