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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Wednesday, April 2, 2014

Sequential Therapy with Bisphosphonates and Strontium

Readers of my blog know that I took Fosamax 70 mg once weekly for six calendar months (28 weeks) before the side effects forced me to stop taking it. I waited one month and then began taking strontium citrate daily. I now believe my initial treatment with the bisphosphonate, although lasting only half a year, may have initially delayed and blunted my response to the strontium. My DXA scores after six months on Fosamax and 18 months on strontium were good but not stellar. Having now been on strontium for more than six years, I have overcome any initial blunting, as shown by my most recent DXA scores, which were terrific.

“A recent study provides evidence that prior bisphosphonate therapy results in blunting and delay of the BMD response to strontium ranelate. In a prospective study in postmenopausal women with osteoporosis, 56 bisphosphonate-naïve women and 52 women treated with an oral bisphosphonate for at least one year, who had stopped bisphosphonate therapy within the last month, were given strontium ranelate 2 g daily, together with calcium and vitamin D supplements. After one year of treatment, BMD in the lumbar spine had increased 5.6% in bisphophonate-naïve women and by 2.1% in women previously treated with bisphosphonates; at both six and 12 months the BMD increase in the former group was significantly less than in the latter. At the total hip there was no significant change in BMD at one year in the bisphosphonate-pretreated women compared to an increase of 3.4% in the treatment-naïve group. In an extension of this study, it was shown that BMD in the spine in pretreated women increased in parallel with treatment naïve women from six months onwards, whereas some blunting of the BMD response at the hip was still observed after two years of treatment. The most likely mechanism to explain these effects is that bisphosphonates inhibit the uptake of strontium into bone because of suppression of bone turnover and the consequent reduction in newly formed bone.”

“Osteoporosis: Diagnosis and Management,” Dale W. Stovall (ed.), Chapter 13, pages 202-203.


Francie said...

It's been one and a half years since I've been on Reclast and I wonder if that drug will inhibit the BMD response of strontium citrate? I am just starting strontium citrate today. What do you think Bone Lady?

BoneLady said...


The women in the study I reported on had taken an oral bisphosphonate for at least one year and then stopped taking it for a month or less before taking strontium ranelate. Some blunting of the BMD response at the hip was still observed after two years of treatment with strontium.

Reclast contains zoledronic acid, a bisphosphonic acid which is an inhibitor of osteoclastic bone resorption. The recommended regimen for osteoporosis treatment is a 5-mg infusion once a year given intravenously over no less than 15 minutes. It has been one and a half years since you’ve had an infusion of Reclast. I do not know of a study showing the BMD response of sequential use of Reclast followed by strontium. My guess is there may be some blunting and delay of the BMD response initially.

I had BMD improvements at all sites after strontium citrate for 18 months preceded by six months of Fosamax. Most likely, my improvements would have been even better had I never been on the bisphosphonate, but I still had improvements. As I continued with the strontium, my BMD continued to get better.

I would not worry about what you took in the past. Just continue with the strontium citrate you started today and see what happens. Hopefully, you will be as happy with your results as I have been with mine.

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.