I am looking for information on strontium, which is an inexpensive supplement. For me now, it is preventative as I only have a tiny met spot. My PCa aggressive but low volume disease. Post radiation 3 years and currently starting Xtandi, PSA rising 26. My life pleasure is now limited to playing full court basketball and softball 4-5 times a week. (Would like to add back other pleasures but ADT will likely prevent that.) My oncologist is suggesting that I start to consider bone-building “bisphosphonate” prescription drugs or even radium 223, even though I have no bone pain (other than what an oldish man (66) gets playing basketball.) I'm the type of person who does not like to add meds until all else is explored. So far my bone density test is normal, but there are changes after 3+ years of Lupron and Casodex. My goal is continue the active sports so I don't think about women (LOL). I get knocked down, but I get up again, no fractures, little pain other than muscular.
Any thoughts on strontium. Thanks so much. Any help is much appreciated.
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Joel, your post came after the initial question. I just saw this. Usually, one uses strontium for a short period of time, if doing spot radiation. I had my doubts about it in general.
My question about Radium 223 is, am I understanding correctly that it is radiation, that is taken orally and reaches every bone in the body?
and, if you read my response below, it doesn't seem to come in any order of my posting.
Actually Radium 223 is given as an injection into the blood stream. It mimics calcium so it moves quickly to the bone, especially to fast growing bone such as bo e mets. It ks an alpha radiation so the throw of the rasiation is very minimal. But, yes it can reach every bone
I vehemently disagree with your analysis, Joel. It's not a question of the side effects of strontium citrate or others, it's a question of the relative side effects of strontium citrate and the gosh awful bisphosphonates in ANY form.
The Protelos studies were essentially with post menopausal women, who are very prone to fractures. Sr Ranelate reduced fractures. Will it do the same in osteoporotic men with metastatic prostate cancer? I don't know. And, as far as I know, NO ONE DOES.
Forget about the thickness of inner and outer bone. It's fractures that kill older people. What's the track record: little benefit with bisphosponates, no info with strontium and men.
Strontium is an easily available, inexpensive, over the counter "drug". It has been in use for decades. The fear is all about Sr90; and this ain't no Sr 90, but docs still jump to that issue.
Yes, users of elevated (600 mg/day) strontium MAY experience some of those side effects (I did not). Then stop the Sr and go take your chances with bisphosphonates.
And, finally, I am a Ph. D. Chemist and studied the available info pretty carefully a number of years ago. I was particularly concerned about the potential for changes in bone crystal structure. No worrisome info came forth. For me, it was a better choice.
Herb, I am glad that you were able to add information especially with your background. I was very clear in my post that I knew nothing about it but only gave a reference to one link
I laughed when I read your original email. I wanted to respond off-line, but couldn't find your email address. So here goes: Years ago I was an expert witness FOR a new auto body shop in a town. I was the wastewater expert, as I recall. But I started to answer one question, about air emissions, with "I'm not an expert on air emissions..." That's as far as the opposition let me get!
Re Stontium--I've used a bone health diet for several years with good results and the authors of the diet show its as good as or better than denosumab without the dental side effects.
If your bone density is normal, why is your oncologist suggesting "bone-building" bisphosphonate?
You have a solitary bone met? You should ask about about possible treatment for oligometastatic PCa. I had a single met at L5 treated last year. I had no bone pain & expected resistance when I suggested that it be treated. I found a radiologist who was very sympathetic & had 15 treatments. It had a profound effect on PSA. I'm all for reducing tumor burden.
Incidentally, after 12 years following a failed RP & salvage radiation, I think that my concern about coagulation factors has had something to do with metastasis being limited to a single boney met. Some might say that Zometa may inhibit the appearance of boney mets, but I would suggest that controlling microclots is a more logical, less invasive, approach.
Patrick, you do know that I follow your posts. You are asking why suggest 'bone building'- What if ADT has caused bone and muscle loss?
When would you use strontium? And, would you. Does PubMed have any information that might contradict it.
Sometimes I have a hard time exactly understanding the posts.
