DEAR DR. GOTT: I am a 60-year-old female with a BMD of -2.1. My doctor wants me to take Fosamax but I am reluctant to do that. Would taking Strontium be safe and helpful for osteopenia? I can’t find much research about it beyond word of mouth.
DEAR READER: Let’s take this one step at a time. Your bone density test placed you in a category indicative of having osteopenia, a term used to indicate that your bones have become less dense than normal. The condition is a precursor to osteoporosis. Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bone fall out of balance.
The average person begins to lose bone strength while in his or her mid 30s. More than 10 million men and women in the United States have osteoporosis. Those primarily affected are post-menopausal women.
Other than advancing age, other causes for osteoporosis include hyperparathyroidism, kidney failure, low body weight, too little calcium in the diet, prior fractures as an adult (in the absence of severe trauma), excessive dieting, eating disorders, and alcoholism.
All bones can be affected by osteoporosis but the most common and complicated bones are in the spine and hip. Vertebral fractures can cause excessive pain, loss of height, and stooped posture. Your physician appropriately ordered a diagnostic bone density study known as a DEXA. Your score compared the density of your bones to that of a healthy, young adult; -1 or greater is normal; readings between -1 and -2.5 are considered osteopenia; -2.5 or lower signifies osteoporosis.
Treatment will not cure osteoporosis; however, it can slow bone loss and rebuild some bone. Thus, the recommendation of Fosamax. This drug is in a class known as bisphosphonates that was designed to slow bone loss while increasing bone mass. Unfortunately, as with virtually every medication available, side effects can occur. They can range from diarrhea, headache, joint pain, abdominal upset, nausea, chest tightness, persistent heartburn, and osteonecrosis (bone death) of the jaw. There is now evidence associating Fosamax with fractures of the femur. It must be understood that a person may remain on this medication for years without one single side effect but the possibility remains.
A 2006 meta-analysis (review of completed studies) of four studies and approximately 6000 European patients, researchers found evidence that strontium was reasonably effective in preventing fractures of the back but not other bones. In 2008 the results of a two-year double-blind study of 88 women over the age of 50 with postmenopausal osteoporosis was released in Osteoporosis International, the official journal of the World Congress of Osteoporosis. Protelos (strontium ranelate) was found to significantly improve bone structure in postmenopausal women when compared with the bisphosphonate alendronate. Through a new non-invasive technique known as high resolution computerized tomography, Protelos was found after the first year to increase cortical bone thickness, bone volume and bone density to a greater extent than alendronate. The product is presently registered worldwide and licensed in 72 countries for the treatment of postmenopausal osteoporosis to reduce the risk of spinal and hip fractures. It is sold under the trade names of Protos, Ossero, Bivalos, Protaxos and Ossum.
Options for treatment include 1000 mg of calcium daily (as recommended by the National Institutes of Health and the National Osteoporosis Foundation) coupled with between 400 to 800 Internal Units of vitamin D and a program of regular exercise. Incorporate such foods as nonfat milk, low-fat yogurt, salmon, leafy green vegetables and cauliflower. Avoid soft drinks, excessive amounts of red meats and foods with phosphate additives, as they can promote bone loss.
Because I do not have access to your full medical chart, I cannot make the decision as to whether strontium is right for you. That’s a decision best left to your primary care physician. I urge you to express your apprehension for not choosing to take Fosamax and personally would recommend you take a calcium with D supplement, discontinue smoking and consuming excessive alcohol if appropriate, exercise regularly, and modify your diet to one that includes tofu, salmon, broccoli and other nutritious foods.
Readers who would like related information can order my Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website, www.AskDrGottMD.com.
