Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
84Sr, 86Sr, 87Sr, 88Sr, 89Sr, 90Sr, alkaline earth metal, atomic number 38, Bisfil-P, Bivalos®, celestine, celestite, Crest®, element, estroncio (Spanish), group 2 (IIA), Hyposen®, isotope, Metastron®, metal, nonessential trace mineral, nonradioactive element, Osseor®, Protaxos®, Protelos®, Protos®, radioactive isotope, radioisotope, radiopharmaceutical, ranelic acid, Sensodyne®, Sr, Sr ranelate, SrCO3, SrH2, SrO, SrRan, SrSO4, SrTiO3, stable strontium, strontia, strontianite, strontium acetate, strontium aluminate, strontium barium niobate, strontium carbonate, strontium chloride, strontium chloride hexahydrate, strontium chromate, strontium citrate, strontium gluconate, strontium hydride, strontium hydroxide, strontium malonate, strontium nitrate, strontium nitride, strontium oxide, strontium phosphide, strontium polyacrylate, strontium ranelate, strontium salts, strontium sulfate, strontium titanate, strontium-84, strontium-86, strontium-87, strontium-87:strontium-86, strontium-88, strontium-89, strontium-89 chloride, strontium-90.
Strontium is a silvery gray element that was first discovered in the early 1800s. It is a soft, easily worked metal that resembles calcium. Because of this similarity, strontium can replace calcium in certain processes in the body. Strontium may promote extra calcium uptake into bones.
Strontium has sixteen forms: twelve radioactive and four nonradioactive. Strontium-88 is the most common form, making up 83% of natural strontium. Strontium-90 is a radioactive form that earned public attention for being a dangerous byproduct released from nuclear weapons testing in the 1950s. Strontium-89 chloride is another radioactive form used to reduce pain in people with cancer and is the active ingredient in the U.S. Food and Drug Administration (FDA)-approved drug Metastron®.
In the United States, strontium salts (carbonate, chloride, citrate, gluconate, sulfate, etc.) are available as dietary supplements. According to secondary sources, the most common form of strontium found in dietary supplements is strontium chloride. Strontium chloride, as well as strontium acetate, may be found in dental products like Sensodyne®, a toothpaste used to reduce pain caused by teeth sensitivity.
In Europe, strontium ranelate is a prescription drug used for osteoporosis. It is marketed under the trade names Protos®, Protelos®, Osseor®, Bivalos®, and Protaxos®. According to previous and ongoing research, strontium ranelate may prevent bone loss, increase bone strength, and reduce fractures in postmenopausal women. It may also benefit people with osteoarthritis.
Strontium nitrate has been studied for skin irritation and inflammation caused by allergic reactions to cosmetics, personal care products, and drugs, and during occupational exposure. However, large, well-designed trials are needed before a conclusion can be made.
According to experts, taking calcium and strontium at the same time may reduce strontium absorption. Strontium ranelate should not be used in people with kidney problems. Preliminary studies suggest that strontium may increase the risk of artery blockages.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Strontium-89 chloride may relieve bone pain associated with prostate and breast cancer. Metastron® is an FDA-approved drug for this use. In clinical research, up to 80% of people reported improvement and 10% reported complete pain relief.
Strontium chloride and strontium acetate, found in dental products like Sensodyne® and Hyposen®, are used for reducing the pain and discomfort of sensitive teeth. Studies suggest that brushing twice daily with toothpastes containing strontium acetate has helped with long-lasting pain relief.
Clinical studies have found that strontium ranelate can prevent bone loss, increase bone strength, and reduce fractures in postmenopausal women. Evidence suggests that treatment compliance may further reduce the risk of hip fractures.
Some studies have found that strontium ranelate may reduce back pain and slow the development of spinal osteoarthritis. However, more studies are needed to confirm these findings.
Strontium salts been found to have an anti-itch, anti-irritant effect against some cosmetics and chemical peels, without numbing side effects. Studies found that applying 20% strontium nitrate to the arm for 30 minutes decreased allergic itch. However, more studies are needed before a clear conclusion can be made.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Age-related macular degeneration (vision problems), cough, eye disorders (pterygia), seizures.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Servier, the manufacturer of various strontium ranelate products, advises patients with severe kidney impairment not to use the product.
To treat osteoarthritis, two grams of strontium ranelate has been taken by mouth daily for three years.
To treat osteoporosis, 500-2,000 milligrams of strontium ranelate has been taken by mouth daily for up to eight years.
To reduce tooth sensitivity, a 10% strontium chloride hexahydrate dentifrice has been used for six months, and toothpastes containing 8% strontium acetate and sodium fluoride have been used twice daily.
To remove dental plaque, a solution containing chlorhexidine gluconate, sodium fluoride, and strontium has been used for two weeks.
To treat skin irritation, 20% strontium nitrate has been applied to the skin once for 20-30 minutes.
To reduce pain associated with cancer, injections of Metastron® ranging from 0.6 megabecquerels (MBq) per kilogram to 400MBq of strontium per person have been given up to 10 times in three months.
To prevent the recurrence of eye disorders (specifically, pterygium), strontium-90 radiation therapy has been administered by eye applicator for a total dose of 30 gray (Gy), given in 3 doses (10Gy weekly on days 1,8, and 15).
Children (under 18 years old)
There is no proven safe or effective dose for strontium in children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in people with known allergy or sensitivity to strontium.
Side Effects and Warnings
Strontium is likely safe when taken by mouth in amounts normally found in food, when used to relieve bone pain associated with cancer in the form of FDA-approved products such as Metastron®, and when used to relieve pain associated with tooth sensitivity in the form of FDA-approved products such as Sensodyne®.
