A treatment not offered to American Women

I published my own case study on the use of Strontium Citrate to treat severe osteoporosis in 2008. [1] The purpose of the present article is to document my progress with the most current Bone Mineral Density test results (May 2010), as well as update the current research literature on the use of the most common drugs prescribed for osteopenia/osteoporosis in the United States.

Disclaimer: My personal history and method of treatment is not a recommendation of treatment options for others. I merely provide a guide to information in the research literature and pose some questions that American women need to ask themselves and their personal physicians.

T-Scores are used to grade Bone Mineral Density (BMD) using the following scale:
Greater than (-1) = Normal BMD
Between (-1 and -2.5) = Low BMD (Osteopenia)
(-2.5 or lower) = Osteoporosis

So what happened to my BMD after I added the mineral Strontium?

Dexascan History Data

T-Scores:

Left Hip Lumbar Spine
2006   -1.2     -1.4
2008   -0.6     -0.2
2010   -0.5     +0.2

The mineral strontium is not unknown to Western Medical practice; in fact strontium lactate was used by Mayo Clinic physicians in a small clinical study of 32 severely osteoporotic women who had suffered one or more vertebral fractures in 1959. [2] Twenty-two of the women took 1.7 grams strontium and calcium; an additional 10 women were treated with the same amount of strontium along with estrogen and testosterone. In the strontium-only group 18 of 22 had marked improvement and the other four had moderate improvement. In the hormone plus strontium-calcium group nine of 10 reported marked improvement of their symptoms. [3]

The dosage of strontium lactate used in the Mayo Clinic study was high by today�s standards (1.7 grams) but 84 percent of these patients reported marked relief of bone pain; the remaining patients (16 percent) reported some improvement. These patients also received Calcium supplementation which is a crucial supplement if one chooses to use strontium.

The question remains as to why no U.S. pharmaceutical company chose to do critical research on the mineral strontium. Many believe that the studies were never done because strontium is a natural mineral and can not be patented. It was not until Servier, a French pharmaceutical company patented a formula of strontium and ranelate under the drug name Protelos and began large scale testing that any clinical trials were conducted. Strontium is only available in the United States as a mineral supplement and women are on their own if they choose this option. They are also on their own if they order Strontium Ranelate through Canada because Servier has not gone through the hoops required by the FDA for approval in the U.S. This treatment is not included in current Standards of Care so American physicians will not venture outside those guidelines lest they be open to censure.

The pressures are on to make sure that both physicians and patients remain compliant. A recent article written by a doctor of Pharmacology published on Medscape for Nurses ends with this strong warning: For patients with diagnosed osteoporosis, FDA-approved treatments are indicated. Tell patients that dietary supplements containing strontium are unproven and should be avoided [4]

A number of Naturopathic doctors (ND) disagree with Dr. Scott�s assessment as well as some traditionally trained medical doctors who treat patients with alternative medical approaches. Ward Dean, M.D. and J.V. Wright, M.D. are two noted experts who have successfully treated osteoporosis with strontium. [5-6]

Further evidence that Strontium is slowly making its way into mainstream medicine was published in the Johns Hopkins Health Alert in 2007. [7] This alert summarizes the research from the TROPOS study conducted in Europe on 5,000 postmenopausal women.

At the end of the three year study period the risk of incurring a non-vertebral fracture was 16 percent lower in the strontium ranelate group. The risk of major fracture was 19 percent lower for all other sites, including hip, pelvis, ribs and wrists. Further, Strontium ranelate reduced the hip fracture risk by 36 percent in the high-risk subgroup�women most likely to develop a hip fracture because of their age and low bone density T scores at the femoral neck. [8]

Drugs currently prescribed for American Women

Bisphosphonate Drugs (Fosamax, Actonel, Boniva, and Reclast are most commonly prescribed in the U.S.): Drugs in this class work by preventing osteoclasts from being removed from bone. All bone has two types of cells osteoclasts (which breakdown bone) and osteoblasts to reform and remodel bone.

Bone homeostasis is maintained by a balance between bone resorption by osteoclasts and bone formation by osteoblasts. [9] One can readily see that by using drugs that inhibit one part of bone homeostasis (balance) have the potential to reap havoc on bone health. The most cogent warning was issued by Dr. Susan Ott, MD, an expert in bone physiology:

The bisphosphonates in doses used today suppress bone formation to a greater extent than other antiresorbing medications, so it is possible that microdamage accumulation would develop after 15 or 20 years�just about the time between menopause and the usual onset of osteoporotic fractures. Certainly this is an issue that requires long-term, carefully designed research [10]

Dr. Ott issues a further warning on her website. [11]

Bisphosphonates have been approved by the FDA for prevention of osteoporosis, and they are widely used in women younger than 65. However I am reluctant to use them in young or low-risk women, and reserve these drugs for those with established osteoporosis or those with osteoporosis taking prednisone.

Dr. Ott states further that unlike many physicians she has a physiological perspective. She reports that bone biopsies from patients taking bisphophonates show 95 percent reduction in bone formation rate; therefore she stops bisphosphonate treatment after five years.

