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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Monday, January 26, 2015

Adverse Skeletal Effects of Drugs

There is an expanding list of drugs for which there are concerns regarding adverse skeletal effects. The effect of long-term use of glucocorticoid drugs to cause accelerated bone loss and increase the risk of fracture is well recognized. For some drugs (TKIs, calcineurin inhibitors and loop diuretics), the available data are inconsistent and/or do not support a definite adverse skeletal effect. Patients receiving these drugs can be managed in line with guidelines for the general population (See table). Other drugs (SSRIs, antipsychotic drugs, AEDs and PPIs) do not seem to affect bone metabolism or BMD, but there is evidence for increased fracture risk. However, the evidence is limited to observational data, and any relationship may be attributable either to nonbone effects of the drug or effects of the underlying condition to increase fracture rate. In these patients, evaluation for other risk factors for fracture and management of these risk factors should be considered. In a third group (depot MPA, chemotherapy and ART), there is evidence for increased bone loss and/or fracture, but the patient population is generally at low risk for fracture. In these cases, patients may require an assessment of risk, but will rarely require specific treatment for fracture risk reduction. In the last group (aromatase inhibitors, GnRH agonists and thiazolidinediones), there is evidence of increased risk of bone loss and/or fracture, and the drugs are more frequently prescribed to individuals at higher baseline fracture risk. Patients receiving these drugs require risk assessment and those at high risk of fracture should receive alternative treatments (or "add-back" HRT in the case of GnRH agonists) or, if necessary, specific treatment for osteoporosis.

Table:  Summary of management recommendations
Example drugs
Evidence for risk
Management recommendations
Tyrosine kinase inhibitors

   Calcineurin inhibitors

   Loop diuretics
No adverse 
skeletal effect 
or data 
Manage as per general population

Selective serotonin re-uptake inhibitors (SSRIs)


   Anti-epileptic drugs

   Proton pump inhibitors
Evidence for increased fracture risk but fracture risk seems to relate to nonbone effects of the drug or effects of the underlying condition
Evaluate for other risk factors for fracture and manage these risk factors

Depot medroxyprogesterone acetate


   Antiretroviral therapy
Evidence for increased bone
loss and/or 
fracture, but low
risk population
Assessment of fracture risk, but will rarely require specific treatment

Aromatase inhibitors

   Gonadotrophin hormone-releasing hormone agonists


Evidence for increased risk of bone loss and/or fracture, and the drugs are more frequently prescribed to individuals at higher baseline fracture risk

Assessment of fracture risk and those at high risk should receive alternative treatments and/or specific treatment for osteoporosis.

 The conclusions and table are from a longer article, “Adverse Skeletal Effects of Drugs – Beyond Glucocorticoids,” by Susannah O'Sullivan and Andrew Grey, Clin Endocrinol. 2015;82(1):12-22. 

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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.