Can strontium promote bone formation and increase bone density?

From the Guidelines

Strontium can contribute to bone formation and is used in some countries to treat osteoporosis, particularly in the form of strontium ranelate, which has been shown to increase bone mineral density by stimulating bone formation and reducing bone breakdown. According to the most recent and highest quality study available, 1, strontium ranelate is considered a treatment option for osteoporosis, especially in patients who cannot tolerate other treatments. The study highlights the importance of assessing osteoporosis and fracture risk in patients with cirrhosis and other recognized risk factors, and considering treatment options such as strontium ranelate, raloxifene, denosumab, and teriparatide.

Some key points to consider when using strontium for bone health include:

• Strontium works by stimulating bone formation and reducing bone breakdown, potentially increasing bone mineral density
• Strontium ranelate is typically used at doses of 2 grams daily, although it is not FDA-approved in the United States due to cardiovascular risk concerns
• Strontium can interfere with calcium absorption if taken simultaneously, and may not be appropriate for people with certain cardiovascular conditions
• Patients should consult with their healthcare provider before considering strontium for bone health, especially if they have a history of cardiovascular disease or are taking other medications that may interact with strontium.

It's also important to note that while strontium can contribute to bone formation, it is not a primary bone-building mineral like calcium, and its effectiveness as a supplement is not well-established. Proven osteoporosis treatments like calcium and vitamin D supplementation, bisphosphonates, or other prescribed medications should not be replaced with strontium supplements without consulting a healthcare provider. As stated in 2, newer data support the use of strontium salts, and 3 recommends strontium ranelate as an option to prevent additional symptomatic fractures in patients with osteoporotic spinal compression fractures. However, the most recent and highest quality study, 1, provides the most comprehensive guidance on the use of strontium for osteoporosis treatment.

From the Research

Strontium and Bone Formation

• Strontium ranelate has been shown to increase collagen and non-collagenic proteins synthesis by mature osteoblast enriched cells, indicating its potential to build bones 4.
• The stimulation of osteoprogenitor cell replication and collagen synthesis in osteoblasts by strontium ranelate provides substantial evidence to categorize it as a bone-forming agent 4, 5.
• Strontium ions have a multidirectional effect on bone tissue, intensifying osteoblastogenesis while inhibiting osteoclastogenesis, which can lead to improved bone density and strength 6.

Mechanism of Action

• Strontium ranelate acts through the calcium-sensing receptor (CaSR) receptor in bone tissue cells, which leads to the activation of multiple signaling pathways, including phospholipase Cβ, inositol 1,4,5-triphosphate, and MAPK ERK1/2 7.
• The activation of these pathways results in the modulation of key molecules that control bone resorption and the regulation of genes promoting osteoblastic cell replication, differentiation, and survival 7.

Clinical Evidence

• Clinical studies have shown that strontium ranelate can increase bone mineral density and reduce the risk of vertebral and non-vertebral fractures in postmenopausal women with osteoporosis 4, 5.
• The SOTI and TROPOS studies demonstrated a significant reduction in the relative risk of experiencing a first new vertebral fracture and a first non-vertebral fracture, respectively, in patients treated with strontium ranelate compared to placebo 4, 5.

Interaction with Other Nutrients

• Vitamin D status does not interfere with strontium ranelate absorption, and treatment of vitamin D deficiency does not enhance strontium ranelate absorption in patients with mild deficiency 8.
• However, adequate vitamin D status is still important for osteoporotic patients, and treatment of vitamin D deficiency is recommended 8.