Strontium is possibly safe when used to treat osteoporosis in postmenopausal women, used in a dental rinse to remove plaque, or applied to the skin to reduce allergic irritation to chemicals.
Strontium may cause bone pain, changes in consciousness, changes in white blood cell count, dermatitis, diarrhea, eczema, hair loss, headache, increased risk of artery blockage, memory loss, reduced platelet count, seizures, skin rash, and stomach pain.
Strontium may interfere with blood and urine colorimetric measurements of calcium. Patients should inform their radiologist of strontium use. Strontium ranelate may cause a severe and life-threatening allergic reaction.
Strontium may increase the risk of bleeding. Caution is advised in people with bleeding disorders or other blood disorders (such as low platelet counts and low white blood cell counts) or in those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
Use cautiously in children or in people with kidney dysfunction or Paget's disease.
Use cautiously in people who are taking algin, androgens, bladderwrack, calcium supplements, estrogens, kelp, laminaria, nifedipine, vitamin D, or vitamin D analogs (such as calcitriol, cholecalciferol, ergocalciferol).
At least six months should be given when switching from a bisphosphonate to strontium.
Avoid in people with severe kidney impairment, known allergy to strontium or any component of the formulation, or in those who are pregnant or breastfeeding. Strontium found in toothpaste, however, appears to be safe during pregnancy and lactation.
Avoid strontium ranelate in people using tetracycline or quinolone antibiotics or in those with phenylketonuria (disorder in which a person is unable to properly break down the amino acid phenylalanine).
Avoid intravenous strontium-89 (Metastron®) in people with incontinence or compromised bone marrow.
Pregnancy and Breastfeeding
There is currently a lack of high-quality scientific evidence on the use of strontium during pregnancy or breastfeeding. Strontium found in toothpaste or taken by mouth in amounts normally found in food is likely safe during pregnancy and breastfeeding. Strontium-89 is radioactive and should be avoided during pregnancy and breastfeeding, as it may harm babies.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Strontium may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Strontium may also interact with agents that may affect the immune system, androgens, antacids, antibiotics (such as quinolones and tetracycline), bisphosphonates, calcium-containing agents, Clearfil® New Bond, corticosteroids, estrogens, nifedipine, pain relievers, and vitamin D analogs (calcitriol, cholecalciferol, ergocalciferol).
Interactions with Herbs and Dietary Supplements
Strontium may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Strontium may also interact with algin, alginate, androgens, antacids, bladderwrack, calcium, dairy products, herbs and supplements that may affect the immune system, kelp, laminaria, NovaSil clay, pain relievers, phytoestrogens, seaweed, and vitamin D.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Benson, L., Cordell, L., Vincent, K., et al. Ancient maize from Chacoan great houses: where was it grown? Proc.Natl.Acad.Sci.U.S.A 10-28-2003;100(22):13111-13115. View Abstract
Cohen-Solal, M. E., Augry, F., Mauras, Y., et al. Fluoride and strontium accumulation in bone does not correlate with osteoid tissue in dialysis patients. Nephrol.Dial.Transplant. 2002;17(3):449-454. View Abstract
D'Haese, P. C., Schrooten, I., Goodman, W. G., et al. Increased bone strontium levels in hemodialysis patients with osteomalacia. Kidney Int. 2000;57(3):1107-1114. View Abstract
D'Haese, P. C., Couttenye, M. M., Lamberts, L. V., et al. Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients. Clin.Chem. 1999;45(9):1548-1556. View Abstract
English, N. B., Betancourt, J. L., Dean, J. S., et al. Strontium isotopes reveal distant sources of architectural timber in Chaco Canyon, New Mexico. Proc.Natl.Acad.Sci.U.S.A 10-9-2001;98(21):11891-11896. View Abstract
Jaakkola, A., Heikkonen, J., Tommila, P., et al. Strontium plaque brachytherapy for exudative age-related macular degeneration: three-year results of a randomized study. Ophthalmology 2005;112(4):567-573. View Abstract
Ketchel, B. P., Heid, C. A., Wood, G. L., et al. Three-dimensional color holographic display. Appl.Opt. 10-10-1999;38(29):6159-6166. View Abstract
Meunier, P. J., Roux, C., Seeman, E., et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N.Engl.J.Med. 1-29-2004;350(5):459-468. View Abstract
Naess, I. A., Christiansen, S. C., Romundstad, P., et al. Incidence and mortality of venous thrombosis: a population-based study. J.Thromb.Haemost. 2007;5(4):692-699. View Abstract
Nakamatsu, K., Nishimura, Y., Kanamori, S., et al. Randomized clinical trial of postoperative strontium-90 radiation therapy for pterygia: treatment using 30 Gy/3 fractions vs. 40 Gy/4 fractions. Strahlenther.Onkol. 2011;187(7):401-405. View Abstract
Oger, E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb.Haemost. 2000;83(5):657-660. View Abstract
Reginster, J. Y., Seeman, E., De Vernejoul, M. C., et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J.Clin.Endocrinol.Metab 2005;90(5):2816-2822. View Abstract
Rizzo, J. A., Medeiros, D., Silva, A. R., et al. Benzalkonium chloride and nasal mucociliary clearance: a randomized, placebo-controlled, crossover, double-blind trial. Am.J.Rhinol. 2006;20(3):243-247. View Abstract
Schrooten, I., Elseviers, M. M., Lamberts, L. V., et al. Increased serum strontium levels in dialysis patients: an epidemiological survey. Kidney Int. 1999;56(5):1886-1892. View Abstract
Silverstein, M. D., Heit, J. A., Mohr, D. N., et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch.Intern.Med. 3-23-1998;158(6):585-593. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017