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.

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Friday, February 16, 2018

BMD Increases by Varying Amounts with Strontium Citrate and Decreases by Varying Amounts after Discontinuation

A study published September 13, 2016, presents three case studies of patients who took strontium citrate (680 mg strontium per day) for six years, five years, and four years (Cases 1, 2, and 3, respectively) and then stopped taking it for two years, one year, and one year (Cases 1, 2, and 3, respectively). The study gives the increases in BMD with SrC and the decreases when the supplement was discontinued.  Of note is the fact that both the increases and decreases vary with the site (lumbar spine or total hip), the individual, and the number of years of use or discontinuation of SrC. Also, keep in mind that stopping any of the osteoporosis drugs will also result in loss of some of the BMD gains because there is no cure for osteoporosis.

Case 1
A 76-year-old female with osteoporosis (OP) took alendronate weekly for 10 years till 2006, then every other week for another year and was initiated on a drug holiday. She started self-administrating SrC (680mg/day) in 2006 and continued to take daily calcium (600mg bid) and vitamin D (2000units). Serum calcium and Vitamin D (32-66ng/ml) remained normal. She continued SrC on her own till 2012, when she agreed to stop taking it due to concerns about accumulation and toxicity.

On dual-energy X-ray absorptiometry (DXA) scan, total hip mean BMD increased 2.7% in the first 2 years on SrC after stopping alendronate, and continued to increase to a maximum of 9.2% after 6 years of treatment with SrC (1.53%/year). Lumbar Spine (LS) BMD was non-diagnostic due to degenerative changes in the spine.

In the first 2 years off of SrC, total hip mean BMD decreased by 5.7%.

Case 2
A 64-year-old female with history of OP, which was diagnosed in 2001, took Actonel 35mg weekly for 5 years, stopped for more than a year and resumed Actonel intermittently for another 2 years before starting drug holiday. She was taking Calcium 500 mg in the multivitamin and 2500 mg of vitamin D. Serum calcium and vitamin D were within normal range. She started strontium citrate (680mg strontium) daily in 2009 and took it for 5 years, stopping it in 2014.

Yearly assessment of her BMD via DEXA scan showed an increase of 4.3% at LS spine (L1-L4 vertebrae), and 7.6 % at total hip within 1 year of SrC treatment. At 5 years, BMD increase was 6.5 % at LS and 12% for mean total hip. She agreed to stop SrC at this time.

One year after stopping SrC, LS BMD decreased by 9.1 % and total hip BMD decreased by 4.2%.

Case 3
A 59-year-old female with OP was treated with weekly alendronate for 4 years till 2007, when she stopped it due to concerns for osteonecrosis of jaw. She was advised to resume alendronate in 2008 due to declining BMD, but opted not to take it.

She started self-administration of 680mg of SrC daily in February 2009 and continued it for four years till January 2013, when she stopped it due to myalgias and concern about risk for toxicity. Due to her history of ulcerative colitis, she was limited in dairy intake, although she averaged half a cup of almond milk daily and took calcium supplements. Serum calcium and vitamin D were within normal range.

BMD via DEXA scan showed an increase of 10.7 % at LS (L1-L4) at 2 years after starting SrC, and 4.3 % at total hip.

BMD decreased by 14% at LS and by 6.4% at total hip a year after stopping SrC.

Mirza FS, Azim S, Bhargava A (2016) Change in Bone Mineral Density with Strontium Citrate: An Illusion or Reality. J Nutrition Health Food Sci 4(3): 1-3. DOI:

Tuesday, January 2, 2018

In Memory of Sara Shackleford DeHart

December 18, 1931 - November 8, 2017

Sara was born December 18, 1931 and passed away at her Lynnwood, WA home on November 8, 2017.
Arrangements under the direction of Purdy & Walters at Floral Hills, Lynnwood, WA.

Published in The Herald (Everett) on Nov. 22, 2017

Sara DeHart was an inspiration to me and others. Ten years ago, when I started looking for alternatives to Fosamax, there was little information about strontium citrate (SC). Strontium ranelate was registered in Europe in 2004 for postmenopausal osteoporosis. I started using SC on January 21, 2008, and Sara's first article about strontium and osteoporosis was posted July 7, 2008.

Sara DeHart wrote three case studies about her struggle with osteopenia and fragility fractures while taking osteoporosis drugs. Only after taking strontium citrate with sufficient vitamin D3, calcium, and magnesium did the fractures cease. She later added vitamin K2 as well. I wrote a post about each of her articles on strontium.

Sara underwent radiation for inoperable throat cancer in 2000 and again for ductal carcinoma in situ in 2016. Of course, she wrote about those experiences and how to minimize the risk of radiation skin burns. She was a medical professional, professor, and writer until the end. She died November 8, 2017, three weeks short of her 86th birthday.


Sunday, November 12, 2017

Strontium and Calcium and Vitamin D

Anyone concerned with bone health, whether taking strontium or not, should have an adequate daily intake of calcium from food or supplements or a combination of the two. In other words, if an individual can get all her calcium from food, she does not need to supplement. However, most people probably will need some calcium supplementation.

The risks of inadequate intake of calcium and vitamin D are reduced calcium absorption, increased serum parathyroid hormone (PTH) concentrations, and bone loss. Low bone mass is a strong predictor of fracture.

