DNC News

 

DNC News: Strontium: A New Treatment for Osteoporosis

 

Subject: Supplemental strontium prevents bone resorption and increases new bone deposition providing a possible treatment for osteoporosis

 

Hormone Replacement Therapy (HRT) is looking less and less attractive to women. First came the news that it did not protect against heart attacks. Then came the news it increased risk of breast cancer and a few other unattractive conditions. Recent headlines say HRT increases the risk of breast cancer occurring as a more malignant form. With risk starting to far outweigh potential benefit, many women have decided to stop using HRT. The one clear benefit of using HRT has been slowing postmenopausal bone loss. Without HRT, we need other effective ways to prevent osteoporosis. It isn't just HRT shy women who this is a concern for. Women who have, or had, or who are at high risk for breast cancer, have no business using HRT. There are also men who develop osteoporosis and who are not the least interested in taking Premarin.

 

We have been looking at several options for treatment. We have used Ipriflavone for a number of years. We have recently added strontium to our list of possible treatments. This is a relatively obscure supplement and is not in common use in the United States as a treatment for. A patient brought in an article about it last winter. It has taken me months to track down two companies that I felt comfortable buying Strontium from.

 

Strontium is obscure. Discovered in 1790 by the Scots-Irish chemist, Adair Crawford from a barium crystal ore found near the Scottish town of Strontian , few people heard of strontium until the radioactive form of Strontium (Strontium 90) became part of the nuclear fear syndrome. What we are using as a nutritional supplement is not the radioactive form but elemental strontium.

 

In the 1940's research began to suggest the strontium was important in the development of a healthy skeletal system. The body contains relatively large amounts of strontium, 90% of which is in the skeleton. Supplementing strontium in animal diets increases the buildup of dentin tissue in teeth [1] and healthy teeth contain more strontium than teeth with cavities. [2] People living in areas where there is more strontium in the water supply have fewer cavities. [3] , [4]

 

If you deprive rats or guinea pigs of strontium in their diets they end up with defective mineralization of both bones and teeth [5] suggesting that strontium is necessary for normal development. We may need to list strontium along with the better known minerals, calcium, magnesium and zinc whenever we talk about bone health. Strontium is almost always present in the same foods and animal products in which we find calcium. [6] It may be that when researchers have thought that calcium rich foods were good for bone health they may have actually been overlooking the benefit of calcium and strontium together.

 

The earliest clinical trial investigating strontium and osteoporosis that I know of was back in 1942 and conducted by Ephraim Shorr, (a name I can't help but notice). In the study patients were given 1700 mg/day of strontium [7] . This supplementation increased retention of calcium, protein and phosphorous. Back then, they didn't have the nifty scans to measure bone density that we do now, but this early study showed clear improvement in subjective symptoms and objective performance tests in people who took strontium. Patients who were hurting experienced clear pain relief.

 

A second study was performed at the Mayo Clinic again using 1700 mg of strontium/day with similar results. Marked improvement in subjective symptoms was seen in 84% of the strontium users with the remaining test subjects obtaining moderate improvement. “No patient failed to improve subjectively” on strontium. [8] Though subjective reports were positive none of the evaluators were able to see any change on the x-rays of the test subjects. We now know that a patient can lose 40% of their bone mass before it becomes noticeable on an x-ray.

 

In the 1980's Skoryna at McGill University was able to show that a daily dose of 6-700 mg of strontium in people with osteoporosis increased the rate of new bone formation by 172%. [9] This should have been exciting. HRT, though touted for preventing osteoporosis, has never been shown to increase bone formation. At its best it slows bone destruction. Large-scale, double blinded, randomized, placebo-controlled studies followed which have demonstrated the safety and effectiveness of strontium as a mineral that aids in building bones. [10]

 

The first of these trials involved 353 women with osteoporosis and at least one previous fracture of vertebral spine. The women discontinued any existing osteoporosis drugs and for two years took calcium, Vitamin D3 and either strontium or a placebo. Strontium was tested at three strengths, 170, 340, or 680 mg/day. After two years the strontium had increased the bone mass more than the placebo in proportion to the strontium taken. Women taking the 680mg dose had about a 6% increase in hip bone mass. Women taking calcium and vit D3 alone lost about 1% bone mass. [11] The ladies in the strontium group had about half the new vertebral fractures and deformities as the control group.

 

A second larger study was undertaken. This time with 1649 subjects, women with osteoporosis who took calcium vitamin D and either a placebo or strontium (680mg). This time the study ran for three years. Women taking the placebo had a 1.3% loss of spinal bone mass over the three years. Women taking strontium increased their bone mass by 11.4%. [12] To put this in some sort of perspective the best of the drug treatments, Fosamax, in combination with other therapies has increased bone mass by 5.5% over a similar time period. [13] In the women taking strontium fracture rate was 41% lower than in the control group taking placebos.

