Skeleton Pirate

Skeleton Pirate
Artist: LindaB


Have you experienced, or read about, negative, and even dangerous, side effects from Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate), and other bisphosphonates prescribed for osteoporosis? If you have, then rest assured there is a safe, effective treatment for this condition. Strontium, primarily in the form of strontium citrate, is taken orally once a day.

Visitors to my blog can leave comments or ask questions and can remain anonymous, if they wish. Their comments are relayed to my g-mail inbox. Below each post, the number of comments for that post is cited and underlined because it is a link. By clicking on that link below any post, a window opens so that a visitor can leave a comment. Ideally, visitors leave comments on posts most relevant to their comments. All comments to my posts are moderated by me.

Browse the posts and visit the link library of references.

Visit me at

Thursday, November 19, 2015

IOF One-Minute Osteoporosis Risk Test

Are you among the one in three women, and the one in five men over the age of 50 who will be affected by osteoporosis in their lifetimes?

Osteoporosis weakens bones and leads to fractures. It causes severe disability. But osteoporosis can be detected early. It can be treated.

If you knew something that could harm you was coming, wouldn't you avoid it?
The test consists of 19 easy questions to help you understand the status of your bone health.

Wednesday, November 11, 2015

Amino Acid Intake and BMD

Jennings et al reported analyses of female identical twins with different amino acid intakes.

Twins with higher intakes of alanine and glycine had higher BMD at the spine than their co-twins, with within-pair differences in spine BMD of 0.012 g/cm2 and 0.014 g/cm2, respectively.

In cross-sectional multivariable analyses of 3,160 females aged 18-79 years, a higher intake of total protein was associated with higher BMD at the spine (quartile Q4 to quartile Q1: 0.017 g/ cm2) and forearm (Q4 to Q1: 0.010 g/cm2.

Intake of alanine, arginine, glutamic acid, leucine, lysine, and proline was associated with higher BMD at the spine and forearm, with the strongest association observed for leucine (Q4 to Q1: 0.024 g/cm2).

When intakes were stratified by source, vegetable or animal, prevalence of osteoporosis or osteopenia was 13% to 19% lower comparing extreme quartiles of vegetable intake for five amino acids (not glutamic acid or proline).

Jennings A, MacGregor A, Spector T, Cassidy A. Amino acid intakes are associated with bone mineral density and prevalence of low bone mass in women: Evidence from discordant monozygotic twins. J Bone Miner Res 2015; doi:10.1002/jbmr.2703.

Tuesday, October 27, 2015

Impact of Treatments for Postmenopausal Osteoporosis on Bone Quality

I came across an excellent review on the impact of treatments for postmenopausal osteoporosis on bone quality. The review covers teriparatide (Forteo), bisphosphonates, strontium ranelate, and denosumab (Prolia). Since strontium is the active ingredient in strontium ranelate, I think it’s safe to assume the same positive changes in bone quality occur with strontium citrate.

“The objective of this systematic review was to examine the influence of treatments for postmenopausal osteoporosis (parathyroid hormone [PTH], bisphosphonates, strontium ranelate, and denosumab) on bone quality and discuss the clinical implications.”

“Most bone-quality data for PTH is from teriparatide. Teriparatide results in a rapid increase in bone-formation markers, followed by increases in bone-resorption markers, opening an “anabolic window,” a period of time when PTH is maximally anabolic. Teriparatide reverses the structural damage seen in osteoporosis and restores the structure of trabecular bone. It has a positive effect on cortical bone, and any early increases in cortical porosity appear to be offset by increases in cortical thickness and diameter.”

“Bisphosphonates are antiresorptive agents which reduce bone turnover, improve trabecular microarchitecture, and mineralization. Concerns have been raised that the prolonged antiresorptive action of bisphosphonates may lead to failure to repair microdamage, resulting in microcracks and atypical fragility.”

“Strontium ranelate is thought to have a mixed mode of action, increasing bone formation and decreasing bone resorption. Strontium ranelate improves cortical thickness, trabecular number, and connectivity, with no change in cortical porosity.”

“Denosumab exerts rapid, marked, and sustained effects on bone resorption, resulting in falls in the markers of bone turnover.”

“Evidence from bone-quality studies suggests that treatment-naive women, aged 60–65 years, with very low BMD T scores may benefit from PTH as primary therapy to improve bone substrate and build bone.”

“Post-PTH treatment with bisphosphonates will maintain improvements in bone quality and reduce the risk of fracture.”

Saturday, September 12, 2015

Fracture Warnings for Invokana and Invokamet Diabetes Drugs

“The US Food and Drug Administration (FDA) has strengthened its warning for canagliflozin (Invokana, Invokamet, Johnson & Johnson/Janssen) related to the increased risk for bone fractures.”

“The …product label for canagliflozin had already mentioned the risk for bone fractures. Now, based on new confirmatory information from several clinical trials, the FDA has added further warning and precaution information. In the trials, the fractures affected the upper extremities, occurred as early as 12 weeks after starting the drug, and typically arose from minor trauma such as falling from a standing height.”

