Sunday, June 10, 2012

What Did Dr. Oz Leave Out About Strontium?

Let me preface today's blog with a head's up that I spent 5 hours researching this subject before writing the blog. It's a little technical, but I thought the detail was important. 

Although I may have a pretty good handle on the subject, I may also have missed something that wasn't available on the internet. Please feel free to comment if you feel I missed something.

Last Thursday, Dr. Oz told his audience about four supplements, extensively researched by his staff, which he highly touts as anti-aging supplements. The four were resveratrol, vitamin D, fish oil, and strontium. Please see my previous blogs about fish oil (Tuesday, April 10, 2012 titled ‘Et tu fish pills?’) and Vitamin D (Tuesday, March 20, 2012 titled ‘What's The Big Deal About Vitamin D? It turns out quite a bit.’   

At a later date, I'll write about resveratrol. In the interim, please note that one of the leading, if not the number one in the world, resveratrol researcher, Depak Das at the University of Connecticut, was dismissed from his university post because he was found to have repeatedly falsified his resveratrol research data. This has thrown the entire field of resveratrol research into dispute and a major conference that was scheduled in India called Resveratrol 2012 was cancelled late last year as he was one of the top experts expected to present. Enough about resveratrol for now; today, let's have some fun with strontium.

Dr. Oz recommended that women take 680 mg of strontium each day separated from the calcium he also recommends they take.  Of course, he made no reference to recent studies that suggest potential harm from taking calcium (see my blog from Friday, May 25, 2012, 'Calcium Pills Raise Concerns -- Again!'). He mentioned on the show that strontium has been studied in Europe and that the studied form is not available in the U.S. 

Here's what he didn’t share. The form of strontium studied in Europe was strontium ranelate, a synthetic salt that combines strontium with ranelic acid.  The studies done in Europe were good studies and one of the studies was published in the New England Journal of Medicine, a peer reviewed prestigious journal published by the Massachusetts Medical Society and associated with Massachusetts General Hospital, the premiere Harvard affiliated public hospital. See reference below.

The study involved the consumption of 2 grams of strontium ranelate each day for a period just short of five years. The strontium clearly increased bone density on scans and decreased fracture risks in post-menopausal women. It was generally well tolerated except for increased nausea and diarrhea during the first three months of administration.  All study participants also consumed calcium and Vitamin D at different dosages.  As a result of the study, the drug was approved and is only available by doctor prescription for dispensing by a pharmacist to people at high risk of fractures in Europe, and requires strict medical supervision. 

Why strict medical supervision? Strontium competes with calcium and magnesium and displaces them. What that does to your bone health and overall health has not been studied and is unknown.  There are reports that it can cause a condition called osteomalacia, which involves the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone, often as a result of hyperparathyroidism. In other words, taking strontium may interfere with your normal function of calcium uptake by bones.

A review of comments from users found on the internet included, a doctor “urged caution and told me about the deaths due to 'hypersensitivity syndrome' and a second consultant told me she was still not happy with calculation of DEXA scores.” The reference to the DEXA scores is that when doing the diagnostic DEXA Scan tests for osteoporosis, the test results are apparently skewed by the use of strontium.  There were many comments that indicated no problems.

So why isn’t it available in the U.S.? The answer is because the French company that owns the patent has not pursued FDA approval. The apparent reason for this and the one most often cited is that the FDA would require some homegrown research before approving it and the company doesn’t want to foot the bill. So you can’t get it here.

Of course, some entrepreneurial folks decided that if you can get the synthetic strontium ranelate here, they should cook up some strontium citrate because as it has no synthetic compound involved (ranelic acid is synthetic and citrate is not) and therefore can be sold as a supplement here in the U.S.  How did they come up with the recommended 680 mg dose? Apparently, strontium ranelate contains 680 mg of strontium. How much strontium does strontium citrate contain? I can’t tell you.

Also, what’s the difference between the way citrate and ranelate act in your body? I don’t know and nor does anyone else because it hasn’t been studied. Let’s look at an example of two other different chemical molecules binding together. Sodium when combined with chloride becomes sodium chloride, the salt we eat. When sodium is combined with citrate, it becomes monosodium citrate, a salt used to prevent anticoagulation of stored blood. Different chemicals when combined create different compounds.

So what’s the biggest problem with taking strontium citrate to prevent or treat osteoporosis? Beyond some of the concerns cited above, it’s never been studied and reported on in humans.

There was a study begun in the U.S. at University of California Davis Medical Center a few years ago that was meant to be completed and results reported in 2010, but the study, named the Scope Study, has mysteriously disappeared.  I’m not kidding. There are conspiracy theories all over the internet regarding what happened to this study. Some claim the bisphosphonate companies got to them. Just theories with no evidence whatsoever to support them. My experience is when a research institute goes mum on a study, it’s often due to something going wrong with the study.  Nonetheless, the results never came out. That gives me pause to ever recommend such a drug under such circumstances.  

Furthermore, while strontium ranelate was studied with 680 mg of strontium, studies with far less amounts have never been reported. If it is actually good for you, could less work just as well?

