Absorption of Strontium From the Gastrointestinal Tract Into Plasma in Healthy Human Adults

Apostoaei, A. Iulian

doi:10.1097/00004032-200207000-00006

Cited by 28 publications

(23 citation statements)

References 13 publications

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“…The summary of product characteristics (SPC) gives a figure of 25% for the gut absorption of strontium. This is consistent with the findings of a recent meta-analysis of strontium gut absorption, which reported a log normal distribution with a geometric mean of 22.3% and 95% confidence interval (CI) 10.9% to 45.6%, or about a factor of 2 around the geometric mean (Apostoaei 2002). If strontium ranelate is prescribed with calcium supplements then these latter should be taken at a different time of day (ie, at lunch time) to avoid reducing gut absorption.…”

Section: Introductionsupporting

confidence: 91%

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

Blake¹,

Fogelman²

2006

Clinical Interventions in Aging

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Strontium ranelate is a new orally administered agent for the treatment of women with postmenopausal osteoporosis that reduces the risk of vertebral and hip fractures. Evidence for the safety and efficacy of strontium ranelate comes from two large multinational trials, the SOTI (Spinal Osteoporosis Therapeutic Intervention) and TROPOS (Treatment Of Postmenopausal Osteoporosis) studies. The SOTI study evaluated vertebral fracture prevention in 1649 postmenopausal women with a mean age of 69 y. The subjects all had at least one previous vertebral fracture and a low spine bone mineral density (BMD) (equivalent to a Hologic spine T-score below −1.9). The strontium ranelate group had a 41% lower risk of a new vertebral fracture than the placebo group over the three-year study period (relative risk [RR]=0.59; 95% confidence interval [CI]: 0.48–0.73; p<0.001). The TROPOS study evaluated non-vertebral fracture prevention in 5091 postmenopausal women with a mean age of 77 y. The subjects were aged 74 y and over (or 70–74 y with one additional risk factor) and a low femoral neck BMD (equivalent to an NHANES III [Third National Health and Nutrition Examination Survey] T-score below −2.2). Over the three-year study period there was a 16% reduction in all non-vertebral fractures (RR=0.84; 95% CI 0.702–0.995; p=0.04) and a 19% reduction at the principal sites for non-vertebral fractures. The TROPOS study was not powered to investigate hip fracture risk. However, in a high risk group of women aged 74 y and over and with an NHANES III femoral neck T-score less than −2.4 there was a 36% reduction in hip fracture risk (RR=0.64; 95% CI: 0.412–0.997; p=0.046). The overall incidence of adverse events did not differ significantly from placebo and were generally mild and transient, the most common being nausea and diarrhea. Strontium ranelate is a useful addition to the range of anti-fracture treatments available for treating postmenopausal women with osteoporosis and is the only treatment proven to be effective at preventing both vertebral and hip fractures in women aged 80 y and over.

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Section: Introductionsupporting

confidence: 91%

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

Blake¹,

Fogelman²

2006

Clinical Interventions in Aging

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“…A similar low strontium absorption factor of 0.24 was determined by Apostoaei (2002) in his review article where major sources of published data on the fraction of the ingested strontium into plasma were (re)analyzed and summarized. However, in this publication, no significant difference was described between the f 1 values obtained using SrCl 2 and the f 1 values obtained using strontium assimilated in food products.…”

Section: Discussionsupporting

confidence: 55%

Methods for Assessing Gastrointestinal Absorption of Strontium in Humans by Stable Tracer Techniques

Höllriegl¹,

Li²,

Oeh³

et al. 2006

Health Physics

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Intestinal absorption of strontium from an oral test dose was studied in 13 healthy human volunteers using double tracer techniques with two stable strontium isotopes as tracers. Defined amounts of one isotope were administered orally, while tracer amounts of the second isotope were injected intravenously. Two different methods were used to assess the total fraction absorbed (f1 value). Fractional intestinal strontium absorption can be calculated from the ratio of the two isotopes in plasma or urine samples (in this paper called the double-isotope method) or the convolution integral technique, since both methods provide an accurate estimate of fractional absorption and yield comparable results. The latter additionally provides information on the absorption kinetics in the gastrointestinal tract. The absorption varies with respect to the chemical form and to the amount administered. Absorption patterns are characteristically different for uptake from solutions or from whole meals.

