My Current Supplements

My bone protocol consists of the following supplements. The dosage for each is  one capsule or tablet per day unless otherwise stated. 

AOR Strontium Support II, 341 mg strontium (from citrate) per capsule (two capsules daily)

Country Life, Gluten Free, Calcium Magnesium with Vitamin D Complex (250 mg Ca, 125 mg Mg, 100 I.U. Vitamin D per capsule) (two capsules daily)

Innate Vitality Magnesium Glycinate, 500 mg/capsule 

Nature Made Multi Men's 50+, No Iron (OK for men and women; contains 1000 IU vitamin D3 and 21 other nutrients) 

Nature Made D3, 1000 IU (one capsule three times/week)

I also take the following supplements for general health. The dosage for each is one capsule or tablet per day unless otherwise stated.

Solgar Citrus Bioflavonoid Complex, 1000 mg per tablet (Bioflavonoids are antioxidants.)

Solary Selenium, 100 mcg

Vitacost Chelated Zinc (zinc glycinate chelate), 30 mg

Doctor’s Best Lutein with Optilut (20 mg lutein, 4 mg zeaxanthin in two capsules)(2 capsules/day)

Nature Made Vitamin C, 500 mg

Solgar Natural Vitamin E (as d-Alpha Tocopherol plus d-Beta, d-Delta and d-Gamma Tocopherols), 400 IU

Horbaach Sublingual Methylcobalamin (Vitamin B12), 5000 mcg

I also take a couple of digestive aids: 

A probiotic (I am trying different brands.)

A multi-enzyme digestive (I am trying different brands.) 

Supplements to Take Along with Strontium

Both the Combination of Micronutrients for Bone (COMB) study and Melatonin-Micronutrients Osteopenia Treatment Study (MOTS) investigated using strontium in conjunction with other supplements. You cannot take strontium without taking sufficient calcium (from food and/or supplements) and vitamin D. You also need magnesium, which was not included in the MOTS protocol, and was provided at a very low dosage in the COMB study. 

The COMB study for osteoporosis: 

strontium citrate (680 mg) 

D3 (2000 IU) 

dietary sources of calcium

magnesium (25 mg) 

K2 (MK7) (100 mcg) 

DHA (250 mg) 

daily impact exercises were encouraged. 

MOTS for osteopenia:

strontium citrate (450 mg)

D3 (2000 IU)

K2 (MK7) (60 mcg)

melatonin, 5 mg 

These ingredients were called MSDK for melatonin, strontium citrate, vitamins D3 and K2.

In addition to study medication, participants were allowed to take less than 1000 IU D3 and less than 1000 mg of calcium. Nearly 87% of the subjects in the MOTS study were taking either calcium/vitamin D3, multivitamins, and/or other dietary supplements.

The BoneLady uses her own protocol for osteoporosis: 

strontium citrate (682 mg),

D3 (1300 IU)

calcium (500 mg tablet, about 700 mg from dietary sources) 

magnesium (450 mg)

daily low-impact exercises  

I do not take DHA, K2, or melatonin. I do take several other supplements: https://strontiumforbones.blogspot.com/2020/07/my-current-supplements.html

Strontium Citrate Protocols

If you decide to take strontium citrate, you need to ensure you are also getting adequate calcium, magnesium, vitamin D, other vitamins and minerals, and protein. You can get these nutrients from a combination of diet and supplements. Choosing a supplement plan, or protocol, that is right for you can be as simple as choosing one of the three protocols described in this post or by modifying one of them with your own choice of supplements. 

Protocols for Osteoporosis:

 COMB                                                                                 BoneLady 

Strontium citrate                   680 mg                                                  680 mg

Vitamin K2 (MK7)               100 mcg                                                none

Vitamin D3                         2000 IU                                                 1000 IU

Docosahexanoic acid (DHA)250 mg                                                 none

Magnesium                             25 mg                                                  250 mg*

Calcium                       Dietary sources                                    500 mg*  

*BoneLady takes a supplement tablet that contains 250 mg Mg and 500 mg Ca. In addition, she gets about 700 mg Ca from food for a total of about 1200 mg Ca per day.  