I can form opinions- being, we decided to not do Zometa. It was in clinical trial when first diagnosed and being pushed on us.
We found out about the jaw problems and actually made the right choice.
Also, in the long run, I've heard this classification of drug cause more brittleness in the bones after a while. The estrogen patch is what we are considering.
Any clarification will help, if you can understand 'my' posts.
My question could be restated as "What is the point of a "bone building" drug when bone density is normal?"
He also has no bone pain.
The only other reason for Zometa is the belief that it may slow down metastasis to bone. From what I read, that is a stretch. Many men with PCa never get bone mets. I suppose that those using Zometa are inclided to credit the drug, but bone mets are not inevitable.
I checked with the authors of the bone health diet I've been using on the use of strontium--the answer indicates that fracture s are much reduced using strontium--details are on strontium ranelate and women with breast cancer but should work with men with Pca.
We are not aware of any easy method to determine the deposition of strontium in vivo. The very real and impressive outcomes discussed in the literature on fracture rates with strontium, however, suggest that the ultimate aim of treatment – to diminish fractures - is significant.
In terms of efficacy, the results suggest that strontium diminishes fracture risk in many people. Large, multi-center human trials involving many postmenopausal women confirm that strontium greatly reduced the risk of vertebral, femur and hip fractures.
Some examples are:
Meunier PJ, Roux C, Ortolani S, et al. Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis. Osteoporos Int. 2009 Oct;20(10):1663-73.
Reginster JY, Seeman E, De Vernejoul MC, 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 May;90(5):2816-22.
Reginster JY, Felsenberg D, Boonen S, et al. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: Results of a five-year, randomized, placebo-controlled trial. Arthritis Rheum. 2008 Jun;58(6):1687-95.
In the SOTI (Spinal Osteoporosis Therapeutic Intervention) and TROPOS (Treatment of Peripheral Osteoporosis Study) trials, some of the results were remarkable. Even in women older than 80 years, strontium produced a 55% reduction for vertebral fractures over the first year of treatment and a 32% reduction over 3 years.
In the SOTI trial, the risk of a clinically symptomatic vertebral fracture was 52% lower. After 3 years, the strontium group had a 41% lower risk of a new radiographic fracture, and the incidence of clinically symptomatic vertebral fractures was 38% lower. When the 4-year data were reported, they showed a 33% reduction in radiographic vertebral fractures.
In the large TROPOS trail, with 5,091 patients whose average age was 77 years, strontium produced a risk reduction of 16% in vertebral fractures and a 19% reduction in risk of non-vertebral fractures (e.g., hip, femur, wrist, ribs, etc.) In TROPOS, in the subgroup of women at highest risk of fracture (women 74 years of age or older who had a low femoral neck BMD score), strontium reduced the risk of hip fracture 36%. Over 3 years, the reduction in vertebral fracture risk was 39% and was similar even for patients who had already had a vertebral fracture when the study began. The 5-year data showed a 24% reduction in vertebral fracture risk.
A recent paper is of particular importance because of the prolonged use of strontium. (Reginster JY, Kaufman JM, Goemaere S, et al. Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis. Osteoporos Int. 2011) They report the results of 10 years of strontium use in the postmenopausal osteoporotic women who, after participating in the SOTI and TROPOS studies for 5 years, were invited to enter a 5-year extension, during which they received strontium ranelate at a dose of 2 grams/day. The results: vertebral fracture risk was reduced by 31%, nonvertebral fracture risk by 27%, major nonvertebral fracture risk by 33%, and hip fracture risk by 24%.
There are a number of other articles which provide evidence for the safety and efficacy of strontium – which are referenced in the paper. As well, ongoing discussion in the literature of the safety issue appears to be reassuring with regards to bone mineralization.
For example:
Osteoporos Int. 2010 Apr;21(4):667-77. doi: 10.1007/s00198-009-1005-z.. In osteoporotic women treated with strontium ranelate, strontium is located in bone formed during treatment with a maintained degree of mineralization.