Many patients cannot take Fosamax due to its side effects. No side effects have been reported in any of the strontium studies.

 

These studies suggest that not only does strontium inhibit excessive bone breakdown but it boosts the body's ability to build new bone. In some nasty sounding animal experiments, researchers created menopausal mice by removing their ovaries. The researchers were then able to compare estrogen replacement therapy against strontium supplementation and its effect on bone loss. The hormones stopped bone loss in these surgical menopausal animals but the strontium actually increased bone volume to a level about 30% greater than before ‘menopause'. [14] Same story when the experiment was done to monkeys. [15]

Is that cool or what?

 

You can't put a patent on strontium. If you can't patent a substance you can't have exclusive rights to sell it. Without exclusive marketing rights, few companies are willing to invest the money it takes for clinical research. This explains why strontium, which appears to work better at treating osteoporosis than any of the prescription drugs available, is unheard of. This situation has changed. Early research on strontium used common chemical forms, strontium lactates, gluconates and carbonates. The recent studies have used a special patented form. The patented form combines strontium with a patented synthetic chemical called ranelic acid to form strontium ranelate. This product is marketed in Europe as Protos. We should see this drug in the U.S. in the next year or so.

Nothing in the research suggests that this patented form is more effective than regular strontium. The difference is that the patent offers the potential for profits and thus the ability to raise money from investors and fund larger, long term studies.

 

There is no reason that I can see to use the semisynthetic drug form of strontium over the nutritional supplement form. Neither cost, safety, or any data suggest an advantage to Protos.

 

We have chosen two companies to purchase strontium products from and will try to keep adequate supplies of these chemicals available in the office.

 

 

[1] Weinman JP. Effect of strontium on the incisor of the rat. Injections of small doses of strontium chloride as a means of measuring the rate of incremental dentine apposition. J Dent Res 1942:21:497

[2] Piercuccini R, Zotti R. Biological function of strontium and manganese in teeth. Atti della Soc Toscanna di Sci Nat Mem. 1949;56:119

[3] Losee FL, Adkins BL. A study of the mineral environment of caries-resitant Navy recruits. Caries Res. 1969;3:223-31

[4] Strontium and dental caries. Nutr Rev. 1983 Nov;41(11):342-4

[5] Rygh O, Recherches sur les oligo elements –l. Des l'importance du strontium, du barium, du thallium et du zinc dans scorbuts. Bull Soc Chim Biol. 1949;31:1052

[6] Schroeder HA, Tipton IH, Nason AP. Trace Minerals in Man; strontium and barium. J Chronic Dis. 1972 sep;25(9):491-517

[7] Shorr E, Carter AC. The usefulness of strontium as an adjuvant to calcium in the remineralization of the skeleton in man. Bull Hosp Joint Dis. 1952 Apr;13(1):59-66

[8] McCaslin FE Jr, James JM,. The effect of strontium lactate in the treatment of osteoporosis. Prc Staff Meetings Mayo Clin. 1959;34(13):329-34/

[9] Marie PJ, Skoryna SC, Pivon RJ, Chabot G, et al. Histomorphometry of bone changes in stable strontium therapy. Trace Subst Env Health. 1985;19:193-208

[10] Brandi ML. New treatment strategies: ipriflavone, strontium, Vita D metabolites and analogs. Am J Med 1993 Nov 30;95(5A):69S-74-S

[11] Meunier PJ, Slosmana DO, et al. Strontium ranelate: dose dependent effects in established postmenopausal vertebral osteoporosis- a 2 year randomized placebo controlled trial. J Clin Endocrinol Metab. 202 May;87(5): 2060-6.

[12] Meunier PJ, Roux c, et al. Stontium ranelate reduces risk of vertebral fracture risk in women with postmenopausal osteoporosis. Osteoporosis Int 2002 Jun;136)521.

[13] Johnell O, Scheele WH, et al. Additive effects of raloxifene and aledndronate on beone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2002 Mar;87(3):985-92.

[14] Marie PJ, Hott M, et al. An uncoupling agent containing strontium prevents bone loss by depressing bone resorption and maintainiing bone formation in estrogen deficient rats. J Bone Miner Res. 1992 May; 8(5):607-15.

[15] Buehler J, Chappuis P, et al. Strontium ranelate inhibits bone resorption while maintaining bone formation in alveolar bone in monkeys. Bone 2001 Aug;29(2):176-9.


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