Readers may want to check her website before making a decision about the use of drugs or supplements to treat osteoporosis. She is hesitant to recommend Strontium supplements because no long-term research studies have been reported in the literature. She does, however, cover the European studies of Strontium Ranelate.

By contrast Jonathan Wright, M.D. is a proponent of the mineral strontium citrate that is available from several reliable sources. [12] He further proposes a warning for one of the newer patent medicine drugs, Forteo that carries an FDA black box warning for bone sarcoma (bone cancer). Forteo is an expensive daily injected drug; it costs approximately $900 per month. Forteo is a synthetic parathyroid hormone and patients are limited to a two year drug experience. Eli Lily developed a program to track patients taking Forteo for bone sarcoma but the rigor of that tracking program is unknown because Eli Lily has not published results of their research.

A very interesting study was conducted in Australia using Strontium Ranelate in women 80 years of age and older. [13] This particular age group comprise about 10 percent of the population, but suffer 30 percent of all fractures�and 60 percent on nonvertebral fractures. The Australian study followed nearly 1500 women in this age group who took calcium, vitamin D3 and either strontium or placebo daily. After five years, the strontium group had a reduced risk of vertebral fracture (31 percent), hip (24 percent) and all major nonvertebral sites (33 percent). Dr. Julian Whitaker reports in his Health and Healing newsletter that strontium ranelate, the type used in this study is not available in the United States but strontium citrate, which is available appears to have similar effects. He recommends taking 680 mg daily at a time separated by at least two hours from any calcium supplementation. [14]

Why I chose to take Strontium Citrate rather than remain on the Bisphosphonates

I suffered two vertebral fractures (sacrum and T9) while taking first Fosamax and then Actonel. During this period I had extreme muscle pain which is now acknowledged as a serious side effect by the FDA. Since 2006 with the last vertebral fracture I switched to Strontium Citrate. (See DeHart, 2008 for that review.) [15]

A Cautionary Note: The importance of exercise and diet often appears as an after-note if it appears at all. Vitamin D3 through sunlight or supplementation is vital for bone metabolism. See Miller and Sardi for reviews of that important vitamin. [16-17]

Please do not skimp on exercise, it is a vital component of any program to reverse osteoporosis.

And last, but not least remember that your physician is there to help you. If you choose not to use patent drugs such as Fosamax, Actonel, Forteo or Reclast your doctor should not dismiss you from his practice. We may be �on our own� but our primary care doctors should still be willing to monitor our progress with laboratory procedures (basic metabolic series and T-telepeptide urine tests to monitor bone turnover.)

I have not discussed Reclast, the yearly bisphosphonate drug and I urge you to think carefully about any drug that will stay in your system for at least a year; particularly a drug that now has recorded a number of deaths. Remember that this is a super bisphosphonate (Fosamax; Actonel) drug. The FDA has attributed seven deaths to Reclast but this count may not be accurate. One of the recorded deaths occurred with the second year�s infusion; the woman had kidney and organ failure.

American women are vulnerable and need to be alert to problems associated with prescription patented drugs.

Notes

1. DeHart, S.S. (2008). Strontium and Osteoporosis: A treatment not offered to American women.

2. Dean, W. (May 5 2004). Strontium: Breakthrough against Osteoporosis.

3. Wright, J.V. Fight -- even prevent osteoporosis with the hidden secrets of this bone-building miracle mineral. (Reprinted from Nutrition and Healing).

4. Scott, G.N. (January 15, 2010) Is Strontium useful for Osteoporosis?

http://www.medscape.com/viewarticle/714870

5. Dean, W. (May 2004). Strontium breakthrough against Osteoporosis.

6. Wright, J.V. Fight -- even prevent osteoporosis with the hidden secrets of this bone-building miracle mineral. (Reprint from Nutrition and Healing. Tahoma Clinic, 2008).

7. John Hopkins Health Alert -- Spotlight on Osteoporosis

8. John Hopkins Health Alert -- Spotlight on Osteoporosis

9. Tanaka Y, Nakayamada S, Okada Y. (2005). Osteoblasts and osteoclasts in bone

emodeling and inflammation. Curr Drug Targets Inflamm Allergy. 2005 Jun; 4(3):325-8.

10. Ott, S.M. (2005). Long term safety of bisphosphonates. The Journal of Clinical Endocrinology & Metabolism, 90 (3):1897-1899.

11. http://courses,washington.edu/bonephys/optreatment.html

12. Wright, J.V., M.D. Fight-even prevent-osteoporosis with the hidden secrets of this bone-building mineral. (Reprint from Nutrition and Healing. Tahoma Clinic, 2008).

13. Seeman, E.M.D., Vellas, B, Benhamou, C & Aquino, J.P (May 2006). Strontium Ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. Journal of Bone and Mineral Research, 21 (7) 1113-1120.

14. Whitaker, Julian, M.D (June 2010). . Health and Healing Newsletter, 20 (6).

15. DeHart, S.S. (July 7, 2008). Strontium and Osteoporosis: A treatment not offered to American Women. Online Journal.com.

16. Miller, D.W., M.D. . (September 10, 2007). Vitamin D in a new light.

17. Sardi, B. (February 20 2007). Just one pill away.