They conclude that “The quality of bone mineral was preserved after treatment with strontium ranelate, supporting the safety of this agent at the bone tissue level.”
and
J Bone Miner Res. 2008 Feb;23(2):215-22. Histomorphometric and microCT analysis of bone biopsies from postmenopausal osteoporotic women treated with strontium ranelate.
They conclude: Histomorphometry provided a 2D demonstration of the bone safety of strontium ranelate, with significantly higher mineral apposition rate (MAR) in cancellous bone (+9% versus control, p = 0.019) and borderline higher in cortical bone (+10%, p = 0.056). Osteoblast surfaces were significantly higher (+38% versus control, p = 0.047). 3D analysis of 3-yr biopsies with treatment (20 biopsies) and placebo (21 biopsies) using microCT showed significant changes in microarchitecture with, in the strontium ranelate group, higher cortical thickness (+18%, p = 0.008) and trabecular number (+14%, p = 0.05), and lower structure model index (-22%, p = 0.01) and trabecular separation (-16%, p = 0.04), with no change in cortical porosity. The changes in 3D microarchitecture may enhance bone biomechanical competence and explain the decreased fracture rate with strontium ranelate.
Furthermore, with millions of people taking strontium in close to 30 European countries, there has not been a lot of reports to my knowledge of strontium use causing problems. (Meunier et al. N Engl J Med. 2004 Jan 29;350(5):459-68.The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis.) They say “To date, no deleterious effects on the primary or secondary mineralization of bone in laboratory animals or humans have been reported.”
In addition, according to CDC’s Agency for Toxic Substances and Disease Registry report on the health effects of natural forms of strontium, (Centers for Disease Control’s Agency for Toxic Substances and Disease Registry Health Effects of Strontium report accessible @ atsdr.cdc.gov/ToxProfiles/t...
“There is no direct evidence that strontium is toxic to humans, but there is suggestive epidemiological evidence that the oral toxicity observed at high doses in juvenile laboratory animals may pertain to humans under special circumstances… At low exposure levels, ingestion of stable strontium poses no harm to organisms with access to adequate calcium, phosphorus, and vitamin D. At higher exposure levels, especially under conditions of inadequate calcium, phosphorus, and vitamin D, stable strontium will interfere with normal bone development, causing ‘strontium rickets’ of variable severity.”
I suggest that you look at my profile and read about my own experience with Xtandi.
Xtandi is a very powerful drug, and some guys cannot tolerate the side effects, while others don't have the same problem with it.
I had more severe side effects from Xtandi than most guys, and my medical oncologist suggested reducing the dose after just a couple of months, but I asked to remain on the maximum, as it was reducing my PSA. I decided that it was worth the fatigue, insomnia, nausea and other side effects for the benefit that I've had in controlling the progression of my cancer.
I've only had two new mets--on my left femur and a small lesion in the bladder, and the other mets---extensive lymph gland involvement, spine and sacrum, have been well-controlled. But after reducing the Xtandi dose, the prostate tumor grew again, and I had to have twenty radiation treatments to shrink it again, and now we increased the Xtandi back up to 120 mg daily, which seems to be still effective after more than 20 months.
I'm writing this to encourage you to stick with the Xtandi, and give your body time to adjust to the drug, in case you have more fatigue than usual. I just have to power through the fatigue, and once I start moving, it's easier.
I forgot to add that, at the time of diagnosis, I already had osteopenia---which is bone density loss, short of osteoporosis. My uro immediately started me on Xgeva injections monthly, and for awhile I had osteoporosis, and then back to osteopenia, and then back to osteoporosis with an increased risk of fracture.
I take calcium citrate daily (easier to absorb than calcium carbonate) with Vitamins D3 and also K2---the vitamin K2 helps the calcium go to the bone, instead of being deposited on arterial walls.
I don't know about strontium, and you don't yet have bone density loss like I have, but you can keep my own experience in mind to discuss with your doctor, if you start having bone loss.