There is a rationale for supplementing the diets of elderly subjects with a combination of calcium and vitamin D. Absorption of calcium and possibly of vitamin D and production of vitamin D by the skin decline with aging. Diets deficient in calcium tend also to be deficient in vitamin D because a single food, milk, is the principal dietary source of both these nutrients.

There is no clinical study of strontium with inadequate calcium and vitamin D because such a study would violate the ethical medical standard of doing no harm to patients.

Before inclusion in the TROPOS study of strontium ranelate, patients were subjected to a run-in study to initiate normalization of their calcium and vitamin D status. The duration of this run-in study was 2 wk to 6 months, depending on the severity of calcium and 25-OH vitamin D (25-OH D) deficiency. All enrolled women received daily supplements of up to 1000 mg of elemental calcium adapted to their needs according to their dietary intake (0, 500, or 1000 mg to reach a total daily intake above 1000 mg), and vitamin D according to their serum 25-OH D levels (800 IU for patients having serum 25-OH D lower than 45 nmol/liter and 400 IU for all the others). For patients with severe vitamin D deficiency (25-OH D lower than 30 nmol/liter) the duration of the run-in period was at least 3 months.

Thursday, October 12, 2017

Combined Strontium and Vitamin D Therapy for Osteoporosis

The following abstract is for a clinical study titled "Correction of Vitamin D Insufficiency with Combined Strontium Ranelate and Vitamin D3 in Osteoporotic Patients" by R. Rizzoli et al. It was made available online 9 December 2013. Please note that I have converted the 25-hydroxyvitamin D units from nmol/l to ng/mL (1 ng/mL = 2.5 nmol/L) and added those units in parentheses. My personal daily osteoporosis therapy includes 2 grams strontium citrate (680 mg strontium) and 1000 IU vitamin D (included in my Nature Made Multi for Him multivitamin).

Objective This study aims to investigate the efficacy and safety of oral fixed-dose combination of strontium ranelate 2 g/vitamin D3 1000 IU daily vs strontium ranelate 2 g daily for correcting vitamin D insufficiency in osteoporosis.

Design A 6-month international, randomized, double-blind, parallel-group, phase 3 study.

Methods A total of 518 men and postmenopausal women aged greater than or equal to 50 years with primary osteoporosis (T-score less than or equal to −2.5 s.d.) and serum 25-hydroxyvitamin D (25(OH)D)greater than 22.5 nmol/l (9 ng/mL) were included. Patients were allocated to strontium ranelate 2 g/vitamin D3 1000 IU daily (n=413) or strontium ranelate 2 g daily (n=105). The participants received calcium 1 g daily. The primary endpoint was serum 25(OH)D at last post-baseline evaluation during 3 months.

Results Both groups were comparable at baseline. Mean baseline of 25(OH)D was 44.1 plus or minus 14.6 nmol/l (17.6 ng/mL plus or minus 5.8 ng/mL). After 3 months, the percentage of patients with 25(OH)D greater than or equal to 50 nmol/l (20 ng/mL) was higher with strontium ranelate/vitamin D3 vs strontium ranelate (84 vs 44%, P less than 0.001; adjusted between-group odds ratio=6.7; 95% CI, 4.2–10.9). The efficacy of the fixed-dose combination on 25(OH)D was maintained at 6 months (86 vs 40%, P less than 0.001). Mean 25(OH)D was 65.1nmol/l (26 ng/mL) and 49.5 nmol/l (19.8 ng/mL), respectively, after 3 months and 66.9 nmol/l (26.8 ng/mL) and 45.4 nmol/l (18.2 ng/mL) after 6 months. Physical performance improved in both groups. Falls were 17 and 20% in the strontium ranelate/vitamin D3 and strontium ranelate groups respectively. Parathyroid hormone levels were inversely correlated with 25(OH)D. No clinically relevant differences in safety were observed.

Conclusions This study confirms the efficacy and safety of fixed-dose combination of strontium ranelate 2 g/vitamin D3 1000 IU for correction of vitamin D insufficiency in osteoporotic patients.

Monday, April 17, 2017

Strontium Ranelate Withdrawal from European Countries

Cessation of marketing of Protelos/Osseor: Extract of the letter sent to European Medicine Agency (EMA) and national European Agencies on 10 February 2017


Similar letters, adapted to local regulations, have been sent to all countries worldwide where Protelos/Osseor® is marketed

PROTELOS/OSSEOR® - Cessation of marketing

On 21 September 2004, Protelos/Osseor® (strontium ranelate), centrally authorised medicinal product, was granted a Marketing Authorisation by the European Commission for the European Union (EU).

Protelos/Osseor® is indicated in the treatment of severe osteoporosis in postmenopausal women and in adult men at high risk of fracture, for whom treatment with other medicinal products approved for the treatment of osteoporosis is not possible due to, for example, contraindications or intolerance.

Les Laboratoires Servier hereby notify the cease of the marketing, permanently, in the European countries where it is currently marketed.
This worldwide and strategic decision is taken for commercial reasons based on the following grounds:
  • The restricted indication/limited use of Protelos/Osseor®,
  • The continuous decrease of patients treated with Protelos/Osseor®.
Les Laboratoires Servier will cease the distribution of Protelos/Osseor® in August 2017.
Servier, founded in 1954, is the first independent pharmaceutical group. We are present in 140 countries, with more than 21 000 employees, including close to 3000 in R&D.

My note: Those who will no longer be prescribed strontium ranelate can buy nonprescription strontium citrate. 

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.