Axial DXA 8 January 2019

The report of my axial DXA scan taken on 8 January 2019 appears below. I have been on 2 grams strontium citrate/day for 11 years. I also take a calcium/magnesium tablet (500 mg Ca/250 mg Mg), a multivitamin with 1000 IU vitamin D3, and several other supplements. I get plenty of protein in my diet. I exercise daily.

As you can see, my DXA results were excellent, except for my left femoral neck, which showed no change from the previous scan.

I am happy with my results, although I know the comparison of this year's results to those of 2.5 years ago contains some built-in error because two different brands of DXA machines were used. My 2016 scan was on a Hologic and the 2019 scan was on a GE Lunar Prodigy.

Changing testing sites, and, therefore, machines, was not my choice. I had been getting my scans in the outpatient radiology department of a large hospital medical center, but the provider is now pushing patients into its freestanding imaging centers. I was told my insurance would not pay for a DXA unless it was done at a freestanding center, but my insurance denied that assertion.

The risk factor for secondary osteoporosis mentioned, but not specified, in the report is early menopause.

INDICATION: Postmenopausal. Follow-up of osteopenia on prior DXA.
Patient reports risk factors for secondary osteoporosis.

COMPARISON: 8/4/2016

FINDINGS:

Spine: Total BMD of the spine (L1-4) is 1.108 g/cm2, with a T-score of
-0.7 and a Z-score of 1.0.

Left Femoral Neck: BMD is 0.883 g/cm2, with a T-score of -1.1 and a
Z-score of 0.6.

Left Total Hip: BMD is 0.928 g/cm2, with a T-score of -0.6 and a Z-score
of 0.9.

Right Femoral Neck: BMD is 0.919 g/cm2, with a T-score of -0.9 and a
Z-score of 0.9.

Right Total Hip: BMD is 0.963 g/cm2, with a T-score of -0.4 and a Z-score
of 1.1.

Compared to the prior study, there has been 9% increase in spine density, 6% increase in left total hip density, but no change in left femoral neck density.

FRAX evaluation calculates 10-year probability of fracture:

Major Osteoporotic: 7.8%

Hip: 1.0%

IMPRESSION:

Based on BMD, diagnosis is consistent with osteopenia.

FOLLOWUP: In 2 years is recommended.

Strontium Ranelate Returns to UK January 2019

The osteoporosis medication strontium ranelate (SR) will once again be available in the UK from January 2019.

The drug was previously available under the brand Protelos but was pulled from the UK market in August 2017.

Servier, the manufacturer of the drug at the time, decided to cease supplying it to the UK due to loss of sales. Use of the drug in the UK had been limited by the health authorities due to safety concerns about cardiovascular risks. A continuous decline in the number of people being treated with it led to the company's decision.

Pharmaceutical company Aristo has now taken on the manufacturing of strontium ranelate, which will be available for prescription beginning January 2019, for the treatment of severe osteoporosis in postmenopausal women and adult men who are at high risk of fracture.

https://nos.org.uk/news/2018/december/strontium-ranelate-returns-to-the-uk-market/

This is good news for UK patients who wish to take SR. It is also good news for those of us in the USA and Canada, where SR is not available, but strontium citrate (SC) is. Some people taking SC got scared when SR was pulled from the UK and the EU. I have continuously taken SC for 11 years. Below is a link to the package information for Aristo.

Package leaflet: Information for the patient

Strontium ranelate Aristo 2 g

granules for oral suspension

Marketing Authorisation Holder

Aristo Pharma GmbH

Wallenroder Straße 8-10

13435 Berlin

Germany

Manufacturer

Lindopharm GmbH

Neustraße 82

40721 Hilden

Germany

https://www.drugs.com/uk/strontium-ranelate-aristo-2-g-granules-for-oral-suspension-leaflet.html

Strontium Citrate Products

Although I have occasionally bought my strontium at www.amazon.com, I usually buy it at www.iherb.com, which ranks its brands by popularity within categories. For example, if you search “strontium,” the eight products listed below will appear. I buy one of the number-2-ranked products, AOR, Strontium Support II, 120 veggie-caps. Buying the larger bottle is cheaper than buying the number-5-ranked 60-capsule bottle of the same product. Buying two or more bottles gives you quantity discounts at iHerb.