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“…25-30% of Sr in diet is absorbed through the gastrointestinal tract and 99.1% of this is distributed in the mineralized tissue [6,7]. The whole-body strontium content of an average (70 kg) human is estimated at 320 mg (approximately 0.0005% by weight).…”

Section: Discussionmentioning

confidence: 99%

Change in Bone Mineral Density with Strontium Citrate: An Illusion or Reality

Mirza¹

2016

JNHFS

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Case 176-years-old female with OP took alendronate weekly for 10 years till 2006, then every other week for another year and was initiated on a drug holiday. She started self-administrating SrC (680mg/day) in 2006 and continued to take daily calcium (600mg bid) and vitamin D (2000units). Serum calcium and Vitamin D (32-66ng/ml) remained normal. She continued SrC on her own till 2012, when she agreed to stop taking it due to concerns about accumulation and toxicity.On Dual Energy X-ray absorptiometry (DEXA) scan, total hip mean BMD increased 2.7% in the first 2 years on SrC after stopping alendronate, and continued to increase to a maximum of 9.2% after 6 years of treatment with SrC (1.53%/year). Lumbar Spine (LS) BMD was nondiagnostic due to degenerative changes in the spine. In the first 2 years off of SrC, total hip mean BMD decreased by 5.7%. Case 264 year old female with history of osteoporosis, which was diagnosed in 2001. She took Actonel 35mg weekly for 5years, stopped for more than a year and resumed Actonel intermittently for another 2 years before starting drug holiday. She was taking Calcium 500 mg in the multivitamin and 2500 mg of vitamin D. Serum calcium and vitamin D were within normal range. She started strontium citrate 680mg daily in 2009 and took it for 5 years, stopping it in 2014.Yearly assessment of her BMD via DEXA scan showed an increase of 4.3% at LS spine (L1-L4 vertebrae), and 7.6 % at total hip within 1 year of SrC treatment. At 5 years, BMD increase was 6.5 % at LS and 12% for mean total hip. She agreed to stop SrC at this time. 1 year after stopping SrC, LS BMD decreased by 9.1 % and total hip BMD decreased by 4.2%. Case 359 year old female with OP was treated with weekly alendronate for 4 years till 2007, when she stopped it due to concerns for osteonecrosis of jaw. She was advised to resume alendronate in 2008 due to declining BMD, but opted not to take it. AbstractWe are seeing an increased use of Strontium Citrate (SrC) as a nutritional supplement in the US in the form of self-administration by patients to improve bone density. There are no current data available on the effectiveness and safety of SrC on bone. Strontium Ranelate (SrR) is used to treat osteoporosis in Australia/Europe but is not FDA approved in the United States (US). Sr is a heavy element and when incorporated in the bone can cause overestimation of BMD. We report an increase in Bone Mineral Density (BMD) in three patients with osteoporosis who took over the counter SrC. After stopping SrC, all of them were noted to have a significant decrease in BMD. These findings suggest that the increase in BMD with SrC may be a result of accumulation of Sr in the bone, and the decrease in BMD after its discontinuation may be related to lower Sr levels in bone. In the absence of data on the efficacy and safety of the effects of SrC on bone and the technical interference of Sr on BMD measurement, it may be safer to avoid using it. Further studies are needed to delineate the effect of SrC on bone health and safety.

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Absorption of Strontium From the Gastrointestinal Tract Into Plasma in Healthy Human Adults

Cited by 28 publications

References 13 publications

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

Strontium ranelate: a novel treatment for postmenopausal osteoporosis: a review of safety and efficacy

Methods for Assessing Gastrointestinal Absorption of Strontium in Humans by Stable Tracer Techniques

Change in Bone Mineral Density with Strontium Citrate: An Illusion or Reality

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