Strontium is present in our food supply. For example, it is available in vegetables such as spinach, lettuce, carrots, peas, beans, potatoes and celery. Wheat, barley and other grains used to make bread also have significant levels of strontium. According to one source I found, flour, grains and breads average 2,150 mg per gram of stable strontium.

So as always, before taking a pill containing a super high dose of a mineral which has not been studied for a prolonged period of time, you should increase your intake of foods containing that mineral that have been used for millions of years.

It is important to remember that high-dose strontium is essentially a bone drug, and, as with all bone drugs, it is only indicated when there is a clear high risk of fracture defined as a 20% likelihood of a major osteoporotic fracture over the next 10 years.

The bottom line is that the long-term safety and efficacy of strontium citrate has not been evaluated on humans in large-scale medical trials.

That’s why once again I say shame on Dr. Oz for recommending it to the general population without good science to support what is available in the U.S. It only serves to make people more anxious and confused that maybe they have misssed something. It is often dangerous to experiment on your own body.

By the way, here are the chemical structures for strontium ranelate and strontium citrate. Do they look similar? If no, it's because they are not. One, ranelate binds with two atoms of strontium, while the other, citrate, only binds with one atom.

Strontium Ranelate 

Strontium Citrate
Meunier PJ, Roux C, Seeman E, et al. The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. NEJM 2004 350;459 -68
Reginster JY, Seeman E, DE Vernejoul MC, et al . Tropos Study. J Clin Endocrinol Metab 2004–1774. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis.


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  2. This comment has been removed by a blog administrator.

  3. From a youngish woman with severe osteoporosis, strontium is worth the risk. There are many strontium success stories on the NOF website- and many more horror stories about the bisposhonates. No one knows exactly what they would do until the moment you are diagnosed. I researched and decided to try the supplement route. I feel the bone meds are poisin and will only cause me more grief down the road.

  4. Suggest you read 'Your Bones' by Lara Pizzorno. You need to get the facts of Strontium Citrate straight.
    As for the Protelos Strontium Ranelate - just check the excipients: Aspartame; Maltodextrin; Mannitol - enough to make anyone sick, that is apart from the Ranelic acid...

  5. I sympathize with anyone suffering with osteoporosis at any age, let alone relatively young.
    However, taking Strontium Citrate based on internet anecdotes without the supervision of a knowledgeable physician is a personal, but dangerous choice.
    For example, did you read on the internet that the European Medicine Agency recently issued a warning regarding the use of Strontium Ranelate for patients who are immobilized, have a history or are at risk of venous thromoboemebolism (blood clots in legs). Doctors in Europe are now prohibited in prescribing the medication to such patients.
    I suspect that you did not know this fact because it was not well publicized here in the US because Strontium Ranelate is not sold here. Strontium Citrate, which is sold as a non-prescribed supplement has never undergone valid clinical testing in the US or elsewhere. Developing a blood clot in your legs is a life-threatening condition that kills many people every year by throwing off clots to the lungs called pulmonary emboli. So biphosphonates may be poison, but Strontium may kill you.
    Don't take supplements without consulting a physician who will monitor their effects.

    1. That's easy to say when you don't have severe osteoporosis. Even when doctors advise us these drugs are all in experimental stage. We have to make some decision and mainstream doctors don't pay attetnion to the dangers of Bisphosphonates. Recently there is more evidence of spontaneous fractures from prolonged use of Bisphosphonates.

    2. For the reasons you state, I don't recommend biphosphonates. But the dangers of biphosphonates don't make strontium a safer bet.It also has been noted to have some life threatening qualities. Unfortunately, for osteoporosis sufferers the best available approach is currently weight-bearing exercise and extra caution to not fall such as making one's house fall-proof to the extent possible.Also getting enough calcium and magnesium in the diet and getting Vitamin D from the sun is ideal.

  6. "According to one source I found, flour, grains and breads average 2,150 mg per gram of stable strontium."

    ...but there is only 1000mg per gram. Curious if it was it mcg/g?

    Otherwise this was a great read!

    1. According to the original source, whose absolute validity I cannot vouch for, flour, grains and breads average 2 mmc/kg of strontium-90 and 2,150 mg per gram of stable strontium. The disparity between the numbers may be due to the type of bread. By the way, in general, I don't recommend breads procured in the bread aisle. I do like breads from the freezer section without much added sugar and made from spouted grains or flaxseed.

    2. No type of bread, or of anything, can contain more than 1,000 mg per gram of any component, unless either:
      1) the other components have negative mass, which seems rather improbable, or
      2) one is writing numbers European style, in which the comma and period have their roles reversed compared to U.S. style, so that "2,150 mg per gram" actually translates into "2.150 mg per gram" in U.S. English.

    3. The logic of your argument makes sense. The quote, which comes from, is either inaccurate or we are misinterpreting it.

  7. If my physician is to be so trusted then why would he prescribe me Atelvia for a diagnosis of osteopenia and never once suggest lifestyle changes? I will trust NOF and WHO first.

