Strontium citrate, fractures and lack of research

@elaussies My suggestion is not to try to get calcium and Vitamin D in the same supplement. The level of Vitamin D in your blood may vary at different times and you need to be able to adjust your dose or in your case stop altogether for awhile. Adjusting your vitamin D should not determine whether you take calcium or not. Both calcium and D are cheap supplements even from good companies - just take two separate pills. I think the best evidence is that we need lots of calcium for bone health and that it does not have to all come from food. My guess the "dangers" of supplemental calcium are way way overblown. My doc suggested I get 1200mg a day from food and supplements combined (1200 is suggested for adults over 70). I cannot get anything like that with food due to food sensitivities so I take calcium supplements. I worry about plenty of stuff but I don't worry about that one.

BTW plenty of people on the bone forums that caution about calcium supplements are drinking milk substitutes and fortified foods that have calcium added to them. They think it's almond milk etc so it's calcium from food but in fact it's a supplemental calcium just mixed in their food. Go figure.

@elaussies I hope you will talk to your doctor because high levels of Vitamin D can cause too much calcium, so supplements might not be harmful. This is complex and probably not a matter for this forum but instead for a doctor or nutritionist. See below:

"The main side effect of high levels of vitamin D (toxicity) is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. It might also progress to bone pain and kidney calcium stones. Other possible side effects are decrease in appetite, constipation, dehydration, increased thirst (polydipsia), confusion, lethargy, and fatigue."
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108

I had hypercalcemia once. I was very sick. My doctor told me to go off calcium and Vitamin D for 3 weeks and then have my levels checked again.

I'm on month 11 of Tymlos and although I'm having some side effects that are manageable, I'm getting tired of being tired all the time. I started looking into strontium and now I'm very interested in anyone who has had success/experience with this supplement. How much per day? Does it interact with Tymlos or any other supplements for that matter? What is the best way to add it to your diet? I take a daily vitamin, fish oil, K2, D3 and magnesium. I eat enough calcium per day to not take an extra supplement, also exercise, walk, bike, weight training, yoga, pilates. No fractures. Last dexa score was -3.6 in the spine and in the -1s in hips. Based on the spine my endo said Tymlos was the cure all, be all. I am not due for another dexa until Jan 2025 and that will be a full year of Tymlos, so hoping it is doing something. Thanks one and all for your input!

The therapeutic dose for strontium that I have read and been told by integrative medicine is 680mg daily.

As you may know, in Europe it was withdrawn from the market for a time due to concerns about cardiovascular effects (the ranelate form). It is back on but being used there only for those who have no other option, I read.

The problem is that it distorts the DEXA so you won't be able to interpret Tymlos results. Strontium is denser than calcium and replaces it in bone so the bone density looks better on DEXA.

I also experienced fatigue on Tymlos. My DEXA was at 18 months and showed amazing gains. But at that point my bone markers didn't show continuing effectiveness. Both endos that I spoke with had me eontinue for two years but I could have stopped.

Bone markers (P1NP and CTX) are controversial but could give some clues, along with the DEXA, as to whether you can stop the Tymlos. I kind of miss it: I felt protected! But it did make me tired.

@windyshores Why are the bone markers controversial and what source does that come from? I had to ask my Endo to order a CTX and P1NP and she did order the CTX but said the P1NP gave the same information and was expensive. In reading Great Bones, I read a they are both useful, CTX for Osteoclasts and P1NP for bone formation.

@windyshores thank you for your informative answer! I have read some about how strontium replaces calcium, which makes sense that it would bolster up a dexa score. But is that really better or does that really improve bone strength because strontium is denser?

Unfortunately I didn't know about bone markers before I started Tymlos so never had them checked. I've seen 2 endos and 1 rheumatologist over the past year and none of them recommend or use them. I've found a new endo I'm seeing in Jan for my yearly check up who specializes in osteoporosis only, so I'm hopeful that she is more open minded. The others were very conservative and only interested in the pharmaceutical route.

Psmnonna,
I think we don't know if Strontium helps. I was on a half a dose and yes my DEXA was much better on it. I went off it and my DEXA was worse. REMS is a test that uses ultrasound so isn't affected by Strontium's extra weight. REMS measures both density and strength. I had to pay cash for it, but will do so again to see if there has been any change. What we really care about is preventing broken bones.

@psmnonna there are situations where I would consider strontium. I actually took it 17 years ago for a few months because I could not- absolutely could not- tolerate the meds available at that time. I would consider it after treatment with other meds. It may not be strong or fast enough for serious osteoporosis situations, I read.

My doctors go by studies but seem to be flexible about protocols when needed. I would ask a doctor about whether combining strontium and another drug is a good idea. I have no idea! Can't find anything on Google either. McCormick, who is often cited on this forum, does not seem to recommend strontium. I do not have my copy of "Great Bones" with me so maybe someone else can quote him.

@loplady my doctor says an entire conference could be held on the topic of bone markers. He does not use them and says they do not give a complete picture of what is going on in bones. With kidney disease mt CTX may be off. McCormick says that these tests are not being done correctly and if done right, they are helpful: fasting and early am for the CTX, consistent timing for comparison. I do have my PCP order them but they have not matched my DEXA so I have not relied on them.

@drsuefowler
I started a reply, but then lost it somehow, so apologies if something appears twice.
I have read that no one is exactly sure how Strontium works. It appears to fill in where bones are lacking, and this does improve dexa numbers....but what does that really mean for strength and flexibility? Bones have to remain flexible enough to take stresses without cracking, splintering and breaking. In my head I compare it to tires on the car. An old tire with a patch is fine and functional for a while, but a new tire has much more strength and will last a long time compared to the old one that has been patched. Since I'm taking Tymlos, I'm supposed to be building new tires...I mean bones (time will tell on that one).

I would love to have a REMS test, but none are offered in my area. I am seeing a new endo at a university who specialized on osteoporosis. I will have to travel to see her but am ok with that now. Hopefully the university has REMS on their machines.