I published two previous case studies on the use of Strontium Citrate to treat severe osteoporosis in 2008 and 2010. [1,2] The purpose of this third article is to document my progress using data from my most current bone mineral density (BMD) test results (September, 2012).According to the WHO classification these BMD results are normal and my fracture risk is not increased from 2010. In this report I have not documented earlier test results prior to a sacral fracture (2003) or a nontraumatic fracture of T-9 (2006).There is scientific value in case study reports especially when data are available over a six year period of time and variables that may influence outcome are carefully documented.
This is my personal journey and not necessarily a recommendation of treatment options for others though I think it is wise for women to know some of the pitfalls that are out there in this era of modern Western Medicine.
In 1995, at age 63 I had my first BMD test and the results were alarming: I fell more than two standard deviations below the expected mineral density and this represented a “marked increase in fracture risk.” I was placed on Fosamax 10 mg. daily and Estraderm patches twice weekly. The Estraderm was discontinued in 1997 because of concerns revealed by the Women’s Health Study. I discontinued Fosamax in 1998 because of severe muscle pain and concerns then being reported in the literature about esophageal damage from gastroesophageal reflux disease (GERD). 
My BMD was stable even after discontinuing bisphosphonate drugs but I had a nontraumatic fracture of the sacrum in 2004 and was placed on Actonel 5 mg five times a week. My Vitamin D3 level was tested and it was quite low (< 20 ng/mL); this level is considered inadequate for bone and overall health.
This result surprised me because I had supplemented with Vitamin D3 400 IU/daily throughout my adult life. The most current NIH factsheet recommends 600 IU for women between the ages of 51–70 years of age and 800 IU for women over the age of 70.
The nontraumatic sacrum fracture and low serum Vitamin D3 level got my attention and I began to independently search the literature on bone health and various treatment modalities. Following this review of the literature I increased my Vitamin D3 supplementation to 5000 IU daily during the fall and winter months and 4000 IU spring and summer.
These reviews also alerted me to ongoing Strontium Ranelate studies being conducted in Europe. Previous to these clinical trials the only American data available on Strontium was a small study (32 severely osteoporotic women) conducted in 1955 at the Mayo Clinic in Rochester MN. (See my first case report published in 2008 for details of this study and the European clinical trials on Strontium Ranelate. 
I followed standards of care medical recommendations until I developed my second vertebral nontraumatic fracture of T9 in 2006. At that point I dropped the current bisphosphonate drug (Actonel) and began taking Strontium Citrate. I first used the research dosage reported in the European trials with Strontium Ranelate (1000–2000 mg/day) but as more literature emerged from alternative medicine sources I decreased the dosage of Strontium Citrate to 725 mg. The current recommendation is between 340 mg and 680 mg. The smaller dose (340 mg) is recommended to maintain and prevent bone loss from occurring, while the larger dosage (680 mg) can help treat osteoporosis. 
It is clear from my data and also from published clinical trials that Strontium increases bone mineral density (BMD), but the gold standard is whether the mineral will prevent fractures in the event of a traumatic fall. In 2009 I experienced the gold standard test when I tripped while gardening and fell onto an asphalt driveway. I just had time to wrap my arms around my chest before my shoulder and hip hit the asphalt. My ribs were sore for about 10 days but nothing fractured; my hip and shoulder were intact.
While taking the larger dosage (1,000—2000mg), I developed muscle tetany from a drop in serum calcium levels. Strontium replaces calcium because it is a heavier mineral so it is vital that while taking Strontium in any form that it is separated by at least 2 hours (4 is better) from calcium supplementation or calcium rich foods. Do not use any supplement that combines Strontium and calcium. I am now very careful about following this rule: take more calcium than Strontium Citrate and separate the timing for taking the two minerals by several hours.
Are Strontium and calcium alone enough to protect bone? A question recently raised in the research literature is whether bone and cardiac health are related? Are Vitamins K1 and K2 the missing links to the epidemic of osteoporosis and arterial calcification? See my review of bone and cardiac health published in 2011. 
On the strength of the Vitamin K2 (MK-7) research I added 90 mcg MK-7 to my supplements. If calcium does not move from the arterial system into bone it tends to attach itself to arterial vessel walls and causes arterial calcification or “hardening of the arteries.” At that time I also reduced my Strontium dosage to 500 mg 5 days/week.
So what happened to my BMD levels between 2010 and 2012? The lumbar spine increased from +0.2 to +0.5 but the left hip decreased slightly from -0.5 to -0.8. Both of these scores are within normal limits but bear watching and reassessment in two years.
