Supplement
Strontium is a mineral that behaves like calcium and settles into bone, where it may support bone building and slow breakdown. People look at it for low bone density, and trials of prescription strontium ranelate found density rose and spinal fractures became about 40% less common in postmenopausal women, with strong evidence for fractures. That form was restricted in Europe in 2014 over heart and clot concerns, and over-the-counter citrate has not been tested for fractures.
Sources: PMID 21405146
- Updated
- How we grade
- 2 studies cited
- Best evidence
- Grade A
- Conditions studied
- 2
- Outcomes
- 6
- Graded outcomes
- 1302
Evidence by condition
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Fracture Risk Multiple large RCTs (SOTI, TROPOS) demonstrated strontium ranelate reduced vertebral fractures by ~40% and non-vertebral fractures in postmenopausal women with osteoporosis. This applies only to the prescription ranelate form, which was restricted in Europe in 2014 due to cardiovascular safety concerns; OTC strontium citrate has not been tested for fracture endpoints. | Improves (the measure goes down) | Moderate effect | 1 study | 7,000 people | ||
Studies that measured fracture risk | ||||||
| Bone Mineral Density RCTs of strontium ranelate showed significant increases in DEXA-measured bone mineral density in postmenopausal women. However, 10-15% of the measured increase is artifact due to strontium's higher atomic mass inflating DEXA readings. An animal study (PMID:38612883) comparing ranelate, citrate, and chloride forms in ovariectomized mice found all forms improved bone mineral density. | Improves (the measure goes up) | Moderate effect | 2 studies | 7,000 people | ||
Studies that measured bone mineral density | ||||||
| Bone Microarchitecture A comparative animal study (PMID:38612883) in ovariectomized female mice found that strontium ranelate, citrate, and chloride all improved bone morphology and microarchitecture, suggesting potential benefits across strontium forms in preclinical models. Human data for non-ranelate forms is lacking. | Improves (the measure goes up) | Moderate effect | 2 studies | |||
Studies that measured bone microarchitecture | ||||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Venous Thromboembolism Risk Pooled analysis of strontium ranelate RCTs revealed a ~50% increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism), contributing to European Medicines Agency restrictions in 2014. This is a significant safety concern observed across multiple large trials. | Worsens (the measure goes up) | Moderate effect | 1 study | 7,000 people | ||
Studies that measured venous thromboembolism risk | ||||||
| Cardiovascular Event Risk Post-marketing surveillance and pooled RCT analyses of strontium ranelate identified increased risk of myocardial infarction and cardiovascular events, leading to contraindication in patients with cardiovascular disease and restriction by the European Medicines Agency in 2014. | Worsens (the measure goes up) | Moderate effect | 1 study | 7,000 people | ||
Studies that measured cardiovascular event risk | ||||||
General
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Tooth Sensitivity Strontium chloride was historically used in desensitizing toothpastes for tooth sensitivity but has been largely replaced by potassium nitrate in the US market. Limited modern clinical evidence supports this application. | Changes; see studies | Small effect | 1 study | |||
Studies that measured tooth sensitivity | ||||||
Key findings
- Fracture RiskImproves (the measure goes down)
- Bone Mineral DensityImproves (the measure goes up)
- Venous Thromboembolism RiskWorsens (the measure goes up)
Safety notes in the studies
- Pooled analysis of strontium ranelate RCTs revealed a ~50% increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism), contributing to European Medicines Agency restrictions in 2014.
- Post-marketing surveillance and pooled RCT analyses of strontium ranelate identified increased risk of myocardial infarction and cardiovascular events, leading to contraindication in patients with cardiovascular disease and restriction by the European Medicines Agency in 2014.
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- Grade A
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Studies cited
2 studies from PubMed