Strontium

Strontium/Drug Interactions:

  • GeneralGeneral: According to the manufacturer, strontium ranelate should be taken two hours before or after food, dairy products, antacids, or any products containing calcium, as these agents may reduce strontium absorption. Strontium ranelate should not be used while taking tetracycline or quinolone antibiotics, as these compounds may chelate.
  • AnalgesicsAnalgesics: In human research, strontium ranelate displayed an analgesic effect and reduced pain scores (54). Theoretically, concurrent use may cause additive analgesic effects.
  • AndrogensAndrogens: According to secondary sources, androgens may reduce urinary excretion of strontium, leading to accumulation of strontium and an increased risk of adverse effects.
  • AntacidsAntacids: According to the manufacturer, strontium ranelate should be taken two hours before or after antacids, as these agents may decrease strontium absorption.
  • AntibioticsAntibiotics: According to the manufacturer, strontium ranelate should be avoided during tetracycline or quinolone use. Quinolones may form complexes in the gastrointestinal (GI) tract, thereby preventing absorption of the antibiotic. Strontium may attach to tetracycline antibiotics in the GI tract and thereby reduce effectiveness.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: According to clinical review, intravenous strontium chloride-89 may cause hemotoxicity, including leukocytopenia and thrombocytopenia (42; 62).
  • BisphosphonatesBisphosphonates: According to human research, a blunting of bone mineral density (BMD) response to strontium ranelate was observed after bisphosphonates were discontinued for up to six months (37). This effect may be due to continued inhibition of bone turnover by bisphosphonates, leading to reduced new bone formation, at the site where strontium is deposited. The researchers concluded that at least six months should be given when switching from a bisphosphonate to strontium (37)
  • Calcium saltsCalcium salts: According to human research, calcium may reduce the intestinal absorption of strontium by 60-70%, possibly due to competition at binding sites (41). Strontium has also been found to replace calcium and inhibit calcium absorption by reducing synthesis of vitamin D. Experts recommend taking strontium two hours before or after taking calcium.
  • Clearfil? New BondClearfil? New Bond: In in vitro research, Hyposen? densitizer (containing strontium chloride hexahydrate) reduced the bond strength of Clearfil? New Bond (containing bisphenol A diglycidylmethacrylate, 2-hydroxyethyl methacrylate, and dibenzoyl peroxide) (63).
  • CorticosteroidsCorticosteroids: In human research, strontium absorption was reduced (approximately 12%) by oral administration of beclomethasone dipropionate (26).
  • EstrogensEstrogens: According to secondary sources, estrogens may reduce urinary excretion of strontium, leading to accumulation of strontium and an increased risk of adverse effects. In human research, oral estrogen did not alter intestinal strontium absorption (64).
  • ImmunosuppressantsImmunosuppressants: According to clinical review, intravenous strontium chloride-89 may cause hemotoxicity, including leukocytopenia and thrombocytopenia (42; 62).
  • NifedipineNifedipine: In vivo, nifedipine reduced the half-life and volume of distribution, likely via its actions in blocking voltage-operated calcium channels; total and renal clearances of strontium were unaffected (38).
  • Vitamin D analogs (calcitriol, cholecalciferol, ergocalciferol)Vitamin D analogs (calcitriol, cholecalciferol, ergocalciferol): According to human research, vitamin D and vitamin D analogs may increase the absorption of strontium (39; 40). In postmenopausal women, 1,25-dihydroxyvitamin D (calcitriol) increased the absorption of strontium by 57% (40). In other human research, strontium absorption increased when it was given 24 hours after oral or intravenous administration of the hormonal metabolite of vitamin D, 1alpha,25-dihydroxyvitamin D3 (1,25(OH)2D3); the area under the curve (AUC) was not affected (39). Additionally, strontium may interfere with vitamin D synthesis.

    • Strontium/Herb/Supplement Interactions:

