Strontium citrate, fractures and lack of research

Here is a posting of research and studies on strontium research which might be helpful to you in your deep dive into strontium research. Notice the bone biopsies and the 2020 review of strontium research etc.. https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/dd823b-strontium-a-compilation-of-research-and-information/
Also, notice the TBS research and newer Rems information.

In the research which you cited, but did not discuss, about the interaction amongst calcium, strontium, and citrate ions, notice that the addition of strontium was found to increase calcium bioaccessibility from calcium citrate suspensions at different temperatures. ( a partial quote from the research)
https://www.sciencedirect.com/science/article/pii/S0167732224000151
I see that you may have misread part of the 2021 research when you say that oral Strontium Ranelate does not affect bone formation. Notice that your provided quote is referring to bone defects not osteoporosis and is in the section discussing local use of strontium for bone defects not osteoporosis. This is not a quote about osteoporosis but about the need for strontium laced materials to be applied directly to the site of the bone defect.
Titled "Local Administration of Strontium Ions". The quoted portion which you provide contrasts the use of strontium used directly at the site of the defect as opposed to oral administration and then points out that strontium is needed directly at the site of the defect rather than orally. It is not negating the use of oral strontium for conditions such as osteoporosis. see acutal osteoporosis quotes from the article below
To reiterate
You say:
"Later in the article they add: "Orally administered strontium ranelate does not significantly affect bone formation in vivo because it does not reach a sufficient concentration near this tissue, assuming a standard drug supply and a normal calcium-rich diet.""
This is a statement about specific bone defects not osteoporosis. No one doubts that specific areas of bone damage need a more concentrated application of strontium. Multiple research upholds this as does current use.
Strontium laced products applied directly to the area of concern are being used in multiple ways for bone defects, jaw necrosis, cranial burr holes. see my first linking of a compilation of strontium research where there is a list of such applications
When osteoporosis is discussed in your 2021 linked research, rather than bone defects, the article says: "Strontium can also be incorporated into bone cells, which increases their density and reduces the risk of developing osteopenia and osteoporosis. "
Then this statement about osteoporosis, strontium and fractures is found:
"The SOTI (Spinal Osteoporosis Therapeutic Intervention) study found a reduction in the incidence of spine fractures in postmenopausal women after just one year of treatment. This decrease, compared to the placebo control group, amounted to 49%. A three-year double-blind study showed a 41% reduction in the incidence of new spine fractures, compared with a placebo group. TROPOS (treatment of peripheral osteoporosis) studies have shown the effective anti-fracture effect of ranelate on non-vertebral fractures within the first three years of use. These fractures were reduced by 16% [37,38,39]."
Plus, a long discussion of how strontium works with osteoblasts and osteoclasts to form bone.

Strontium citrate is easily obtained as a supplement in itself without the price tag of the AlgaeCal products. AOR and Vitacost are just two providers.

Part of a deep dive into strontium might be to research the newer bone tests such as REMS and Dexa with TBS. Both of these bone scans show that strontium users have good bone density and good bone quality. The research of Dexa with TBS shows that strontium users place within the top three of bone quality results. Page 7 of the research, https://www.panoramaortho.com/wp-content/uploads/2019/03/TBS-Review-JBMR-2014.pdf
see further research in the first provided posting of strontium research at the top

The discussion of strontium ranelate, its differences and its complicated history in the European medical community makes for a long and involved posting. It may be found in my first linked offering above.
Probably the quickest answer is that strontium ranelate is not available in the USA. Strontium citrate is available and strontium citrate has never been banned or limited in its use. I do think that further testing would be helpful, but the current testing and research has not found strontium citrate to be associated with any cardio vascular problems.

There is a tendency to "poo-Poo" strontium use in terms of osteoporosis results. This probably has to do with a back lash against the Naural vs Medical discussion. My use of strontium for my once osteoporosis now "normal" bones is based entirely on research and on my doctor's recommendations. There are not many osteoporosis treatments which have years of research, bone biopsies, plus good results from DEXA, REMS, and TBS and an almost non existent chance of side effects. Strontium is hard to believe, but a read of the actual research and studies at least says that this is a supplement which needs more study.
Thank you for the discussion.

Yes, the dexa score for strontium is consistently adjusted by 10% in all research. This is to account for the way that radiation flows thru the denser strontium.
The dexa 10% skew for strontium users is really a non argument and concern now with REMS and TBS showing consistently good scores and microarchitecture for strontium users.
In addition the 10% skew for strontium users is only pertinent with the first score which is comparing strontium treated bone vs non strontium treated previous dexas. After that with each new dexa you just need to see that the dexa score continues to improve and that you are not fracturing.
But with the advent of more available REMS and even TBS, we will be discussing this less and less.

I believe that you are referring to this product:
Garden of Life Organics Plant Calcium Supplement Made from Whole Foods with Magnesium, Vitamin D as D3, and Vitamin K as MK7, Gluten-Free
It contains 6mg of strontium which is provided by the algae. This is a vitamin dose level.

