REMS scan and strontium citrate

[Met00]

I had my third REMS scan yesterday (once every couple of years) and was pleased that my spine bone density and fragility score have both improved! My hip scores stayed the same as 2 years ago, but the hip fragility score was slightly worse. Dr Nick Birch gave a very informative consultation, and explained that the fragility score doesn't relate directly to bone density. I need to increase my impact exercise to improve my hip bone strength! I think the main reason for the improvement in my spine scores is down to taking strontium citrate (half dose), which may impact more on the spine than the hips, although the good fragility score suggests I may have done more upper body exercises than I realised! I now have a dilemma, as I'd like to maintain my scores without relying on strontium citrate, but I've read that bone density may decline fairly rapidly if strontium is stopped (not the same risk as Prolia (denosumab), as it doesn't lead to rebound fractures). Has anyone taken strontium citrate for a while, seen an improvement in their bone density and then stopped it without loss of density?

[wellness1]

That's good news on your spine fragility/density scores, Met00. I can imagine you're pleased. Sorry, I know nothing about strontium citrate. Did you discuss it with Nick Birch? Would be curious to know what he thinks about it. Do you want to discontinue it because of concerns you have?

[Met00 in reply to wellness1]

We did discuss it briefly, but Nick doesn't know anyone else who's taking strontium citrate and has found very little when he's tried researching it. He seemed very happy for me to continue to take it because it seems to have made a big difference to my spine. I'm just not sure about continuing to take it long-term when there are question marks over it.

[walk21]

Did Dr Birch have to make any adjustments for strontium ? I am told it causes problems on a DEXA scan.

[Met00 in reply to walk21]

Strontium gets absorbed into the bones and is denser than calcium, so can make it look like you've gained more bone density than is actually the case. I've read that you need to reduce any increase by about 50%, so Nick did quickly work out what my spine scores would have been otherwise (but obviously still an improvement, when you'd normally expect some loss). I don't know how that relates to my hip scores, as they all stayed the same! Maybe without the strontium there would have been a small amount of loss.

[walk21 in reply to Met00]

Thank you! I much prefer my strontium ranelate to AA and Denosumab. I hope to continue with it unless I get any blood/heart problems. I just won't have any DEXA scans, but I am old so it's not important for me. I hope you continue to keep well

[Met00 in reply to walk21]

You're lucky to get strontium ranelate prescribed. It's something I've considered asking for, instead of strontium citrate, because then I could be more closely monitored, but I don't fancy having to drink a load of liquid at bedtime! I'm glad it's suiting you. It's one of the few bone meds that actually helps build new bone, rather than just retaining old bone.

[walk21 in reply to Met00]

Yes, I appreciate how lucky I am! I have been taking it for many years, apart from the time it was unavailable, but no monitoring! I have tea early, then SR at 8pm. No other evening drinks or snacks. Look after yourself as best you can

[Sandiesj]

Hi Met00,

Interesting to read your posts and very informative Thankyou.

I too am in the UK and I see Nick regularly for scans and consultations. My osteoporosis journey has been bewildering!

I have severe (-4.3) diagnosis from CT scan as dexa showed only -1.6, obvs wrong, although my rems scan was somewhere in between. My fragility score has been not great but not too bad either. However I continued to fracture and now have 7 thoracic and lumbar, also sacral fractures.I have always refused medication but have taken Algaecal and strontium citrate for 3 years. I continue to take Algaecal but discontinued the strontium 8 months ago. My last fractures were in August 2022. I started teriparatide only 2 months ago and I haven’t fractured for 11 months now so am feeling pretty good. Nick has been somewhat bewildered by my tendency to fracture and referred me to professor Richard Keene for treatment of teriparatide. They both recommended It was time to start some treatment. I think my bone density decreased rapidly after my cessation of strontium but weirdly I have also stopped fracturing since then. Who knows if there is any connection? I certainly don’t.

My next visit to Nick will be in October so will report here the outcome and results of my scan

Wishing you well,

Sandra.

[Met00 in reply to Sandiesj]

Hello Sandra. Thanks so much for sharing your story. That's very disappointing for you to have had all those fractures despite the strontium citrate and despite a not too bad fragility score. I've never heard of being able to get t-scores from a CT scan! Nick told me he didn't know anyone else taking strontium citrate, so had clearly forgotten about you! Your experience with bone density decreasing on stopping strontium ties in with what I'd read elsewhere and leaves me with something of a dilemma! For the time being I've decided to halve my dose (I was only taking a half-dose anyway, so this will reduce it to a quarter dose), and see what effect that has, combined with increasing my high impact exercise. Can I ask, have you had all the blood tests necessary to rule out underlying causes of your osteoporosis? In particular, have you been checked for hyperparathyroidism (not the same as hyperthyroidism)? I wish you well with your two years on teriparatide, which I've heard is one of the most effective drugs for osteoporosis.

[karmel]

I had read very positive posts about Strontium Citrate but unfortunately I found that they triggered my IBS and haven't been able to tolerate them. When I had my scan I told Mr Birch that I used a step when doing my exercises and he said to use it more so I have tried to up the exercises I do on the step. Do you have a step that you can use when you exercise Met00.

[Met00 in reply to karmel]

No, I don't have a step, but we do have stairs and I occasionally exercise at the bottom of them! I've wondered about getting a step, but we're a bit limited with storage space. I could keep it in the garage, but then would almost certainly forget it! Are there any particular advantages to a step over a stair?

[karmel]

Hi MEt00 we also have stairs but you can use a step to do exercises\jumps on that you cannot do on the bottom step of the stairs.

[Met00 in reply to karmel]

Thanks. I've never used a step, so wasn't sure how much more versatile it might be.

[karmel in reply to Met00]

I used to do step classes years ago and bought a step for home when I learnt how beneficial using a step is for making bones stronger. There are lots of step videos on-line for all levels.

[Met00 in reply to karmel]

That's really helpful, thanks Karmel

[Raleigh59]

Congratulations!

Do you think it’s ok to take Tymlos and 250 mgs strontium citrate ?

[Met00 in reply to Raleigh59]

I wouldn't take strontium citrate with a prescribed osteoporosis medication.

[Raleigh59 in reply to Met00]

Can you explain why?

[Met00 in reply to Raleigh59]

They both act on the bones, so unless research has been done that shows they are safe to take together, I wouldn't risk it. Also, we don't know whether the potential side effects of one might be exacerbated by the other.

[Raleigh59]

I haven’t taken it when on Tymlos but when I tried the bisphosphonates the pharmacist approved the strontium citrate she said just take them 12 hours apart

[Met00 in reply to Raleigh59]

Tymlos works differently to bisphosphonates, so you'd need to check with the pharmacist again.

[Raleigh59 in reply to Met00]

my top endocrinologist told me not to take strontium citrate but he said that before I had medicine but he was ordering me Tymlos. I didn’t hear his specific reason and I tried to ask him why and he just answered I am not going to debate this.

Before that I had another endocrinologist told me that they don’t like patients to take strontium citrate and bisphosphonates bc then they don’t know which got the patients better.

[Met00 in reply to Raleigh59]

I'd be inclined to listen to your endocrinologist. Only limited research has been done with strontium citrate and if you're on another medication it may be best to steer clear of it.

[Raleigh59]

I am not taking the strontium citrate but I would like to take just 250 mgs per day

[Met00 in reply to Raleigh59]

I can't advise about that, but if your endocrinologist advised against it, then I would heed his advice