DNC NEWS: Changing Treatments for Osteoporosis
Subject: A review of current treatments for osteoporosis.
A new study supports the use of strontium.
Our suggested treatments for osteoporosis have changed over the years.
We continue to use basic mineral supplements Calcium, Magnesium, and vitamin
D. Other things have changed. Natural progesterone was a common
treatment in the early 1990's. John Lee's study said it would increase
bone density and this was very exciting, but it never panned out in clinical
practice. Later studies didn't show the increased bone density that
Lee saw. So we no longer use progesterone for osteoporosis.
We still prescribe a great deal of progesterone, but for other things.
The studies about specific forms of calcium have not convinced us that
one form is vastly superior. Although some forms of calcium have
been heavily promoted as more effective, especially hydroxyappatite, it
appears that the more generic calcium supplements are adequate. We continue
to use Ipriflavone, a semi-synthetic isoflavone, for osteoporosis and
for a growing number of other conditions as well. It affects the
bones, slowing bone loss in much the same way as estrogen. We have
discovered that in rare individuals it lowers white blood counts and learned
to watch for this.
There are two new things which we have added over the last year that we
are excited about. We started prescribing Menatetrenone (Vitamin
K-2) and Strontium.
The research says Vitamin K-2 will either maintain or slightly increase
bone density. More important though, it will make bones stronger and cut
fracture rates by more than half. Vitamin K-2 also appears to have
a role in treating dysplastic anemia and possibly cancer.
The other supplement we added to our osteoporosis list is strontium.
Strontium has a long history in treating osteoporosis. It was studied
fifty or more years ago with good results but little use. No drug company
was interested in either funding research or promoting it. Apparently
since strontium is natural it isn't patentable. This has changed.
A European company combined strontium with a chemical called Ranelate
which they hold a patent on, to produce a patented form of strontium called
Strontium Ranelate. With this patent in place, they have funded
several large clinical trials. One was published just a week or
two ago in the New England Journal of Medicine.
The results of this Strontium Ranelate trial are very good. The
women taking strontium had about half the fracture risk of women who didn't.
Bone density in the spine increased by 15% in three years of use.
Strontium Ranelate isn't sold in the United States yet. It will
probably show up eventually as a prescription drug. No evidence
is available that this Ranelate form is superior to other forms of strontium.
We have been using strontium citrate which is available from one of our
The supplements we suggest change over the years and at times I find this
annoying. It would be nice to have a nutritional cookbook that remains
the same. Unfortunately experience and science leaves us little
choice. Some supplements seem to come and go in popularity like
fads. One day they are touted as miracles, the next day they are
forgotten history. Steering a rationale course between hype and
ethical practice can be challenging. We make the best choices available
based on tradition, experience, and current science. Yet whatever
choices we make, we make them in the context of naturopathic medicine.
The general tenets of our practice do not change. As naturopathic
doctors our focus was, is, and always will be to focus on therapies that
encourage and allow the natural healing ability of the body to mend illness.
What changes is our knowledge of what will do this, but not our underlying
principles or goals.
Here is the abstract of the new strontium study:
The Effects of Strontium Ranelate on the Risk of Vertebral Fracture
Women with Postmenopausal Osteoporosis. N Engl J Med 2004;350:
Background: Osteoporotic structural damage and bone fragility result from
reduced bone formation and increased bone resorption. In a phase 2 clinical
trial, strontium ranelate, an orally active drug that dissociates bone
remodeling by increasing bone formation and decreasing bone resorption,
has been shown to reduce the risk of vertebral fractures and to increase
bone mineral density.
Methods: To evaluate the efficacy of strontium ranelate in preventing
vertebral fractures in a phase 3 trial, we randomly assigned 1649 postmenopausal
women with osteoporosis (low bone mineral density) and at least one vertebral
fracture to receive 2 g of oral strontium ranelate per day or placebo
for three years. We gave calcium and vitamin D supplements to both groups
before and during the study. Vertebral radiographs were obtained annually,
and measurements of bone mineral density were performed every six months.
Results: New vertebral fractures occurred in fewer patients in the strontium
ranelate group than in the placebo group, with a risk reduction of 49
percent in the first year of treatment and 41 percent during the three-year
study period (relative risk, 0.59; 95 percent confidence interval, 0.48
to 0.73). Strontium ranelate increased bone mineral density at month 36
by 14.4 percent at the lumbar spine and 8.3 percent at the femoral neck
(P<0.001 for both comparisons). There were no significant differences
between the groups in the incidence of serious adverse events.
Conclusions: Treatment of postmenopausal osteoporosis with strontium ranelate
leads to early and sustained reductions in the risk of vertebral fractures.
Excerpt from text of study: Throughout the study, subjects received daily
calcium supplements at lunchtime (up to 1000 mg of elemental calcium,
depending on their dietary calcium intake), to maintain a daily calcium
intake above 1500 mg, and vitamin D (400 to 800 IU, depending on the base-line
serum concentration of 25-hydroxyvitamin D). After a run-in period of
2 to 24 weeks, depending on the severity of the deficiency of calcium
and vitamin D, the subjects were randomly assigned to receive 2 g a day
of strontium ranelate (two packets a day of a powder that they mixed with
water) or placebo powder for 3 years. Subjects were instructed to take
the study drug once daily, at bedtime, or twice daily (one packet 30 minutes
before breakfast, and one at bedtime). Most subjects (87 percent) chose
the once-daily regimen.
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