Another score that needs to be carefully monitored is height. At age 60 my height was 67”; by age 80 my height had decreased to 64.8” reflecting a 2.2 inch loss. People typically lose about ½ inch every 10 years after the age of 40 with a greater acceleration in height loss after the age of 70. It remains to be seen if I can minimize this loss through daily stretching exercises.
A five-year experimental study with placebo controls of 1,500 women age 80 and above was conducted in Australia. The results are impressive. The group of women who took Strontium, Vitamin D3 and calcium had a reduced fracture risk: Vertebral (31%), hip (24%) and all major nonvertebral sites (33%). (Strontium Ranelate was the experimental variable while the placebo group took both calcium and Vitamin D3 but no strontium.) 
Both women and men aged 80 and above are at significant risk for fractures but there are limited data on preventive measures for this age group. Is it time for Western Medicine to move out of the Standards of Care paradigm that forbids them from recommending Strontium Citrate because it has not been sanctioned by FDA?
A myriad of problems with bisphosphonate drugs have been reported in the medical and lay literature but these data rarely get translated into Standards of Care. The most damning data about the bisphosphonate drug Fosamax appeared on the Diane Sawyer Good Morning America program March 9, 2010. She reported a number of femur (thigh bone) fractures in women who had taken the drug longer than 5 years.  Osteonecrosis of the jaw bone has been reported for patients taking bisphosphonate drugs for at least ten years. Oral surgeons now routinely ask about Fosamax and Actonel use prior to tooth extraction. Use of any of the bisphosphonate drugs make them extremely cautious.
Both Merck, the manufacturer of Fosamax, and FDA have been slow to act; however a suggestion that Fosamax use should be limited to 5 years now appears in the Merck literature, but this may be a maneuver to protect the company from lawsuits rather than concerns about patient safety and welfare. I question whether a drug that only inhibits removal of osteoclasts from bone should ever have been approved in the first place.
Where does all this information leave most postmenopausal women? Essentially we are “on our own” because discussions of the mineral Strontium Citrate are not part of patient-physician visits and patients must be fairly assertive to introduce the topic.
We need to know what happens when Strontium Citrate, Vitamin D3 and Vitamin K2 are added to supplement regimes. I have revealed my personal BMD test results to add to the clinical data base. When will we get some well-funded studies of Strontium Citrate? This will never happen because pharmaceutical companies cannot patent a natural mineral and their studies are the only ones that count with the FDA in their approval process.
As a final note, we await a large clinical study of the effect of Vitamin K2 on arterial vessel walls and bone matrix. The data are intriguing but a recommendation needs to go into standards of care about its use to prevent arthrosclerosis, osteoporosis and osteopenia. I added Vitamin K2, without medical approval, and the only data I can personally report is when a recent ultrasound was done on my neck to check for a thyroid enlargement, the radiologist commented to the technician that my carotid artery had minimal plaque. This is in contrast to a CT-scan report in 2004 that the carotid artery showed “considerable vascular calcifications indicating arthrosclerosis.” Since that time I’ve become a VEGAN and added Vitamin K2. My lipid panel results are excellent with a total cholesterol of 163 mg/dL and an HDL of 57 mg/dL; a level that is protective against heart disease.
These data are impressive for an 80-year-old woman with a history of osteoporosis and throat cancer. But that is another story that I will write about in a future case study report.
 DeHart, Sara S. (2008). Strontium and osteoporosis: A treatment not offered to American women.
 DeHart, Sara S. (2010). Strontium and osteoporosis II: On our own.
 Modern Medicine (2010). Before the breaking point: Predicting and reducing fracture risk.
 Picco, M.F. M.D. Mayo Clinic Staff (2012). GERD: Can certain medications increase severity?
 Pizzorno, L. MA, LMT with Wright, J.V. M.D. (2010). Your Bones. Praktikos, Mt. Jackson, VA.
 Seeman, E.M.D. et al (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) 113–1120.
 Romo, Christine and Salahi, Lara (March 9, 2010). Fosamax: Is long term use of bone strengthening drug linked to fractures? (Diane Sawyers Good Morning America).
Sara S. DeHart, MSN, PhD is Associate Professor Emeritus University of MN, School of Nursing. She also served as a Visiting Scholar University of WA. She currently resides in the Northwest and writes about various issues including public health and public policy. See substituting deception for sound public health policy, in Jerry Barrett’s (2004) Big Bush Lies, Riverwood Books (117–128). She welcomes questions and can be contacted at email@example.com.