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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Thursday, April 5, 2012

Minimum Effective Doses of Strontium

The aim of the PREVOS study (PREVention Of early postmenopausal bone loss by Strontium ranelate) and the STRATOS study (STRontium Administration for Treatment of OSteoporosis) was to determine the minimum dose at which strontium ranelate (SR) is effective in, respectively, the prevention of bone loss in early postmenopausal nonosteoporotic women and the treatment of postmenopausal vertebral osteoporosis.
The minimum dose at which SR is effective in preventing bone loss in early postmenopausal nonosteoporotic women and in the treatment of postmenopausal osteoporosis is 1 g/day and 2 g/day, respectively.

Strontium ranelate phase 2 dose-ranging studies: PREVOS and STRATOS studies, J. Y. Reginster and P. J. Meunier, Osteoporosis International, Volume 14, Supplement 3, 56-65, DOI: 10.1007/s00198-002-1349-0

The chemical structure of strontium ranelate is composed of two atoms of stable strontium combined with organic ranelic acid. Strontium is the bone active component and makes up 34% by weight of the whole molecule, so each 2 g dose of strontium ranelate delivers 680 mg of elemental strontium.

 Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy, Glen M Blake and Ignac Fogelman, Clinical Interventions in Aging, Dec. 2006, 1(4): 367-375


Kathy said...

Thanks so much. This very question of dosage and what '680 mg daily' means when compared to the '1 g necessary for strontium to have any effect' (that I read on one study conclusion) was something that confused me a lot when trying to decide how many strontium pills to take!

I am wondering whether anyone has studied whether strontium must be taken consistently for any given period to have an effect. If a person takes strontium for a few months, then stops for a period and starts again would the positive effects be lost over time.

Since the Mayo clinic did a study on strontium 50 odd years ago, there must be some people out there who've been taking it for long periods.

I realize that this information may not even be out there but just thinking about it and hoping someone might have thoughts.

BoneLady said...


You're welcome. I posted this information because I believe many people are confused about strontium dosage.

Strontium should be taken consistently for optimal results. Several studies have shown changes in bone turnover markers and BMD after only six months on strontium.

I have been on strontium citrate for more than four years, and I know a few people who have been on it for more than five years.

Kathy said...

Thank you again, Bone Lady!

Like a few others have mentioned, I'm taking it in the middle of the night when I wake up to go to the bathroom. I see many different thoughts about the time interval (from food/Ca) in both directions: varying from 1 hour to 3 hours!) that this seemed like a good idea.

Trouble is, sometimes I sleep right through but I'll try and be consistent (and drink lots of water before bed heh heh).

BoneLady said...


"Protelos should be taken at least 2 hours after intake of food, milk or milk products, or calcium supplements, to enable better absorption from the intestine." That is a quote from the website of Servier, the manufacturer of strontium ranelate (Protelos).

I take levothyroxine in the middle of the night when I wake up to go to the bathroom. A couple of times, I haven't gotten up till almost 6:00 a.m. Thankfully, my bladder usually won't let me wait that long.

I take strontium citrate at 10:00 p.m., which is 15 to 30 minutes before bedtime. Sometimes I feel there are so many pills and so few hours in the day.

Kathy said...

True enough! I have a habit of snacking on nuts in the evening and even (hic!) a glass of wine. So I figure the early (3 a.m. or so) might be the only time when I'm 'clean'. I suppose I could rediscover 'discipline' (fat chance).

My pal in the UK is suffering with exhaustion and now (I hear) gastric issues (she's been on Protelos for a month or so). Since she goes off on work trips of several weeks duration, it's becoming a serious problem for her. So I was thinking...well, maybe a month on and a month off is better than not taking the strontium ever (she's in the op range). If only there was a study along those lines...

BoneLady said...


Your friend needs to talk to her doctor or pharmacist. Exhaustion and gastric issues can be serious. The following information on Protos (brand of strontium ranelate used in Australia) is from the following site:

“This Consumer Medicine Information (CMI) is intended for persons living in Australia. This page contains answers to some common questions about Protos.”

