Skeleton Pirate

Skeleton Pirate
Artist: LindaB


Have you experienced, or read about, negative, and even dangerous, side effects from Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate), and other bisphosphonates prescribed for osteoporosis? If you have, then rest assured there is a safe, effective treatment for this condition. Strontium, primarily in the form of strontium citrate, is taken orally once a day.

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Friday, April 4, 2014

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.

Wednesday, April 2, 2014

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.

Sunday, March 2, 2014

Calcium Polycarbophil, Strontium & Other Meds

I am writing this post because of a mistake I recently made. I want to prevent others from doing the same. I have repeatedly written that, because products containing calcium may prevent your body from absorbing your strontium, you should not take products containing calcium within two hours before or after taking strontium. Yet, recently, I began taking calcium polycarbophil at night, with my simvastatin (statin drug for lowering cholesterol levels), followed an hour later by my strontium citrate. A week or two later, I realized I may have reduced the effectiveness of both the simvastatin and the strontium citrate.

I knew there was calcium in the polycarbophil laxative, but I simply forgot while trying to juggle all my over-the-counter medications, prescription drugs, and supplements.  I also knew that laxatives can make it harder for your body to absorb other medicines. Therefore, you should avoid taking polycarbophil within two hours before or after you take any other medications.

Calcium polycarbophil is used to treat constipation. It is known as a bulk-forming laxative. Brand Names include: Equalactin, Fiber Lax, FiberCon, Fiberlax, Fibernorm, Konsyl Fiber, Perdiem Fiber Caplet.

I’ve been using Publix Fiber Caplets, which contain 625 mg calcium polycarbophil (active ingredient) per caplet. The list of inactive ingredients includes calcium carbonate. Each caplet contains 125 mg calcium, and the normal dose is two caplets up to four times a day. My one dose once a day contains 250 mg calcium.  FiberCon has 244 milligrams of calcium per two-caplet dose.

Friday, February 21, 2014

Strontium Ranelate to Remain Available in EU

As of February 21, 2014, the European Medicines Agency (EMA) has concluded its review of strontium ranelate (Protelos/Osseor). The EMA is recommending the medication remain available in the European Union (EU) but further restricting its use to patients who cannot be treated with other medicines approved for osteoporosis due to contraindications or intolerance. These patients should continue to be evaluated regularly by their doctor, and treatment should be stopped if patients develop heart or circulatory problems. Patients with established, current or past history of ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease, or those with uncontrolled hypertension should not use the medicine.

Study data showed a beneficial effect in preventing fractures, including in patients at high risk of fracture. Available data do not show evidence of an increased cardiovascular risk with Protelos/Osseor in patients who did not have a history of heart or circulatory problems.



Monday, February 10, 2014

Two New Studies Show Strontium Ranelate Not Associated with Increased Risk of MI

The safety of all centrally registered drugs is closely monitored by the European Medicines Agency (EMA) through a new committee, the Pharmacovigilance Risk Assessment Committee (PRAC), which was launched in October 2012. The procedures include regular submission of periodic safety update reports (PSURs).

In November 2012, the PSUR for strontium ranelate, which encompassed a number of new randomized clinical trials, included an updated assessment of the overall safety of the treatment and was submitted to the PRAC. The overall safety analyses showed an increased cardiovascular risk in patients treated with strontium ranelate. This ongoing process has led to a label change, and, in order to mitigate the cardiovascular risk, strontium ranelate is now contraindicated in patients with a history of cardiovascular disease, i.e. in patients with a history of ischemic heart disease, peripheral artery disease, and/or cerebrovascular disease and in those with uncontrolled hypertension.

In the light of these procedures, the results of two new studies were published together online on December 10, 2013, in Osteoporosis International. Both constitute retrospective observational studies conducted in databases of electronic healthcare records and were set up to analyze the cardiovascular risk associated with the prescription of strontium ranelate in real-life clinical practice in the UK and in Denmark.

The results of the studies are consistent on three points. First, observational data do NOT indicate that the use of strontium ranelate was associated with a significant increase in myocardial infarction (MI). Cooper et al. compared the risk of ischemic cardiac events in postmenopausal osteoporotic women who were currently receiving treatment with strontium ranelate—or had received it in the past—with the risk in those who had never received strontium ranelate. Current use or past use of strontium ranelate was not associated with any significant increase in the risk for three cardiovascular events: first MI, hospitalization with MI, or cardiovascular death. Abrahamsen et al. reported that the risk for MI in men and postmenopausal women was not significantly elevated, though they did find a very borderline result for stroke and cardiovascular death and a significant increase in risk for all-cause mortality.

Second, both studies highlighted substantial differences in patient profile of users of strontium ranelate compared with users of other osteoporosis treatments. Strontium ranelate patients are generally older and have more severe osteoporosis and a longer duration of disease. They also have more comorbidities, notably those related to elevated cardiovascular risk, such as cardiac failure (22 % in the Danish study), peripheral vascular disease (6 %), and cerebrovascular disease (11 %), with a combined prevalence of ischemic heart disease, peripheral vascular disease, and cerebrovascular disease of 19 % in women and 30 % in men. The cases of ischemic cardiac events in the UK study were also at substantially higher risk compared with the controls, with higher rates of history of hospitalization for MI (12 versus 4 %), ischemic heart disease (71 versus 24 %), peripheral artery disease (18 versus 7 %), and cerebrovascular disease (23 versus 15 %). This is a significant finding for clinical practice: the majority of cases of MI occurred in patients who would not be treated with the agent according to the new contraindications for strontium ranelate.

Third, while both studies are highly robust, neither managed to properly address the major challenge of the potential channeling bias by which more fragile or severe patients are being switched to strontium ranelate. Clearly, further research is warranted with appropriate handling of the remaining bias for a more complete evaluation of risk.

The role of the clinician is to select the best treatment for the patient’s profile and individual therapeutic objective, which should remain the prevention of osteoporotic fracture. By strictly applying the new contraindications for strontium ranelate, we can hope to achieve our primary goal of treating disease, preventing osteoporotic fracture, while markedly reducing the risk for side effects.

Saturday, January 25, 2014

Final Opinion on Possible Suspension of Strontium Ranelate to Be Made in February

The recommendation of the European Medicine Agency's Pharmacovigilance Risk Assessment Committee that strontium ranelate (Protelos and Osseor) should no longer be used to treat osteoporosis is still under consideration by the Committee for Medicinal Products for Human Use (CHMP). At its January 2014 meeting the Committee requested additional information from the company to inform its scientific decision making. A final opinion will be made by the CHMP at its meeting in February 2014.

Wandering Skeleton

Wandering Skeleton
Artist: Joel Hoekstra

Osteoporotic Bone

Osteoporotic Bone

How Strontium Builds Bones

Strontium is a mineral that tends to accumulate in bone. Studies have shown that oral doses of strontium are a safe and effective way to prevent and reverse osteoporosis. Doses of 680 mg per day appear to be optimal. See my "For More Information About Strontium" links section.

Osteoporosis is caused by changes in bone production. In healthy young bones there is a constant cycle of new bone growth and bone removal. With age, more bone is removed and less new bone is produced. The bones become less dense and thus more fragile.

Scientists believe that strontium works in two ways. It may stimulate the replication of pre-osteoblasts, leading to an increase in osteoblasts (cells that build bone). Strontium also directly inhibits the activity of osteoclasts (cells that break down bone). The result is stronger bones.

When taking strontium, be sure to take 1200 mg calcium, 1000 IU vitamin D3, and 500 mg magnesium daily. It is best to take strontium late at night on an empty stomach. Calcium and strontium may compete with each other for absorption if taken together.