Strontium: New data may change how I view this drug in Osteoporosis

By Dr Irwin Lim, Rheumatologist

Strontium is a medication used for Osteoporosis.

There is good clinical trial data of it's ability to improve the density and strength of bones, and most importantly, it reduces the future likelihood for osteoporotic (or minimal trauma) fractures.

It's packaged as a sachet that you mix with water and then drink a couple of hours after dinner. It needs to be taken daily. It's most common side effect, which does happen to some extent relatively regularly, is gastrointestinal upset. Bloating, tummy upset, loose stools.

These symptoms are already common in the elderly population that makes up the main target group for these medications to be used in. So, the potential side effects do limit the use of Strontium, at least in my hands.

And there are also good alternatives.

Oral medications that can be taken once weekly to once monthly, an intravenous preparation that only needs to be given once yearly, and a subcutaneous (under the skin) preparation that's injected 6 monthly.

Bottom line is I personally don't use much strontium.

However, there has been recent trial data suggesting another effect of strontium on a different and very common disease, osteoarthritis of the knee (link re difference between Osteoarthritis & Osteoporosis).

This is quite exciting. While there has been great progress in rheumatology in the treatment of inflammatory arthritis such as rheumatoid arthritis, the progress in that most common of arthritis, Osteoarthritis, has been very muted.

In this trial (see abstract), the use of 2g/day of Strontium Ranelate (Protos) was shown to slow the progression of osteoarthritis at the knee. In addition, there was improved pain control and physical function.

Holy grail stuff. We don't currently have any medication or supplement clearly proven to slow down the speed in which cartilage is lost.

(I should still emphasise that the mainstay of treating knee osteoarthritis remains non-drug interventions, including weight loss, appropriate exercise and correction of biomechanical abnormalities.)

Time, and follow-up data is required to test how robust these results are, and most importantly, whether this degree of reduced progression is actually clinically meaningful to the patient.

As we get more info, I might be increasing my use of Strontium.

In my patients who have both osteoporosis and knee osteoarthritis, why not use one drug to benefit two separate problems?