Most of the strontium discussion which we are having centers around a therapeutic dose of strontium, research based level to impact osteoporosis; this is usually 680mg daily sometimes transitioning to a maintenance dose of 340mg.

Right! All I can say I have been taking 4/day in addition to a plant based multi, and in one year gained 5% bone density. At that dose. I will be going for a new dexa in feb-will report results. I think the 680 dose is for strontium renalade not from algae. Could there be that much if a difference?

But @mcchesney the study that was cited above measured increase in DEXA, which may be a false increase. I would like to see a study on improvement in REMS and TBS if those are now available to more people.

The suggested therapeutic dose for strontium citrate is 680mg, the dose in Strontium Boost.

I am not at all critical of strontium use and tried it 18 years ago for a short time,. I would love good news given my sensitivities to most med options (which I am doing anyway in an adjusted fashion). But I need more than a study showing increase in DEXA on strontium since we know it is denser than calcium and throws the scan results off, I cannot afford to try a year and compare results done the second time with the first- bones can't afford that risk! In any case it may work too slowly for those of us with severe osteoporosis.

send me the study which to which you are referring.
I think that you are misunderstanding the over read by dexa for strontium. It is not that it is a all a false increase it is that 10% is a false read. So yes, your bones need to increase by more than 10% on your first dexa comparing your strontium bones to your previous dexa read of non strontium bones. Most strontium users increase by more than 10% and many stop fracturing. In dexas after that first one you are comparing dexa with strontium to dexa with strontium so any increase is an increase, as long as it is over the 10%.
The 10% over read is exactly what researchers use when looking at dexa reads for strontium users so this is a standard formula for dexas and strontium users.
But as I said the moaning over the dxa read is all moot now; TBS and REMs has shown consitently that strontium bones are good dense bones with good bone quality. So why would anyone care if the dexa machine falsely overreads by about 10%?
I posted a TBS study on strontium bone density and bone quality earlier. I will repost below with a long time strontium user's tbs results also...
The REms results are all personal stories at this point. I have not seen a single strontium user who has had a bad result or lower than their dexa result on the Rems machines. Still, time will be needed to accumulate enough strontium users using Rems to show a statistical applicable number.
https://strontiumforbones.blogspot.com/2024/11/dexa-bone-density-axial-skeleton-with.html
Strontium was in the top comparison of DEXA and Microarchitecture with Prolia and Forteo. found on Page 7 panoramaortho.com, see chart attached...... panoramaortho.com,

We all have to make the best decisions for ourselves, and no one should feel compelled to take any drug or supplement with which they do not feel comfortable. I am finding that a drug regime is as much about mental comfort as it is about the research.
Are you feeling pressured to take strontium? Most of us support any drug or supplement which an individual feels comfortable with and which feels less risky to that person.
But yes, strontium has a more natural and probably slower progression to go with the fewer side effects scenario. I understand completely if you are fracturing and have a very low bone density that you feel more comfortable with a pharma med.
You seem to feel comfortable with your pharma med. Why are you posting concerns about strontium?

@kathleen1314 not sure you read my post thoroughly. I tried strontium 18 years ago and would consider it after my other treatments, though the cardiovascular effects behind the short term cessation of approval in Europe for the ranelate form did concern me.

More radiologists should adjust the DEXA score for strontium so that improvements can be accurately assessed.

And yes for me it was too slow, but as a follow up to the meds that have helped me so far, I am considering it.

So far, even Keith McCormick , the oft cited author of "The Whole Body Approach to Osteoporosis" and "Great Bones," does not recommend strontium citrate. Clearly more studies are needed. One problem is that it is not a pharmaceutical, ironically, so produces aren't as regulated and ingredients in strontium may not be reliable.

Not sure why you asked if I feel pressured? I chart my own course and have a
"top doc" doctor who is flexible and caring. Osteoporosis meds have time limits and when I am done with low dose Reclast I am taking after Tymlos and 4 months of Evenity, I will need something to keep things going. So far, all my treatment doses have been customized due to various health issues.

Can you please provide a reference for your claim that most strontium users increase their bone density by more than the 10% adjustment on the DEXA results? Over the years I have considered taking the OTC strontium citrate supplement available in the USA but haven’t been convinced yet of the value especially considering the impact it has on DEXA measurements. I have a 10 year history of measurements on the same machine so I am reluctant to impact that unless there is proven value.

Many thanks.

Do you have a strontium that has the most positive research,etc

A long time ago I used Doctor's Best but they stopped making it when the EU reversed approval of the ranelate.

Since 680mg is far above the "natural" level of strontium I do consider it similar to a pharmaceutical, just not regulated.

@gravity3 I have not researched this in a long time given my current regimen with meds for fractures. In the future hope for more info. McCormick still does not recommend it.