“The FDA has also added new information to the label about decreased bone mineral density at the hip and lower spine.”

“The FDA is also evaluating the possible risk for bone fractures for other drugs in the sodium glucose cotransporter 2 (SGLT2) inhibitor class, including dapagliflozin (Farxiga, Xigduo XR, AstraZeneca) and empagliflozin (Jardiance, Glyxambi, Synjardy, Lilly/Boehringer Ingelheim), to determine whether additional label changes or studies are needed. The label for Farxiga mentions a small number of cases of fractures in patients with renal impairment; the Jardiance prescribing information does not mention bone effects.”

“…SGLT2 inhibitors increase concentrations of phosphate in serum, probably via increased tubular reabsorption, which has the potential to adversely affect bone.”

“Furthermore…SGLT2 inhibitors increase concentrations of parathyroid hormone (PTH). Sustained increases in PTH concentration enhance bone resorption and increase the risk for bone fractures.”

"Although canagliflozin causes a small increase in mean PTH concentration (7.9%), the standard deviation is large. Thus, a substantial number of patients treated with canagliflozin might have a 50% or greater increase in PTH concentrations — a change that could be clinically significant…"

Simeon I. Taylor, MD, professor of medicine at University of Maryland School of Medicine in Baltimore, said, "Although not proven, I believe that increased risk of bone fracture is likely a class effect. Nevertheless, individual drugs differ with respect to selectivity for SGLT2 vs. SGLT1, and also with respect to where on the dose-response curve the approved dose falls. So, it is certainly possible that the magnitude of the risk could vary among individual SGLT2 inhibitors."

Thursday, August 27, 2015

BMD and Strontium Artifact

“The greater increases in BMD are in part due to combined anti-catabolic and bone anabolic effects of strontium ranelate and in part due to the higher atomic number of strontium in bone as compared to calcium. The higher atomic number of strontium (Z = 38) than calcium (Z = 20) leads to greater attenuation of X-rays and consequently an overestimation of BMD as measured by DXA (and expressed as calcium hydroxyapatite equivalent). The greater changes in BMD are clinically useful, allowing the clinician to more easily demonstrate positive changes in BMD as an indication of patient response to therapy. With most osteoporosis therapies, BMD changes in individual patients are likely to fall within the precision error for the densitometer.”

“Although various algorithms for adjusting the bone density in patients on strontium ranelate therapy have been proposed, none are validated. There are likely to be differences in strontium incorporation in bone at different skeletal sites for many reasons. Strontium is preferentially distributed in bone newly formed during strontium ranelate treatment rather than in older bone, formed before treatment initiation. Strontium exchanges more readily on the surface of bone than in deeper bone. It is therefore likely that at different bone sites (trabecular and cortical bone), and with different levels of bone turnover, bone strontium content would be quite variable between individuals. Consequently, adjustment algorithms will not be clinically useful.”

“An adjustment of the lumbar spine BMD was first proposed in the STRATOS study and has been used as an attempt to approximate the increase in BMD related to the pharmacological effect of strontium ranelate. However, this algorithm for adjustment of lumbar spine BMD is complex and based on numerous assumptions.… By the above adjustment algorithm, it is estimated that the BMD overestimation due to strontium in bone accounts for approximately 50% of the measured change in BMD after 3 years of treatment.”

“The increased BMD observed clinically in patients treated with strontium ranelate is both due to the presence of strontium in bone as well as the pharmacological antiresorptive and anabolic activity on bone cells resulting in increased bone tissue with normal bone calcium mineralization. In animal studies, measured-BMD increases correlate with improved bone strength and adjustment of the BMD does not improve the strength-BMD correlation compared with the unadjusted BMD. This indicates that the measured, unadjusted BMD is optimal in predicting improved biomechanical properties in patients on strontium ranelate therapy. The easily discernible BMD increases in strontium ranelate-treated patients will assure the clinician that medication has been ingested, that strontium has been absorbed, and that anti-fracture efficacy in keeping with the results from the pivotal trials can be expected.”

Wandering Skeleton

Wandering Skeleton
Artist: Joel Hoekstra

Osteoporotic Bone

Osteoporotic Bone

How Strontium Builds Bones

Strontium is a mineral that tends to accumulate in bone. Studies have shown that oral doses of strontium are a safe and effective way to prevent and reverse osteoporosis. Doses of 680 mg per day appear to be optimal. See my "For More Information About Strontium" links section.

Osteoporosis is caused by changes in bone production. In healthy young bones there is a constant cycle of new bone growth and bone removal. With age, more bone is removed and less new bone is produced. The bones become less dense and thus more fragile.

Scientists believe that strontium works in two ways. It may stimulate the replication of pre-osteoblasts, leading to an increase in osteoblasts (cells that build bone). Strontium also directly inhibits the activity of osteoclasts (cells that break down bone). The result is stronger bones.

When taking strontium, be sure to take 1200 mg calcium, 1000 IU vitamin D3, and 500 mg magnesium daily. It is best to take strontium late at night on an empty stomach. Calcium and strontium may compete with each other for absorption if taken together.