Hi, I"m a big believer in strontium. Studied the available literature at length several years ago and did use strontium citrate for several years. Yes, it did seem to help maintain my bone density (at least). Two problems, however, it is harder to read and interpret a DEXA scan; doc must (at least) know that you're on Sr and, ideally needs to understand the effects.
Second problem is that it can darken ex=rays, making interpretation harder for the radialogist. In your case, with a bone met, I would not recommend Sr since it might hide this and other mets. I don't know of a way to get around this; I don't even know if the new MRI/PETs with choline or the other thing? are affected by Sr.
Unfortunately, main line medicine is largely ignorant or opposed to sr. Why not, they make no money on Sr and would make good money on Zometa shots. I'm a skeptic. The French product, which has been extensively studied, is not available in the US, but I don't believe it will have any advantages anyway...other than that it's patent-protected.
First of all, I want to thank everyone who responded to my initial post. I am logical but a layman trying to understand this complicated world that intersects with mine, resulting in a new adventure that has drastically changed my life.
Here's what I take out of all this. I'm trying to put it in simple layman's terms so I can go forward and make logical decisions. Again, it is logic that I use as I feel fairly ignorant in biology, but want to learn to help myself and others. Please feel free to correct me and my analysis. As a patient who recently discovered this website, I am so grateful to all of you. The information presented on this site has been the most helpful I have seen to date.
First a little about myself. My world has been rocked by prostate cancer. I have endured and survived quintuple bypass surgery 10 years ago to the point that I am now able to play full court basketball and softball with guys in my age range (55-80+), even while undergoing radiation and ADT. I gave up my career in law to be a full time mom and dad to my teenagers and that probably led to all these health issues. During that time, I had no vacations, no help, no "me" time. I did not take care of myself. Those were my decisions and I have no regrets. My kids are very appreciative and supportive to me and that has been awesome. I go through pity parties but I have no regrets if that makes sense.
After being diagnosed with aggressive, but low volume PCa, and after treatment with external beam radiation, Lupron and Casodex, my significant other of 15 years left me as she felt, perhaps rightly, that I was sleeping all day and feeling sorry for myself. I went from a "Type A" to perhaps Type D. Social life has been difficult as I went from being "in demand" to feeling that ADT had robbed me of motivation and much of what is ME. I fight that every day and now look forward to meeting new people and sharing an attitude I previously had of kicking ass vs this horrible disease. So far, other than those issues, I have no pain and no other symptoms. When I read posts from others, I don't want to be a crybaby, wah wah, my SO left me, I can't play basketball. But that's human nature I guess. I'm trying to focus on the positive, but it's a struggle. So layman education at this website really helps. I don't do excessive alcohol, weed, Xanax or any other chemicals or couch-analyst so I need to rely on an ex-lawyers ability to generate verbal garbage. Most of the time I talk to myself and thus am a perfect listener.
I'm being treated at Dana Farber. I feel it is a good match. I go in with tons of questions and am never rushed. I get very little resistance when I ask the typical off the wall questions about preclinical studies, foreign journals, alternative science, etc. My doctors have been kind, understanding and willing to listen. But "standard of care" is king and I understand that.
The following is my summary of relevant bone issues and attempt to make a plan for my disease: Most cancers with bone issues result from absorption process and loss of bone material (via osteoclasts). However, PCa (prostate cancer) tends to create more problems in bone building (via osteoblasts) and that explains why there is often pain. For some reason, Zometa, and I imagine the other bisphosphonates , inhibit absorption but this reduces pain. One of the articles cited above says this is counterintuitive, so for now, I accept this and the statement that it works to some extent.
However, Zometa has not shown anti-tumor, overall survival (OS) benefits and it does have some potential significant side effects, (see, e.g., the dental issues.) I've got strong teeth, rarely ever get cavities. I've been to a dentist twice in 40 years and my only real problems were related to fillings that I got in my teenage years and a flying elbow while playing basketball. So I'm concerned about anything that might change this dynamic.
My initial inquiry about strontium seems to have been answered. As strontium travels a similar route to the bones as calcium, it can help bone density. However, it can create diagnostic problems for that reason also. Small doses may have some benefit and may reduce the negative issues. But there is not much agreement and no real incentive to really study this "alternative therapy." I am reluctant to "rock the boat" and try strontium at this point.
