Strontium Citrate for Osteopenia

For several years now alternative doctors have recommended strontium citrate as a supplement in the treatment of osteopenia and as a preventive against osteoporosis. I used to recommend it as well but then stopped because I couldn’t find any research on its use for osteoporosis prevention. Every time I contacted supplement manufacturers about their research claims, they sent me articles on Strontium Ranelate, a drug approved in Europe for the treatment of osteoporosis.  But strontium citrate is not Strontium Ranelate and I am not a big fan of “borrowed science”.  I dislike any kind of intellectual “bait and switch” so I persisted in my pursuit of any information on the benefits of strontium supplementation. All I could find on the internet was a study that was started in 2010 at UC Davis but apparently it either was never completed or the results were somehow removed from the internet. Big Pharma at play? Who knows and besides conspiracy theories won’t help my patients’ bone density.

Your bone density does increase when you take strontium as a supplement and your bone density test (DEXA scan) will show the increased density. This is because your body will take in the strontium and deposit it in your bones and since the atomic number of strontium is higher than that of calcium, your bone density will increase. Strontium is heavier than calcium and so your bones will be denser when scanned.

However, it didn’t take long for conventional doctors to declare that this was a “fake” increase in density, that the scanner had been “tricked” into measuring a greater bone density. The true test, the experts declared, was whether or not your fracture risk is less with strontium and since that had never been researched, strontium couldn’t be trusted. I have to say that I also agreed with this position. We just didn’t have the data needed to recommend strontium.

Well, I am happy to report that in January, 2017 a strontium citrate study was published in the journal Aging, the MOTS study (Melatonin-micronutrients Osteopenia Treatment Study).  The study was conducted jointly by the Department of Orthopedic Surgery at the Mayo Clinic and the School of Pharmacy at Duquesne University. Here is the NIH announcement link - https://clinicaltrials.gov/ct2/show/NCT01870115?term=mots&rank=3.  The link for the actual article is -http://www.aging-us.com/article/101158/text.

Basically, what the study showed was that taking melatonin, 5 mg., strontium citrate, 450 mg., Vitamin K2, 60 mcg., and Vitamin D3, 2000 I.U. nightly for a year increased bone density as measured by a DEXA scan. It also showed that when human mesenchymal stem cells and human peripheral blood monocytes are exposed to these supplements (MSKD) there is increased osteoblastogenesis and decreased osteoclastogenesis. Bone is living tissue and it is continually remodeled. The osteoblasts build up the bone and the osteoclasts resorb it.  Osteoporosis is basically a decrease in bone formation and an increase in bone resorption. Bisphosphonate drugs like Fosamax® inhibit the osteoclasts, the bone resorption cells. They don’t stimulate the osteoblasts, the bone forming cells. By inhibiting the resorption, less density is lost by keeping more old bone.  Well, these supplements (MSDK) stimulate the bone forming cells, the osteoblasts and inhibit the bone resorbing cells, the osteoclasts, thus increasing bone density in human stem cells even in a petri dish. This results in a more natural balance of the two cell types and hence a healthy bone density. The results are happening on a cellular level and are not “fake” or the tricking of the DEXA scanner.

The most important finding is that subjects who received the MSKD mixture of supplements showed good FRAX® scores. FRAX® is a computer based algorithm developed at the University of Sheffield and is used to estimate a patient’s 10 year risk of fracture. This tool is approved by the FDA and the NIH and many medical specialty societies. This answers the biggest objection of the mainstream experts. Yes, taking these supplements will lower your risk of fracture. Nothing fake, no tricks. Period.

I will end this entry with two words of caution. First, the number of subjects was exceedingly small – just 22. I am sure that the medical industrial complex will focus exclusively on this fact. However, I am encouraged by the fact that at a cellular level there was increased osteoblast activity. The supplements are inexpensive, readily available and when taken in the recommended amounts they are safe.

The second word of caution is that you should discuss taking these supplements with a knowledgeable physician. People with hypothyroidism should probably not use 5 mg of melatonin each night as it might lower thyroid function. Some people will feel groggy in the morning or awaken with a headache from that much melatonin. The dose needs to be adjusted slowly over time. People should also have a Vitamin D level drawn to assess whether 2,000 I.U is enough or perhaps too much. A baseline DEXA scan should be done before starting this protocol and perhaps repeated in a year instead of the usual two year interval. Patients on blood thinners will need to adjust their medication dose as vitamin K will counteract the blood thinners somewhat.

And, one last thing. Remember that UC Davis study that mysteriously disappeared from the internet? Look what I found -  http://phs.ucdavis.edu/research/scope.php . It seems like their study is on again and they are actively recruiting volunteers. No melatonin and the study will last only 3 months. I wonder whether they will have FRAX® scoring. I wonder what they are trying to prove.

 

UPDATE:  Some conventional doctors are now saying that strontium citrate is dangerous! Here's the scoop - there was a problem with strontium ranelate in Europe. The EU's version of the FDA put out some warnings about strontium ranelate. It seems that there have been some studies done in Europe which indicate that patients with ischemic heart disease, peripheral vascular disease, uncontrolled hypertension and cerebral vascular disease should not use strontium ranelate.  One was a Danish study published in 2013. It was a  large study using the Danish Prescription Database. In Denmark, the government has ready access to prescription records and medical records so studies like this are easy to do. I believe it is a good correlational study. The authors did note, however, that patients using strontium ranelate were older than the patients in the study who were taking other drugs for osteoporosis. So the take-away was this: if you have plaque in your heart arteries, if you have a tendency to get blood clots, if you have high blood pressure that's not controlled with medication and if you are at risk for or have already had a stroke, you should NOT take strontium ranelate.

Is strontium ranelate the same as strontium citrate? No. Remember, we started this entire discussion because they are not the same and marketers were claiming that they were identical in their effects. So, they are still not identical except now there is some bad news about strontium ranelate.

It is also important to note that the usual dose of strontium ranelate is actually 2,000 mg per day and the dose of strontium citrate in the MOTS study was 450 mg. The Canadian government is now recommending caution when taking any strontium supplements if you have pre-existing heart disease. Yet, the Canadian government readily admits that there are no studies showing any danger from strontium ranelate below a dose of 680 mg. per day and there are no studies indicating any harmful effects of any strontium supplements.  This is all cautionary.

Here's my recommendation - don't run out and buy all the supplements mentioned in the MOTS study. Come in and we'll talk about it. Some patients don't even know if they have heart artery plaques but there is an easy way to find out. Come in and we'll talk about it. If you have any of the conditions mentioned above, then be extra safe and don't take strontium in any form. In fact, some manufacturers of strontium citrate have already put a warning on their labels just to be extra cautious. Strontium citrate and the other supplements in the MOTS study are still a good alternative for osetopenia treatment and osteoporosis prevention for patients without cardiovascular disease. The MOTS study suffers from a small subject pool but the in vitro stem cell results add more weight to their results for me.