Protocol for Osteopenia:

MOTS 

Strontium citrate     450 mg

Vitamin K2 (MK7)     60 mcg

Vitamin D3            2000 IU*

Melatonin                    5 mg

DHA                             none

Magnesium                  none    

Calcium                          * 

*In addition to study medication, participants in the MOTS study were allowed to take less than 1000 IU of vitamin D3 and less than 1000 mg of calcium daily. 

http://strontiumforbones.blogspot.com/2017/02/mots-and-comb-study-comparison.html

http://strontiumforbones.blogspot.com/2012/02/combination-of-micronutrients-for-bone.html

https://s3-us-west-1.amazonaws.com/paperchase-aging/pdf/vmFJfarchkyMAtwWn.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310667/

https://clinicaltrials.gov/ct2/show/NCT01870115?term=strontium+citrate&rank=1

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.

In Memory of Sara Shackleford DeHart

December 18, 1931 - November 8, 2017

Sara was born December 18, 1931 and passed away at her Lynnwood, WA home on November 8, 2017.
 

Arrangements under the direction of Purdy & Walters at Floral Hills, Lynnwood, WA.

Published in The Herald (Everett) on Nov. 22, 2017

Read obituary at Herald, The (Everett).

http://obits.dignitymemorial.com/dignity-memorial/obituary.aspx?n=Sara-DeHart&lc=4171&pid=187298167&mid=7633682&Affiliate=heraldnet&PersonID=187298167&FHID=11419

Sara DeHart was an inspiration to me and others. Ten years ago, when I started looking for alternatives to Fosamax, there was little information about strontium citrate (SC). Strontium ranelate was registered in Europe in 2004 for postmenopausal osteoporosis. I started using SC on January 21, 2008, and Sara's first article about strontium and osteoporosis was posted July 7, 2008.

Sara DeHart wrote three case studies about her struggle with osteopenia and fragility fractures while taking osteoporosis drugs. Only after taking strontium citrate with sufficient vitamin D3, calcium, and magnesium did the fractures cease. She later added vitamin K2 as well. I wrote a post about each of her articles on strontium.

Sara underwent radiation for inoperable throat cancer in 2000 and again for ductal carcinoma in situ in 2016. Of course, she wrote about those experiences and how to minimize the risk of radiation skin burns. She was a medical professional, professor, and writer until the end. She died November 8, 2017, three weeks short of her 86^th birthday.

http://strontiumforbones.blogspot.com/2009/02/strontium-and-osteoporosis.html

http://strontiumforbones.blogspot.com/2010/08/another-strontium-citrate-success.html

http://strontiumforbones.blogspot.com/2012/10/case-study-on-strontium-citrate-for.html

http://www.intrepidreport.com/archives/2608

http://www.intrepidreport.com/archives/2612

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

 

Combined Strontium and Vitamin D Therapy for Osteoporosis

The following abstract is for a clinical study titled "Correction of Vitamin D Insufficiency with Combined Strontium Ranelate and Vitamin D3 in Osteoporotic Patients" by R. Rizzoli et al. It was made available online 9 December 2013. Please note that I have converted the 25-hydroxyvitamin D units from nmol/l to ng/mL (1 ng/mL = 2.5 nmol/L) and added those units in parentheses. My personal daily osteoporosis therapy includes 2 grams strontium citrate (680 mg strontium) and 1000 IU vitamin D (included in my Nature Made Multi for Him multivitamin).

Objective This study aims to investigate the efficacy and safety of oral fixed-dose combination of strontium ranelate 2 g/vitamin D₃ 1000 IU daily vs strontium ranelate 2 g daily for correcting vitamin D insufficiency in osteoporosis.

Design A 6-month international, randomized, double-blind, parallel-group, phase 3 study.

Methods A total of 518 men and postmenopausal women aged greater than or equal to 50 years with primary osteoporosis (T-score less than or equal to −2.5 s.d.) and serum 25-hydroxyvitamin D (25(OH)D)greater than 22.5 nmol/l (9 ng/mL) were included. Patients were allocated to strontium ranelate 2 g/vitamin D₃ 1000 IU daily (n=413) or strontium ranelate 2 g daily (n=105). The participants received calcium 1 g daily. The primary endpoint was serum 25(OH)D at last post-baseline evaluation during 3 months.

