Strontium Citrate
Commonly used for
Bone Health
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What is it? / Overview
Strontium is chemically similar to calcium and incorporates into bone, appearing to modestly increase bone formation and reduce resorption -- prescription strontium ranelate reduced vertebral fracture risk in postmenopausal osteoporosis trials, but much of the measured bone-density 'gain' is partly a scanning artifact from strontium's atomic mass, and the OTC citrate salt lacks its own fracture-outcome trials.
How is it used? / Administration
Form: Strontium citrate -- an OTC supplement distinct from prescription strontium ranelate (production discontinued, never FDA-approved), which carries almost all the clinical trial evidence
Typical dose studied: ~680 mg elemental strontium/day is commonly used by extrapolation from ranelate dosing, though this hasn't been independently validated for the citrate salt
Timing: At bedtime or between meals, separate from calcium and food -- calcium reduces strontium absorption
The cardiovascular/thromboembolic signal that led the EMA to restrict prescription strontium ranelate is the reason for the cardiovascular contraindication list here, even though the OTC citrate salt hasn't been studied at that scale -- treat it conservatively.
How well does it work? / Evidence
~ Moderate evidence
Who should avoid it?
Avoid with: Bleeding disorder / Coagulopathy; Chronic coronary disease / Coronary artery disease; Peripheral artery disease; Primary hypertension / High blood pressure; Chronic kidney disease (Stage 3, 4, or 5) — NOT on dialysis; Breastfeeding
Interacts with: Quinolone and tetracycline antibiotics -- strontium reduces their absorption; separate dosing by 2+ hours; Calcium supplements -- compete for absorption, separate dosing
Already taking it? Not first-line for osteoporosis -- reasonable to continue only if a doctor is already monitoring bone density and cardiovascular risk, given the signal that led European regulators to restrict the prescription form.
Research & references
Deeks ED, Dhillon S (2010). Strontium Ranelate: A Review of Its Use in the Treatment of Postmenopausal Osteoporosis. Drugs. Reginster JY et al. (2012). Maintenance of Antifracture Efficacy Over 10 Years With Strontium Ranelate in Postmenopausal Osteoporosis. Osteoporosis International. Khosla S, Hofbauer LC (2017). Osteoporosis Treatment: Recent Developments and Ongoing Challenges. Lancet Diabetes & Endocrinology.
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