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.

Case Study on Strontium Citrate for Osteoporosis with Fragility Fractures

Sara S. DeHart, MSN, Ph.D., is an 80-year-old woman who was diagnosed with osteopenia at age 63. She was treated initially with Fosamax 10 mg. daily and Estraderm patches twice weekly.  She discontinued the patches after about two years, and Fosamax after about three years. Following a fragility fracture of the sacrum, she was prescribed Actonel 5 mg five times a week. Her vitamin D blood level was found to be very low, although she had supplemented with 400 IU vitamin D3 throughout her adult life.

She followed “standards of care” medical recommendations until she developed a second fragility fracture at T9 while taking Actonel.  At that point, she stopped using Actonel and began taking strontium citrate. She increased her vitamin D3 supplementation. Today, she is 80 years old and her BMD is normal. More importantly, she has not fractured, even after a recent fall onto an asphalt driveway! Follow this link to read her amazing story:

http://www.intrepidreport.com/archives/7529

 

Improved T-Scores After Treatment

My first DEXA scan on 05/08/07 diagnosed me with osteoporosis. My second scan was done 07/06/09 after the following treatment: Fosamax 70 mg weekly from 06/18/07 to 12/24/07, two capsules Doctor's Best Strontium Bone Maker daily from 01/21/08 to 07/06/09. Here are my BMD results in g/cm2 and my T-scores for my second scan:


Spine (L1-L4): BMD 0.749, T-Score -2.7

Lt. Hip (neck): BMD 0.563, T-Score -2.6

Lt. Hip (total): BMD 0.739, T-Score -1.7

Despite my best efforts, my scores were not corrected for strontium intake by the radiologist. My first and second scans were not on the same DEXA machine, but they were both on DXA Hologic scanners. Even so, I am very happy with my results. My T-scores improved 10.0% at the spine, 7.1% at the left hip (neck), and 22.7% at the left hip (total). I plan to continue taking strontium citrate.

Study Shows Protelos Builds Better Bone Than Fosamax

A two-year double-blind study included 88 women over age 50 with postmenopausal osteoporosis who were treated with either Protelos (strontium ranelate) 2 g. daily or Fosamax (alendronate) 70 mg. weekly. The study, which used high-resolution computerized tomography, showed that Protelos increased cortical bone thickness, bone volume and trabecular bone density to a significantly greater extent than Fosamax over a one-year period.

The one-year interim results on bone microstucture, a determinant of bone strength, showed a +5.3% increase in cortical thickness and a +2.0% increase in bone volume in the Protelos-treated group. There was no change in the Fosamax-treated group.

For more information and references, see www.medicalnewstoday.com/printerfriendlynews.php?newsid=132149

FDA Bisphosphonate Alert

Information on Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa)

FDA ALERT [1/7/2008] - FDA is highlighting the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates. Although severe musculoskeletal pain is included in the prescribing information for all bisphosphonates, the association between bisphosphonates and severe musculoskeletal pain may be overlooked by healthcare professionals, delaying diagnosis, prolonging pain and/or impairment, and necessitating the use of analgesics.

The severe musculoskeletal pain may occur within days, months, or years after starting a bisphosphonate. Some patients have reported complete relief of symptoms after discontinuing the bisphosphonate, whereas others have reported slow or incomplete resolution. The risk factors for and incidence of severe musculoskeletal pain associated with bisphosphonates are unknown.

This severe musculoskeletal pain is in contrast to the acute phase response characterized by fever, chills, bone pain, myalgias, and arthralgias that sometimes accompanies initial administration of intravenous bisphosphonates and may occur with initial exposure to once-weekly or once-monthly doses of oral bisphosphonates. The symptoms related to the acute phase response tend to resolve within several days with continued drug use.

Healthcare professionals should consider whether bisphosphonate use might be responsible for severe musculoskeletal pain in patients who present with these symptoms and consider temporary or permanent discontinuation of the drug.
This information reflects FDA's current analysis of data available to FDA concerning this drug. FDA intends to update this when additional information or analyses become available.

Alternative Medicine For Osteoporosis

Strontium citrate is an excellent alternative medicine for osteoporosis treatment. Instead of poisoning your body with drugs such as Fosamax, take strontium, a naturally occurring mineral present in water, food, and the human skeleton in trace amounts. Studies show that strontium promotes bone formation and decreases bone resorption (loss), leading to higher bone density.