Results Both groups were comparable at baseline. Mean baseline of 25(OH)D was 44.1 plus or minus 14.6 nmol/l (17.6 ng/mL plus or minus 5.8 ng/mL). After 3 months, the percentage of patients with 25(OH)D greater than or equal to 50 nmol/l (20 ng/mL) was higher with strontium ranelate/vitamin D₃ vs strontium ranelate (84 vs 44%, P less than 0.001; adjusted between-group odds ratio=6.7; 95% CI, 4.2–10.9). The efficacy of the fixed-dose combination on 25(OH)D was maintained at 6 months (86 vs 40%, P less than 0.001). Mean 25(OH)D was 65.1nmol/l (26 ng/mL) and 49.5 nmol/l (19.8 ng/mL), respectively, after 3 months and 66.9 nmol/l (26.8 ng/mL) and 45.4 nmol/l (18.2 ng/mL) after 6 months. Physical performance improved in both groups. Falls were 17 and 20% in the strontium ranelate/vitamin D₃ and strontium ranelate groups respectively. Parathyroid hormone levels were inversely correlated with 25(OH)D. No clinically relevant differences in safety were observed.

Conclusions This study confirms the efficacy and safety of fixed-dose combination of strontium ranelate 2 g/vitamin D₃ 1000 IU for correction of vitamin D insufficiency in osteoporotic patients. 

http://www.eje-online.org/content/170/3/441.short

MOTS and COMB Study Comparison

A one-year study on strontium citrate combined with melatonin and other supplements and named the Melatonin-micronutrients Osteopenia Treatment Study (MOTS) was recently published (January 26, 2017). I’d like to compare it to the Combination of Micronutrients for Bone (COMB) Study published in 2012. See the following chart:

        
    COMB Study                                                               MOTS

Study size                        114                                                                                  20

Baseline BMD status      osteoporosis                                                                   osteopenia

Strontium (citrate)               680 mg                                                                          450 mg

Vitamin K2 (MK7)               100 mcg                                                                         60 mcg

Melatonin                              none                                                                                5 mg                        

Vitamin D3                         2000 IU                                                                          2000 IU

Docosahexanoic acid (DHA)   250 mg                                                                      none

Magnesium                             25 mg                                                                          none

Lumbar spine BMD             6% increase                                                             4.3% increase

Femoral neck BMD             4% increase                                                             2.2% increase

Total hip BMD               3% increase                                                             No sign. diff., pos. trend

I could have predicted the results on BMD. How? Well, it had previously been shown, from studies on strontium ranelate, that strontium increased BMD at all dosages studied, but the optimum increases were gained with 680 mg strontium. Also, melatonin has been used for years as a sleep aid, but there is little evidence for it as a bone supplement. The authors of MOTS named two studies on melatonin listed below.         

“Limitations to this study include low number of subjects, lack of a diverse cohort and lack of different micronutrient combinations on primary and secondary endpoints in MOTS clinical trial.”

Despite the limitations of MOTS, there is valuable information to be gained from it:

MOTS increased awareness of the importance of preventative care in patients with osteopenia. “Over half of all women in the U.S. above age 50 have osteopenia with a prevalence of approximately 3.4 times more than osteoporosis. Consequently, twice the number of fractures arises from women with osteopenia as they represent almost 50% of the total population at risk.”

“The 10-year vertebral fracture risk probability decreased by 6.48% in response to MSDK (melatonin, strontium, vitamins D and K) therapy compared to 10.8% increase in placebo.”

“MSDK reduced bone marker turnover primarily by increasing the bone formation marker P1NP and maintaining healthy bone turnover.”

“MSDK demonstrated positive effects on inflammatory status and improved quality of life especially related to sleep.”

MOTS confirmed that dosages lower than 680 mg strontium will increase BMD by lower percentages.

                       

http://strontiumforbones.blogspot.com/2012/02/combination-of-micronutrients-for-bone.html

https://s3-us-west-1.amazonaws.com/paperchase-aging/pdf/vmFJfarchkyMAtwWn.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310667/

https://clinicaltrials.gov/ct2/show/NCT01870115?term=strontium+citrate&rank=1

Kotlarczyk MP, Lassila HC, O’Neil CK, D’Amico F, Enderby LT, Witt‐Enderby PA, Balk JL. Melatonin osteoporosis prevention study (MOPS): a randomized, double‐blind, placebo‐controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women. J Pineal Res. 2012; 52:414–26. doi: 10.1111/j.1600‐079X.2011.00956.x

Amstrup AK, Sikjaer T, Heickendorff L, Mosekilde L, Rejnmark L. Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial. J Pineal Res. 2015; 59:221–29. doi:10.1111/jpi.12252