Anyone concerned with bone health, whether taking
strontium or not, should have an adequate daily intake of calcium from food or
supplements or a combination of the two. In other words, if an individual can
get all her calcium from food, she does not need to supplement. However, most
people probably will need some calcium supplementation.
The risks of inadequate intake of calcium and
vitamin D are reduced calcium absorption, increased serum parathyroid hormone (PTH)
concentrations, and bone loss. Low bone mass is a strong predictor of fracture.
There is a
rationale for supplementing the diets of elderly subjects with a combination of
calcium and vitamin D. Absorption of calcium and possibly of vitamin D and
production of vitamin D by the skin decline with aging. Diets deficient in calcium tend also to be deficient in vitamin D because a single
food, milk, is the principal dietary source of both these nutrients.
There is no clinical study of
strontium with inadequate calcium and vitamin D because such a study would violate
the ethical medical standard of doing no harm to patients.
Before inclusion in the TROPOS study
of strontium ranelate, patients were subjected to a run-in study to initiate
normalization of their calcium and vitamin D status. The duration of this
run-in study was 2 wk to 6 months, depending on the severity of calcium and
25-OH vitamin D (25-OH D) deficiency. All
enrolled women received daily supplements of up to 1000 mg of elemental calcium
adapted to their needs according to their dietary intake (0, 500, or 1000 mg to
reach a total daily intake above 1000 mg), and vitamin D according to their
serum 25-OH D levels (800 IU for patients having serum 25-OH D lower than 45
nmol/liter and 400 IU for all the others). For patients with severe vitamin
D deficiency (25-OH D lower than 30 nmol/liter) the duration of the run-in
period was at least 3 months.
https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2004-1774
