Strontium, Vitamin K2 and Osteoporosis: Case Study III

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). [4]

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. [1]

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. [5]

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. [6]

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.) [7]

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. [8] 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.

References

[1] DeHart, Sara S. (2008). Strontium and osteoporosis: A treatment not offered to American women.

[2] DeHart, Sara S. (2010). Strontium and osteoporosis II: On our own.

[3] Modern Medicine (2010). Before the breaking point: Predicting and reducing fracture risk.

[4] Picco, M.F. M.D. Mayo Clinic Staff (2012). GERD: Can certain medications increase severity?

[5] Pizzorno, L. MA, LMT with Wright, J.V. M.D. (2010). Your Bones. Praktikos, Mt. Jackson, VA.

[6] DeHart, Sara S. (2011). Bone and cardiac health: Are Vitamins K1 and K2 the missing links to the epidemic of osteoporosis and arterial calcification?

[7] 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.

[8] 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 dehart.ss@frontier.com.

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10 Responses to Strontium, Vitamin K2 and Osteoporosis: Case Study III

  1. Excellent article, much appreciated.

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  4. Kat McCullough

    I was diagnosed with osteopenia in 95, osteoporosis in 2000. Declined any biophosphanates but upped ca before I really knew much. Now I get lots of ca from plant-based food (vegan for 6 mo.) take Vit D3 (2000 units), 340 mg strontium citrate(taken at night). Haven’t had a dex scan in awhile (don’t really trust results) I am 78, exercise daily. No falls or fractures but I am cautious. Your reports are very helpful and encouraging.

  5. Ms McCullough:
    We need more reports like yours and mine published with comments so that it can become possible for women and men to discuss supplements such as strontium citrate with their primary care doctors.

    There is an excellent article in the August 2012 issue of Scientific American: Cracks in he Bone Test. Bone Mineral Density is only one variable to consider. http://www.nature.com/scientificamerican/journal/v307/n2/full/scientificamerican0812-30.html

    Please read about Vitamin K2 (MK7). Lara Pizzorno has an excellent section in her book “Your Bones” about the action of that supplement. As Vegans, we can not get sufficient K2 unless we eat a lot of Natto (fermented soy).

  6. I have some anecdotal, maternal, familial stories. My mother will turn 91 Jan. 1, 2013. I remember she was told that she was developing osteoporosis in 1978, and at that time showed a noticable, beginnings of posture sag. She was also told that she was developing heart disease, athrosclerosis. She was advised to do vigorous walking for both. She declined, but added calcium and multiviatamin supplements. She also started raising two grandchildren to keep her busy. In 1997, she was told, after thorough testing, that her osteoporosis was severe. She started taking Fosomax and similar medication, but stopped after developing jaw bone complications. Also ’97, she started using a cane and graduated to a walker some years ago. In 2010, she fell and broke her left thigh bone just below the upper joint. Actually the thigh probably broke by itself and caused the fall. After surgery to implant pins and physical therapy, she is essentially back to where she was before. She has been told that she has no spine to speak of.

    She has three sisters, of which she is the youngest. None have osteoporosis. The oldest is 95, has been obese to morbidly obese all her life, has only recently stopped working and confined to a wheelchair due to joint problems. She is mentally alert and a joy to be around. Another older sister died in a home several years ago and was suffering from some form of dementia. She was mobile at the time of her death and also had been obese all her life. Another sister, one year older than mom, died several years ago of Alzheimers. She walked two miles a day with her husband, now 95 and suffering from osteoporosis, though she never did. She was fit to the day she died.

  7. I recommend Lara Pizzorno & J.V. Wright, M.D. (2010). “Your Bones”. Praktikos (available in bookstores and on Amazon.com). Ms. Pizzorno is the first member of her family that has not developed osteoporosis. She cites research references and I use her book both as a reference and for her insights about preventing osteoporosis.

    You certainly have some long-lived relatives so take good care of your body because you will probably mimic them. I am very impressed with the Vitamin K2 (MK7) research and its effect on atherosclerosis and osteoporosis. The Japanese studies are impressive.

  8. Marlene Lily

    I was diagnosed with osteopenia and lupus in 2005. I had to take prednisone for the lupus and knew that was bad for bones. My doctor wanted me to take Fosamax, but I declines, did some research and found this article by Jonathan Wright, MD: http://tahomaclinicblog.com/strontium/
    I began taking 680 mg strontium citrate at night when I got up to use the bathroom. I also took NOW Full Spectrum Minerals CAPS, Vitamin C 2000 mg and Vitamin B-50 daily. In 2006, a DEXA scan showed no change after a year on strontium and prednisone. I stopped taking prednisone and waited 5 years before having another DEXA scan. My 2011 scan shows a 27.3% BMD increase in the spine and a 26.7 increase in the total hip. Both are “consistent with normal bone density.”

    I now take 340 mg strontium, and have added Vitamin K2 as MK4 to my regimen.

  9. We need multiple case studies published to impact the system. I am delighted that you were able to discontinue Prednisone because only then could the effects of Strontium Citrate be observed. Have you read the Japanese studies of the effect of Vitamin K2 on bone metabolism?

  10. Great article! Didn’t know there is connection between vitamin K2 and osteoporosis.