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  1. Strontium is one of the few supplements I still take, for bone health. But the new alert from Al Pater (thanks Al!) has got me wondering if this is wise. The news story (included below), talks about Canada putting warning labels on supplements and pharmaceuticals containing strontium. It cites [1], a European study that found increased risk of cardiovascular events in at-risk individuals taking strontium. On the other hand, the introduction of [1] points out that strontium really does appear pretty effective at building/maintaining bone health. Plus, from [1], it doesn't sound like someone WITHOUT CVD risk factors should be worried, but we're all a lot more paranoid about supplements in general these days, so I'm still a bit concerned. I take a 680/mg strontium capsule (as strontium citrate) per day. Study [1] talks about strontium ranelate, but I'm not sure if that makes any difference, since the Canadian authorities are talking about warnings for all strontium supplements, including strontium citrate. I'm hoping someone with deep expertise in supplements and nutrition (I'm looking at you Michael :-) ) will be able to shed some light on the wisdom or folly of strontium supplements for CR practitioners. Thanks! --Dean ---------------- http://www.cbc.ca/news/health/strontium-1.3284679 Strontium health products may carry heart risks: Health Canada Affected products products contain either strontium citrate, strontium gluconate or strontium lactate. CBC News Posted: Oct 22, 2015 5:23 PM ET| Last Updated: Oct 22, 2015 5:23 PM ET Health Canada has asked companies to strengthen their labels on natural health products containing strontium to warn of an increased risk of heart-related side-effects. The department said Thursday the label changes are for strontium-containing products with a daily dose between 4 mg and 682 mg, which are used to help support bone mineral density. Health Canada says findings in Europe led to restrictions for use of oral prescription drugs containing strontium at 680 mg/day, due to the increased risk of cardiovascular events seen in patients who have risk factors for heart or circulatory-related side-effects. (Sean Kilpatrick/Canadian Press) The products contain either strontium citrate, strontium gluconate or strontium lactate. Under the new directions, use of the products will be limited to people who have no history of, or risk factors for, heart disease, circulatory problems or blood clots. "While uncertainties remain, Health Canada is using a precautionary approach and considers that strontium, regardless of the form it comes in or dose taken, may have a potential risk of cardiovascular side-effects in people who are already at risk," it said. Health Canada recommends: Do not use a strontium-containing product if you have, or are at high risk for heart disease, circulatory problems, or blood clots. Risk factors include: a history of heart disease, heart attack, stroke, peripheral arterial disease, high blood pressure, high blood fat levels, diabetes, taking prescription hormone drugs, or if you are temporarily or permanently immobilized. If you have any cardiovascular risk factors, read the label of products you are taking to know if they contain strontium. Consult a healthcare practitioner for use beyond six months. Talk to a healthcare practitioner if you have questions or if you are unsure whether these products are appropriate for you. ---------------------- [1] Expert Opin Drug Saf. 2014 September; 13(9): 1209–1213. Published online 2014 July 14. doi: 10.1517/14740338.2014.939169 PMCID: PMC4196504 Cardiac concerns associated with strontium ranelate Abstract Introduction Strontium ranelate is proven to reduce vertebral and non-vertebral fracture risk in osteoporosis. Concerns about cardiac safety have led to a new contraindication to strontium ranelate in patients with uncontrolled hypertension and/or current or past history of ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease. Areas covered A literature search was performed; data were also collected from the European Medicines Agency website. Randomised controlled trial (RCT) data indicate a higher incidence of non-adjudicated myocardial infarction (MI) with strontium ranelate versus placebo (1.7 vs 1.1%; odds ratio [OR]: 1.6; 95% CI: 1.07 – 2.38; p = 0.020) (Mantel-Haenzel estimate of the OR). There was no increase in cardiovascular mortality. MI risk was mitigated by excluding patients with cardiovascular contraindications (OR: 0.99; 95% CI: 0.48 – 2.04; p = 0.988). Three observational studies performed in the context of real-life medical practice in the UK and Denmark did not report a signal. Expert opinion The increased risk for cardiac events with strontium ranelate has been detected in RCTs but not in real life. Excluding patients with cardiovascular contraindications appears to be an effective measure for controlling the risk of MI. Strontium ranelate remains a useful therapeutic alternative in patients with severe osteoporosis without cardiovascular contraindications who are unable to take another osteoporosis treatment. Keywords: cardiac safety, myocardial infarction, osteoporosis, strontium ranelate Go to: 1.  Introduction Strontium ranelate, an osteoporosis medication registered in Europe in 2004, has been studied in a range of randomised controlled trials (RCTs) [1-6]. It was originally indicated for the treatment of women with postmenopausal osteoporosis to reduce the risk for vertebral and hip fracture. The efficacy of strontium ranelate for preventing fracture in osteoporosis is well established, having been demonstrated in two pivotal RCTs – Spinal Osteoporosis Therapeutic Intervention (SOTI) trial and TReatment Of Peripheral OSteoporosis (TROPOS) [2,3]. SOTI showed that, over 3 years, treatment with strontium ranelate 2 g/day reduced the risk of vertebral fracture in postmenopausal osteoporotic women and increased lumbar spine bone mineral density [2]. Strontium ranelate was demonstrated to have an effect on non-vertebral fracture (including hip) in postmenopausal osteoporotic women in TROPOS [3]. Strontium ranelate also increases bone mineral density in osteoporotic men [4], and there is evidence that its antifracture efficacy is maintained up to 10 years [5,6].
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