  8. There is no doubt that all physicians are not the same and if you are uncomfortable with medications being prescribed by a physician, it is both wise and prudent to consult another physician. In 1980, I was taught in medical school that the smartest patients are those who challenge their physicians when they don't agree. We were shown a video of a patient slugging a nurse trying to add something to her IV. The lesson was patients should be involved in their care and not follow directions blindly. Over 30 years later, I still believe this to be true.

    1. My experience is only a specialist in the field will have any idea at all of the intricacies. Primary doctors just listen to the drug company reps and don't want to get involved with going any further or questioning their statements. All treatments carry a risk and doing nothing carries a risk. Each person has to decide what to believe for their own sake.

    2. You are absolutely correct that each person has to ultimately decide on their own what to do. That said, no specialist in the US has experience with Strontium Ranelate because it is not available here and no prudent physician, specialist or otherwise, will prescribe an untested treatment such strontium citrate.

    3. was hospitalized after just one dose of foxamax, so I told doctor NO THANKS, did my research, and decided on strontium citrate, along with 500 mg calcium (& healtlhy diet) plus magnesium, hoping for great results! Dr will monitor

  9. Since studies cost $$$$$, it is unlikely strontium citrate will be tested here (or anywhere else).

    Nan Kathryn Fuchs, PhD has an e-book that describes what too much calcium does to our bones plus she says that most of us don't get enough magnesium in our diets or supplements.

    She strongly supports taking strontium citrate (apart from calcium.

    She has been active in the damage too much calcium can do for over 20 years. Maybe she is correct about strontium.

    She says it helps both density and flexibility.

  10. I'm not sure that Nan Fuchs is a reliable source of information. Please see my previous blog about Ms. Fuchs. Her PhD is from a dubious educational source.

  11. While I enjoyed your objectivity I would like to make 2 comments regarding your suggestions. Firstly, to a society who wants to eat the wrong kind of bread to a fault your bread comments give the suggestion that bread will, at a minimum, curb osteoporosis, and at a maximum prevent it. Eating bread from the frozen isle of sprouted beans and legumes may do the trick, however that is NOT the isle the majority of the people go to get their bread. You could yourself be sending people into harms way if they believed eating lots of extra grain wonder breads curbs osteoporosis. Secondly, and personally disappointing, I have NEVER found a doctor who wants to monitor anything that I suggest in terms of supplements, nor have I found they are the slightest bit interested in them as a whole. People will die before they get on board with any new miracle or supplemental discovery. I do my own research now and will take yours in balance. One other get my cockles up when you dismiss and discredit other professionals. It always strikes me as self serving and makes me want to point out your flaws...and I did. Still I enjoyed the read.

  12. I welcome all comments including those that misinterpret what I write. I never suggested that bread will treat or cure osteoporosis. Rather, I wrote that if you believe that strontium is an effective treatment for osteoporosis then you may prefer to get it from bread as opposed to a pill. I do not advocate bread as a treatment for osteoporosis and personally only eat sprouted or flaxseed bread from the freezer section. I agree with you that most people would be better off doing than eating the preservative and sugar added breads on the bread aisle.

    As to your comments about my refuting others such as Dr. Oz, as I have no motive other than making people think twice about and try and validate elsewhere what others with a possible financial motive claim such as Oz, I'm not sure why you would think that makes me self-serving. I sell nothing and receive no compensation, cash or otherwise, for my writings. As an aside, Dr. Oz was summoned this week to appear before a U.S. Senate committee hearing where he was chided for exactly the same complaints I have about him. I'm not sure what took them so long. Here's a link to the story:

    Keep the comments coming even if you disagree.

  13. This comment has been removed by the author.

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  15. My apologies for not getting back with my edited comment after deleting the original one. (Maybe I did get back here but experienced the same loss of my typed comment on trying to sign in that I experienced just now.) But here's my original comment, which was based on the assumption, perhaps incorrect, that the bonding of the strontium in both strontium ranelate and strontium citrate is ionic.
    >>> Is there any reason, other than the fact that it could be patented, that strontium ranelate was introduced in Europe rather than some combination of strontium with a naturally-occurring complement like citrate? And if the point of taking a strontium compound is to get strontium ions into the blood and thence into the bones, why would the choice of which non-toxic negative ion to combine it with matter, beyond the differences in the ease with which the strontium separates from that ion? And wouldn't there be more reason to feel safe with citrate ions in one's body than with ranelate ions, the physiology of the latter certainly being less studied? <<<

    1. I haven't looked at this topic in quite some time and my chemistry background is rusty so I can't even comment. That said, you are asking a hypothetical question that I don't have the expertise to answer and I'm not sure in the absence of a good study does. Nevertheless, I wouldn't put anything in my body based on hypothesis alone.

    2. Since we regularly consume citrate as citric acid, the main thing I would be concerned about is whether the quantity of strontium being consumed is dangerously high. We constantly, BTW, consume things about whose biochemistry we know less than we know about strontium, or even which chemicals we are consuming at all and in what quantities. And that even includes natural, organic foods!

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