If you buy AOR products directly from the manufacturer at www.aor.us, you can use the code, aor25off, for 25% off your entire order. This code will work until the end of 2018 and can be used multiple times.

Nature's Life and AOR claim to follow Good Manufacturing Practices (GMP). The GMP designation is very important in assuring quality. Check with each manufacturer’s website for full details.

Number 1 in Strontium

     Life Extension, Strontium Caps, Mineral for Bone Health, 750 mg, 90 vegetarian capsules

750 mg strontium in three capsules, other ingredients: microcrystalline cellulose, vegetable stearate, silica, vegetable cellulose capsule

Number 2 in Strontium (tied with Nature’s Life)

Advanced Orthomolecular Research AOR, Advanced Series, Strontium Support II, 120 veggie-caps

682 mg strontium in two capsules, other ingredients: sodium stearyl fumarate, hypromellose capsule, Good Manufacturing Practices (GMP) manufacturing, independent testing, quality assured

Number 2 in strontium (tied with AOR, Strontium Support II, 120 veggie-caps)

  Nature’s Life, Strontium, 680 mg, 60 tablets

680 mg strontium in two tablets, other ingredients: cellulose, silica, stearic acid, GMP manufacturing, quality assurance procedures

Number 4 in strontium

       Best Naturals, Strontium, 680 mg, 90 capsules

680 mg strontium in two capsules, other ingredients: gelatin (capsule), rice powder, vegetable magnesium stearate, meets GMP

Number 5 in strontium (tied with Nature’s Life, Strontium Plus D-3, 60 tablets)

     Advanced Orthomolecular Research AOR, Advanced Series, Strontium Support II, 60 veggie-caps

682 mg strontium in two capsules, other ingredients: sodium stearyl fumarate, hypromellose capsule, meets Good Manufacturing Practices (GMP) manufacturing, independent testing, quality assured

 Number 5 in strontium (tied with AOR Strontium Support II, 60 veggie-caps)

       Nature’s Life, Strontium Plus D-3, 60 tablets

680 mg strontium and 400 IU D3 in two tablets, other ingredients: cellulose, stearic acid, magnesium stearate and silica, meets Quality Assurance Procedures and Good Manufacturing Practices

Number 7 in strontium

        EuroPharma, Terry Naturally, Strontium, 60 capsules

680 mg strontium in two capsules, other ingredients: hydroxypropyl methylcellulose (vegetable cellulose capsules), cellulose powder, vegetable source magnesium stearate

Number 8 in strontium and number 62 in multimineral formulas

       Onnit, Stron Bone, 90 capsules

680 mg strontium, 100 IU Vitamin E, 90 mcg Vitamin K2 as Menatetrenone, 2 mg copper, 2 mg manganese, 80 mg potassium, 5 mg black pepper (fruit) extract (BioPerine), and 150 mcg boron in three capsules, other ingredients: vegetarian capsule (hydroxypropyl methylcellulose, water), nu-flow (rice concentrate), nu-mag (rice extract, rice hulls, gum arabic and sunflower oil)

Quantitative Ultrasound as Alternative to DXA

Because BMD measured by DXA is prone to overestimation when one is taking strontium, I look at the CHANGE in my DXA score (at each site) from one scan to the next, not the absolute value. So far (10 years on strontium), each scan has been progressively better than the previous scan.

Another option for someone on strontium is to have a quantitative ultrasound (QUS) to assess bone health. QUS is not affected by strontium content in bone. Another positive is that the procedure uses ultrasound waves, not radiation.

https://www.ncbi.nlm.nih.gov/pubmed/29080282

https://www.researchgate.net/publication/12959124_Stiffness_index_identifie s_patients_with_osteoporotic_fractures_better_than_ultrasound_velocity_or_a ttenuation_alone

https://www.ncbi.nlm.nih.gov/pubmed/27806594

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837236/

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: http://dx.doi.org/10.15226/jnhfs.2016.00167

https://pdfs.semanticscholar.org/bdce/ac5e3fae890f6dd1902cb45734b96433b165.pdf