“Tell your doctor or pharmacist if you notice any of the following and they worry you:
Nausea, vomiting, diarrhoea, stomach pain or discomfort, irritation in the mouth (such as mouth ulcers and sore gums). If you do experience diarrhoea, it is advisable to avoid taking any laxatives (medicines which assist bowel movements or treat constipation). Ask your doctor or pharmacist if you are unsure.
Skin irritation, unusual hair loss,
Headache, feeling of confusion,
Bone, muscle and/or joint pain and muscle cramps, swelling of hands, ankles or feet.
Feeling excessively tired, looking pale, getting frequent infections and bleeding and bruising easily may be signs of reduced red or white blood cells or platelets (Bone Marrow Depression).
Right side stomach pain and/or a general feeling of unwell with nausea, vomiting, loss of appetite, fever, itching and dark coloured urine; with or without jaundice (yellowing of the skin and eyes).”

Kathy said...

Thank you Bone Lady,

I will tell her right away


Kathy said...

Please forgive my barrage of questions. I'm 62 and last year for my annual visit to ob/gyn, she told me I wasn't taking enough supplemental calcium (one pill of 600 mg). She told me to double it, so I did.

Yesterday I spoke with a knowledgeable friend who's a medical researcher in the field of osteoporosis and she told me recent clinical studies have shown association with artery hardening when taking anything over 1000 mg of calcium daily (that includes dietary intake).

She strongly recommends cutting back to one supplement pill (600 mg daily) and I have done so. I checked on the net and it bothers me that so many references from accredited institutions are telling folks over 51 to take 1200 mg calcium.

Do you have any thoughts about this?


Anonymous said...

I am 73 and just had my second Kyphoplasty in my upper back.
My D in town told me about Bone-up & Stontium. I have started taking them and after my last fracture my Surgeon has been pressuring me to get stronger Osteo Meds and I say NO!!I watched my Mother try to take them and she was so ill.
Thank You, Linda

BoneLady said...


The daily calcium recommendation of the National Osteoporosis Foundation (NOF) for women 50+ is 1200 mg. This is the total recommended from food and supplements. Therefore, the amount to supplement depends on the amount one is getting from one's diet. I get 700 mg calcium from supplements and the rest from my diet, which includes fat-free milk and low-fat cheese.

Some research suggests that taking vitamin K2 (MK4 or MK7) keeps calcium from being deposited in the arteries. I am not taking vitamin K2, however, just vitamin K1. I do take lecithin, which helps keep cholesterol from forming deposits in blood vessels, lessening chances of heart attacks, arteriosclerosis, and gallstone formation as well.

So, if you are eating plenty of calcium-rich foods, one 600-mg calcium tablet should be fine. I use the recommended 1200 mg calcium as my guide and will not argue about whether the guidelines for women 50+ should be 1200 or 1000.The main problem appears to be that some people don't understand that they must first determine how much calcium they are getting from their food and then decide how much to supplement.

BoneLady said...


You're lucky to have a doctor who recommends strontium and supplements. If you are still getting fractures, you need to have you vitamin D blood level tested. You may need much more than the 1000 I.U. contained in six Jarrow's Bone Up pills. Also, check with Jarrow to find out the lead content of Bone Up because the calcium hydroxyapatite is from cattle. Some bovine calcium hydroxyapatite products have been found to contain lead and are not recommended no matter what the manufacturer says about their safety.

Good luck to you, and thank you for writing.

Claire C said...

Dear BoneLady

I would value your comments regarding the following press release issued by the BMJ (British Medical Journal) on 30 July 2010. It was entitled “Calcium supplements linked to increased risk of heart attack”.

In the text, the press release said “calcium supplements were associated with about a 30% increased risk of heart attack and smaller, non-significant, increases in the risk of stroke and mortality…. Given the modest benefits of calcium supplements on bone density and fracture prevention, a reassessment of the role of calcium supplements in osteoporosis management is warranted …”

I’m rather confused by this and am now wondering if I should stop my calcium supplements (600mg twice a day) and rely instead on natural food calcium.

