The promotion of essential micronutrients like sex hormones, vitamins and minerals for multisystem health including bones is vital.
But what evidence for longterm cost:benefit is there for strontium for anything let alone bones?
A warning was published in 2005 (Prescrire Int. 2005;14:207-11) Strontium: new drug. Postmenopausal osteoporosis: too many unknowns. [No authors listed]). http://www.level1diet.com/759319_id. No new trials have appeared since. .
There is in fact only one solitary major trial published of sodium ranelate in osteoporosis, the SOTI-TROPOS trial by Reginster, Meneur ea for the strontium ranelate SrR manufacturers (Servier) at 72 centers in 11 European countries and Australia, in some 5000 postmenopausal women recruited from 1996 through 1998 ie till about 2003, with either previous postmenopausal fracture or frank osteoporosis: All on 1 to 1.5gm calcium and vitamin D 400-800iu/day, they were randomized to placebo or SrR 2gm/day. After a mean of 3 years, compared to placebo, vertebral fractures in 1442 women at a mean of 69yrs were reduced by 49% from baseline , but in the entire cohort nonvertebral fractures were reduced by only 16% from baseline at mean age of 77yrs.. All fractures were reduced from 12.9% to 11.2% ie 4.3%pa to 3.7%pa; hip fractures from 3.4% to 2.9%, vertebral fractures from 14% to 7.7%.
Are these differences significant for patient care, when the longterm effects of strontium therapy are unknown, and the longterm adverse effects of biphosphonates are becoming horrifically clear?
But these trials of SrR used only weak baseline prevention of lowdose calcium and vitamin D . Numerous other preventative bone-and muscle-strengthening supplements were apparently specifically excluded or omitted – magnesium, estrogen. vigorous-dose vitamin D eg 2000iu/d, vitamin K, androgen, boron, zinc.
And like the concurrent Womens’ Health Initiative, the SOTI-TROPOS trial was stopped woefully too soon instead of letting it run for at least 10 years to see the longterm benefit (if any). Worst of all, it did not test whether SrR adds any benefit on a sensible baseline of all the proven supplements that we have used for decades.
As Winzenberg ea ask in a recent 2007 Australian review, Strontium ranelate Does it affect the management of postmenopausal osteoporosis? Strontium ranelate did not cause gastritis, back pain or death, but more or less doubled numerous adverse effects :
*50% more (ie six out of 100 women taking strontium ranelate) experienced diarrhoea compared to four out of 100 taking placebo,
• The risk of vascular system disorders including venous thromboembolism (two trials, n=6669, 2.2 vs. 1.5%, OR: 1.5, 95% CI: 1.1–2.1) , pulmonary embolism (two trials, n=6669, 0.8 vs. 0.4%, OR: 1.7, 95% CI: 1.0–3.1) * as well as nervous system disorders such
as headache (3.9 vs. 2.9%), seizures (0.3 vs. 0.1%), memory loss (2.4 vs. 1.9%) and disturbance in consciousness (2.5 vs. 2.0%) is
slightly increased with taking 2 g of SrR daily over 3–4 years
• There were no RCTs identified which compared SrR to other treatments of postmenopausal osteoporosis.”
http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp2007august/200708wizenberg.pdf
It is common cause that the chief risk factor for fracture is not bone density but frailty, falls; and that the only microsupplements that strengthen muscle are apparently androgen, zinc, calcium and magnesium and the vitamins D and B6, 9 and 12. There is no absolute contraindication to appropriate long term human androgen plus estrogen replacement .
Now Fuchs ea show that “Strontium ranelate does not stimulate bone formation in ovariectomized rats”.. http://www.galenicom.com/pt/medline/article/18385919/Strontium+ranelate+does+not+stimulate+bone+formation+in+ovariectomized+rats./ – sex hormones are necessary for strontium to benefit bones.
With the oldfashioned calmag, zinc, boron, fluoride vitamins A-E, and parenteral androgen plus estrogen, we have seen bone density rise by 1%pa and hip density by 1/2% pa over 15years from age 52 in a frail woman with severe rheumatoid arthritis, despite management with corticosteroid and other remittive drugs, and repeated surgeries to replace destroyed joints. She has never sustained an osteoporotic fracture.
So what is the indication to add the costly long-term (ie >10year) unproven strontium to proven effective supplements?
Strontium ranelate may work in the medium term (3 to 5 years) but there is still apparently no more justification for using strontium routinely for preventing/ treating ageing osteoporosis than there is for biphosphonates or calcitonin. Considering it’s cost including risks, it may be asked if it is ethical to recommed strontium at more than trace levels?
Refs:
Reginster, Meneur ea J Clin Endocrinol Metab. 2005;90:2816-22. http://jcem.endojournals.org/cgi/content/full/90/5/2816
Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study; and N Engl J Med. 2004:29;350:459-68. http://content.nejm.org/cgi/content/full/350/5/459 The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis (SOTI).
Fuchs RK, Burr DB ea .Indiana University USA, Osteoporos Int. 2008 Apr 3. Strontium ranelate does not stimulate bone formation in ovariectomized rats. SrR may function dual action in the treatment of postmenopausal osteoporosis with anti-resorptive and anabolic skeletal benefits. Three-month old virgin castrated female rats were treated daily by oral distilled water or SrR (25 or 150 mg/kg/day) for 90 days, and a low (0.1%) or normal (1.19%) calcium (Ca) diet. SrR at dosages of 25 and 150 mg/kg/day did not stimulate an anabolic bone response, and failed to improve the bone biomechanical properties. http://www.galenicom.com/pt/medline/article/18385919/Strontium+ranelate+does+not+stimulate+bone+formation+in+ovariectomized+rats./
Arch Dermatol. 2008 ;144(2):268-9.
Interstitial granulomatous reaction to strontium ranelate.
Groves C, McMenamin ME, Casey M, Barnes L.
Aust Fam Physician. 2007;36(8):631-2.
Strontium ranelate–does it affect the management of postmenopausal osteoporosis? Winzenberg T, Powell S, Jones G. University of Tasmania.
show that after 5years treatment with ALA 600mg /day for diabetic neuropathy, “when ALA was stopped, neuropathy relapsed within 2 weeks in 73%; but in those swopped from ALA to gabapentin 1200mg/d, only 42% responded – the other 55% did not respond to gabapentin up to 3600mg/day; on which 45% developed intolerable symptoms.. They found that ALA not only relieves neuropathic symptoms but also neuropathic deficits eg impaired sensory function; with trivial side-effects compared to symptomatic therapies.” 