Some of the replies talk about Vitamin K. I had no knowledge of this supplement and now feel that perhaps I should explore this route. Suggestions are very welcome. I get plenty of sunlight, do take Vitamin D3, eat plenty of low fat dairy. I don't do calcium supplements. My numbers here are good. My attitude on supplements has changed. When first diagnosed, I had an Amazon bill of perhaps $100/month taking anti-oxidants that had been linked in pre-clinical studies or just website chat, e.g. pomegranate, garlic, oregano, etc. Doing Provenge 6 months ago, I was asked to stop all this. During radiation 4 years ago, I got the same request. The theory is that anti-oxidants might actually be helping cancer cells. Nobody really knows. I complied and now I'm off anti-oxidants, except through healthy diet. Nothing seems to slow my PSA rising (now 26) so I might as well go with this theory. (And now my Amazon bill is pretty much non-existent, if only I could cure PSA rise that easily.)
I've tolerated radiation, ADT, recently Provenge and now 3 days of Xtandi well without so far missing a beat in my sports life. The feeling of being tired, enduring pity parties, being very hot and cold sensitive, etc., I can live with and fight against. But I want to find some way to understand and fix why my body is not getting rid of this invader before it takes away what I have left to enjoy in life.
I found the response about localized treatment interesting. I only have one tiny spot on my scapula, no pain there, except perhaps some hopefully imaginary sensations when I swing my bat too hard. I have spoken to my radiation oncologist and he says it would be inappropriate to use radiation there, given no symptoms. I did like the comment here about getting rid of as much cancer as possible so this is something I may explore, or alternatively, freezing, HIFU or high heat, microwave.
I'm also going to explore the link about diet and exercise as it mimics my own point of view, thanks again.
Anyway, that's a rambling response, for which I apologize, a thank you to all who replied, and a summary of what I see here on my issues. Again, feel free to correct, comment, etc.
For those with wives, family members, significant others who help you, make sure you appreciate and show thanks to them. I was not so lucky and I sure envy you. I've been a care giver in my "spare time" to parents/relatives with ALS, cancer, alzheimers, etc, and I know only some are cut out for this, even though many are asked. My kids have fortunately been very supportive and have returned some of the love I gave them as a single Dad.
This has gotten entirely too convoluted for me to know who said what when. But I think there is need for a bit of clarification.
a. I feel (opinion) that using strontium citrate (over the counter) as a preventative for a guy with prostate cancer but no osteoporosis, would be a mistake. Here's where the side effects issue wins.
b. Strontium is the metal of a salt, citrate is sort of the equivalent of the chloride. We do not use strontium as the metal. That is why I feel that it doesn't matter whether you use strontium citrate, gluconate or the French ranelate (Protelos product). Once in the acidic stomach, I think the strontium ION is essentially free.
c. Yes, the European drug gurus have warned about the side effects, but I must ask if Protelos is still widely (and legally) available several years after those announcements.
d. Strontium citrate (or gluconate or ranelate) should be taken SEPaRATE from calcium to maximize effectiveness of both. I think a good bit of the reported intestinal upset may be due to taking strontium with certain drugs or supplements or foods. Experimentation may solve the problem.
e. Other supplements noted, e.g., Vit D, Vit K are all "good". I'm surprised not to see reference to boron and magnesium.
f. Last one: STRONTIUM IS OR WAS USED AS STRONTIUM CHLORIDE FOR DIRECT TREATMENT OF BONE METS. THAT WAS RADIOACTIVE STRONTIUM, A WHOLE DIFFERENT ANIMAL...PROBABLY! IT HAS A PRODUCT NAME THAT ESCAPES ME. I DON'T KNOW IF IT IS STILL USED.
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Spinal fusion & bone thining 
Bone Marrow Involvement?
How often are people here with bone metastases getting bone scans and/or CT scans?
Does ALP indicate bone mets?