The full text of the press release is here:

Please let me know if the link doesn't work.

BoneLady said...


I am aware that some studies have linked calcium supplements with increased risk of heart attacks and other cardiovascular events. The press release in the BMJ reports that an international team of researchers analyzed the results of 11 randomized controlled trials of calcium supplements (without co-administered vitamin D) involving 12,000 patients. I have not read the research report, and the press release does not give such important particulars as the amount of calcium the patients were given and the type of calcium supplement provided.

This is what I think. More research is needed. In the meantime, I will continue taking 700 mg calcium from my supplements and about 500 mg calcium from food for a total of 1200 mg calcium daily.

If you can get 1200 mg calcium from food each day, that is probably the optimum solution. If you can cut back to one 600-mg supplement and get the rest from food, that is probably also safe, and is close to what I am doing. Most people today would agree that it is not a good idea to take 1200 mg per day from supplements alone. You must be getting some calcium from food, so that taking two 600-mg tablets would put you over the recommended 1200 mg calcium for women 50+.

BoneLady said...

Kathy wrote:

I thank Claire for the link. I checked out this one.

(link to “Today,” a BBC radio program deleted by administrator)

That’s a link to Prof Cleland talking about the study. It’s a 4 minute audio file. By the way, he’s not one of the researchers of this study (done by Reid, in New Zealand et al.) but I found what he has to say important for clarification.

I understand him to say the risk (in taking calcium supplements) of having a heart attack or stroke appears to be 30% higher from what was previously understood. In other words, the risk, which was only about 1%, now appears to be a risk of about 1.3% (out of the 12,000 or so folks studied who were all taking supplemental calcium).

This is WAY different than what most of us would understand from the BMJ official statement of
“They found that calcium supplements were associated with about a 30% increased risk of heart attack and smaller, non-significant, increases in the risk of stroke and mortality”

I’d go further and say the above quoted statement is seriously misleading! The interviewer was just as confused by that statement as I was.

Cleland says that since the calcium is found only to increase bone density (but NOT to decrease incidence of fracture) that there’s usually no point taking the supplemental calcium (he gives some exceptions…people with bone cancer, old people in shelter care who rarely see the light of day etc.). But for most of us, he says there’s no point taking calcium supplements at all!

I am now skeptical of the blanket statement that women over age 51 should be getting 1200 mg total calcium daily. My ob/gyn said I should be taking two supplemental calcium pills daily when I was taking only one! So now, I’ve cut that back down to one 600 mg pill a day. It’s surely better than the higher amount. I’m thinking of cutting out the other pill too and try to get all calcium from dietary sources instead. But I’m wondering how I can easily manage that. We need more studies, that’s for sure!

Anonymous said...

My mother, who is 82 years old, had been on Evista 60 mg one time a day for six years. Her bone scan after this time showed more hip bone loss. Her doctor put her on Fosomax 70 mg one time a week, while still taking prescribed Evista. She has been on these two drugs together for 1.5 - 2 years. She wants to know if she would benefit more from quitting these two drugs and taking 680 mg of Doctor's Best Strontium Bone Maker, along with 1200 mg calcium, Vitamin D and Magnesium. Carma

BoneLady said...


This is the first time I have heard of a doctor prescribing both Evista and Fosamax simultaneously!If, after six years, Evista did not prevent further hip bone loss, why keep her on it and add yet another drug? You should have gotten a second medical opinion for your mom long ago.

I am not a medical doctor, and I do not know your mother's entire medical history. I would take her to another doctor. I can tell you that for myself and many others who have written about their successes, taking 680 mg Doctor's Best Strontium Bone Maker, 1200 mg calcium from food and supplements, Vitamin D3, and magnesium, has improved BMD without negative side effects. I wish you and your mom good health. Please keep me posted on what she decides to do.

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.