  • GeneralGeneral: According to the manufacturer, strontium ranelate should be taken two hours before or after food, dairy products, antacids, or any products containing calcium. Strontium ranelate should not be used while taking tetracycline or quinolone antibiotics, as these compounds may chelate.
  • AlginAlgin: According to human research and secondary sources, algin or alginate may bind to strontium and reduce its absorption from the GI tract and thereby lead to strontium toxicity (65).
  • AnalgesicsAnalgesics: In human research, strontium ranelate displayed an analgesic effect and reduced pain scores (54). Theoretically, concurrent use may cause additive analgesic effects.
  • AndrogensAndrogens: According to secondary sources, androgens may reduce urinary excretion of strontium, leading to accumulation of strontium and an increased risk of adverse effects.
  • AntacidsAntacids: According to the manufacturer, strontium ranelate should be taken two hours before or after antacids, as these agents may decrease strontium absorption.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: According to clinical review, intravenous strontium chloride-89 may cause hemotoxicity, including leukocytopenia and thrombocytopenia (42; 62).
  • CalciumCalcium: According to human research, calcium may reduce the intestinal absorption of strontium by 60-70%, possibly due to competition at binding sites (41). Strontium has also been found replace calcium and inhibit calcium absorption. Experts recommend taking strontium two hours before or after taking calcium.
  • Calcium montmorillonite clay (NovaSil)Calcium montmorillonite clay (NovaSil): In human research, high doses (3g) of NovaSil clay (a dietary supplement used in animal feeds to bind and inactivate aflatoxins) for three months increased strontium levels (66).
  • ImmunosuppressantsImmunosuppressants: According to clinical review, intravenous strontium chloride-89 may cause hemotoxicity, including leukocytopenia and thrombocytopenia (42; 62).
  • LaminariaLaminaria: Laminaria contains alginate. According to secondary sources, alginate may bind to strontium and reduce its absorption from the GI tract and thereby lead to strontium toxicity.
  • PhytoestrogensPhytoestrogens: According to secondary sources, estrogens may reduce urinary excretion of strontium, leading to accumulation of strontium and an increased risk of adverse effects. In human research, oral estrogen did not alter intestinal strontium absorption (64).
  • Seaweed, kelp, bladderwrackSeaweed, kelp, bladderwrack: Bladderwrack or kelp contains alginate. According to secondary sources, alginate may bind to strontium and reduce its absorption from the GI tract and thereby lead to strontium toxicity.
  • Vitamin DVitamin D: According to human research, vitamin D and vitamin D analogs may increase the absorption of strontium (67; 39; 68; 40). In postmenopausal women, 1,25-dihydroxyvitamin D (calcitriol) increased the absorption of strontium by 57% (40). In other human research, strontium absorption increased when strontium was given 24 hours after oral or intravenous administration of the hormonal metabolite of vitamin D, 1alpha,25-dihydroxyvitamin D3 (1,25(OH)2D3); the area under the curve (AUC) was not affected (39). Additionally, strontium may interfere with vitamin D synthesis.

    • Strontium/Food Interactions:

  • GeneralGeneral: According to the manufacturer, strontium ranelate should be taken two hours before or after food or dairy products.
  • Dairy productsDairy products: According to human research, calcium-containing foods may reduce the intestinal absorption of strontium (41). In human research, strontium bioavailability was not significantly affected by lactose (28).
  • Seaweed, kelp, bladderwrackSeaweed, kelp, bladderwrack: Bladderwrack or kelp contains alginate. According to secondary sources, alginate may bind to strontium and reduce its absorption from the GI tract and thereby lead to strontium toxicity.

    • Strontium/Lab Interactions:

  • Bone mineral density (BMD)Bone mineral density (BMD): Supplementation with strontium ranelate has been found to improve BMD, as evidenced by increases in bone volume and thickness in areas at high risk for fracture, such as femoral neck, hip, and vertebrae (69; 70; 71; 72; 73; 51; 74; 75; 5; 76; 77; 34; 6; 78; 79; 80; 81; 52; 82; 56). It has been found to increase cortical and trabecular bone density (83; 79).
  • Bone formation and resorption markersBone formation and resorption markers: According to secondary sources and human research, evidence of bone formation and resorption has been reflected by decreases in the concentrations of bone resorption markers, including serum and urinary collagen type I cross-linked C-terminal telopeptide (CTx), serum and urinary collagen type I cross-linked N-telopeptide (NTx), and bone sialoprotein (BSP). Also, increases in the concentrations of bone formation markers, including bone alkaline phosphatase (bone ALP), osteocalcin (OC) and N-terminal propeptides of type 1 procollagen (P1NP) have been noted (70; 84; 85; 86; 73; 78).
  • Calcium colorimetric assayCalcium colorimetric assay: According to secondary sources, strontium may interfere with blood and urine colorimetric measurements of calcium.
  • Creatine phosphokinaseCreatine phosphokinase: According to secondary sources, strontium ranelate may cause transient increases in the musculoskeletal fraction of creatine phosphokinase.
  • C-terminal crosslinked telopeptide type II collagen (CTX-II)C-terminal crosslinked telopeptide type II collagen (CTX-II): In postmenopausal women, strontium ranelate caused a decrease in urinary CTX-II, a marker of cartilage destruction (87; 88).
  • Insulin like growth factor-1 (IGF-1)Insulin like growth factor-1 (IGF-1): In human research, strontium ranelate increased serum IGF-1 levels (89; 23).
  • Platelet countsPlatelet counts: According to clinical review, intravenous strontium chloride-89 may cause reduced platelet counts (42; 62). Blood cell counts reportedly recovered in approximately six months.
  • White blood cell countsWhite blood cell counts: According to clinical review, intravenous strontium chloride-89 may cause reduced white blood cell counts (42; 62).