Prunes for Bone Health

Certain lifestyle and nutritional factors are known to reduce the risk of osteoporosis. Among the nutritional factors, dried plums or prunes (Prunus domestica L.) are the most effective fruits in both preventing and reversing bone loss.

A clinical study published in the British Journal of Nutrition in 2011 examined the extent to which dried plums reverse bone loss in osteopenic postmenopausal women. In the study, 160 women who were 1–10 years postmenopausal and not on hormone replacement therapy or any other prescribed medication known to influence bone metabolism were randomly assigned to one of the two treatment groups: dried plums (100 g/d) or dried apples (comparative control). (One hundred grams of dried plums per day equals about 10 dried plums.) Participants received 500 mg calcium plus 400 IU vitamin D daily.

Dried plums significantly increased the BMD of the ulna and spine in comparison with dried apples. In comparison with corresponding baseline values, only dried plums significantly decreased serum levels of bone turnover markers, including bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase-5b. The findings of this study confirmed that dried plums improve BMD in postmenopausal women, in part due to suppressing the rate of bone turnover.

http://dx.doi.org/10.1017/S000711451100119X

Dr. Hoffman’s Comments on Strontium and Vitamin D

In Dr. Ronald Hoffman’s recent podcast, he answered the following questions pertaining to strontium and vitamin D:

http://drhoffman.com/podcast/intelligent-medicine-podcast-qa-with-leyla-part-1-5/

Are there dangers to using strontium?

He says there is an increased risk of blood clots with strontium ranelate, but he believes it is due to the ranelate, not the strontium. He says he has not seen this problem with strontium citrate.

My take: An increased risk of blood clots is only one of several adverse events attributed to strontium ranelate. I believe most of the negative side effects of strontium ranelate may be due to ranelic acid and/or aspartame, although no one knows for sure. I have not read of anyone who got a blood clot that could be attributed to strontium citrate. The most common adverse events associated with strontium citrate are constipation, other gastrointestinal disorders, and nausea. I have been using strontium citrate for six and a half years with no problems except minor constipation.   

Can strontium falsely elevate DEXA bone density scans?

He says there is a false elevation and the improvement is actually about half of what we see on the bone density test. He says you can take your percent increase and divide it by two.

My take: It is a fact that there is a false elevation of BMD with strontium. Servier, the manufacturer of strontium ranelate, says the BMD can be falsely elevated by as much as 50% after three years of strontium use. This 50% figure is an estimate. It depends on how long you have been taking strontium, how well you absorb it into your bones, and the type of DEXA equipment used. The exact correction will vary for each individual. If you have been taking strontium for three years or longer, you can use the 50% correction as a general rule.

Can you use an osteoporosis medication and strontium together?

This was not posed as a question in the podcast. Dr. Hoffman stated that he had one patient with very low bone density and that he prescribed a medication (not specified) and natural support (strontium, I assume, since the discussion was about strontium) together.

My take: If he prescribed a bisphosphonate and strontium together, it was probably not a good idea. The two may be antagonistic. A recent study provides evidence that prior bisphosphonate therapy results in blunting and delay of the BMD response to strontium ranelate. This study was on sequential use of a bisphosphonate followed by strontium ranelate. See my April 2, 2014 blog post, “Sequential Therapy with Bisphosphonates and Strontium” for more information on this study. We do not know if taking a bisphosphonate and strontium simultaneously would also result in blunting and delay of the BMD response.

Which vitamin D should you take, D2 or D3?

He says to avoid vitamin D2 because it cancels the effect of D3 to some extent. He says D3 is more bioavailable and more bioactive than D2.

My take: I use vitamin D3. I believe D3 is more bioavailable than D2 and will do a better job of raising your vitamin D blood level.  

Strontium Basics

What is the recommended amount of strontium?

The amount of a strontium salt (e.g. strontium citrate) for prevention of bone loss in early postmenopausal non-osteoporotic women is roughly 1 gram per day to get about 340 mg of elemental strontium.

The amount of a strontium salt for treatment of postmenopausal osteoporosis is roughly 2 grams per day to get about 680 mg of elemental strontium.

When should you take strontium as per time of day and how far apart from calcium?

You can take strontium at any time as long as you take it at least 2-3 hours after taking food, milk or milk products, or calcium supplements. Calcium competes with strontium for absorption; so, you will absorb less strontium if you take calcium and strontium too close together. You will absorb strontium better on an empty stomach. I take my strontium at night shortly before bedtime. Take it when it is most convenient for you.

In what ratio to calcium should you take strontium?

You do not need to worry about a ratio of calcium to strontium. The amount of calcium you need, whether you take strontium or not, depends on your age and sex. Adult men (51-70 years old) need 1000 mg daily. Adult women (51-70 years old) need 1200 mg per day. These are total amounts of calcium. So, what you need to do first is figure out how much calcium you are getting from food, and then supplement the rest, if needed. You should strive to get all, or most, of your calcium from food.

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.